School of Psychology, University of Aberdeen, UK.
Am J Surg. 2011 Oct;202(4):375-81. doi: 10.1016/j.amjsurg.2010.11.009. Epub 2011 Apr 7.
Surgical research on decision making and risk management usually focuses on perioperative care, despite the magnitude and frequency of intraoperative risks. The aim of this study was to examine surgeons' intraoperative decisions and risk management strategies to explore differences in cognitive processes.
Critical decision method interviews were conducted with 24 consultant surgeons who recalled cases and selected important decisions during the operations. These decision were then discussed in detail in relation to decision-making style and risk management.
The key decision in each case was made using either a rapid, intuitive mode (46%) or a more deliberate comparison of alternative courses of action (50%). Decision strategy was not related to surgical approach (endoscopic vs open), context (elective vs emergency), perceived time pressure, or situational threats. Risk management involved perceiving threats and assessing impact but also indicated the role of personal risk tolerance.
Surgeons described making key intraoperative decisions using either an intuitive or an analytic mode of thinking. Surgeons' risk assessment, risk tolerance, and decision strategies appear to be influenced by their personalities.
尽管术中风险的程度和频率更高，但手术相关的决策制定和风险管理研究通常侧重于围手术期护理。本研究旨在通过检查外科医生的术中决策和风险管理策略来探讨认知过程的差异。
对 24 名顾问外科医生进行了关键决策方法访谈，这些外科医生回忆了手术过程中的病例并选择了重要决策。然后，根据决策风格和风险管理详细讨论了这些决策。
每个病例中的关键决策都是通过快速、直观的模式（46%）做出的，还是通过更仔细地比较替代行动方案（50%）做出的。决策策略与手术方法（内镜与开放）、背景（择期与急诊）、感知到的时间压力或情境威胁无关。风险管理涉及感知威胁和评估影响，但也表明了个人风险容忍度的作用。
外科医生描述了使用直觉或分析思维模式做出关键的术中决策。外科医生的风险评估、风险容忍度和决策策略似乎受到他们个性的影响。
