Cardiothoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK.
Postgrad Med J. 2019 Mar;95(1121):148-154. doi: 10.1136/postgradmedj-2018-136184. Epub 2019 Apr 19.
To identify and analyse variations in self-reported decision-making strategies between medical professionals of different specialty and grade.
We conducted a cross-sectional survey of doctors of different specialities and grades at St. George's Hospital, London, UK. We administered 226 questionnaires asking participants to assign proportions of their clinical decision-making behaviour to four strategies: intuitive, analytical, rule-based and creative.
We found that physicians said they used rule-based decision-making significantly more than did surgeons and anaesthetists (p = 0.025) and analytical decision-making strategies significantly less (p = 0.003). In addition, we found that both intuitive (p = 0.0005) and analytical (p = 0.0005) decision-making had positive associations with increasing experience, whereas rule-based decision-making was negatively associated with greater experience (p = 0.0005).
Decision-making strategies may evolve with increasing clinical experience from a predominant use of rule-based approaches towards greater use of intuitive or analytical methods depending on the familiarity and acuity of the clinical situation. Rule-based strategies remain important for delivering evidence-based care, particularly for less experienced clinicians, and for physicians more than surgeons, possibly due to the greater availability and applicability of guidelines for medical problems. Anaesthetists and intensivists tend towards more analytical decision-making than physicians; an observation which might be attributable to the greater availability and use of objective data in the care environment. As part of broader training in non-technical skills and human factors, increasing awareness among trainees of medical decision-making models and their potential pitfalls might contribute to reducing the burden of medical error in terms of morbidity, mortality and litigation.
识别和分析不同专业和级别的医疗专业人员在自我报告的决策策略方面的差异。
我们对英国伦敦圣乔治医院的不同专业和级别的医生进行了横断面调查。我们共发放了 226 份问卷，要求参与者将其临床决策行为的比例分配给四种策略：直觉型、分析型、基于规则型和创造性。
我们发现，与外科医生和麻醉师相比，医生表示他们更倾向于使用基于规则的决策（p = 0.025），而较少使用分析型决策策略（p = 0.003）。此外，我们发现，直觉型（p = 0.0005）和分析型（p = 0.0005）决策都与经验的增加呈正相关，而基于规则的决策则与经验的增加呈负相关（p = 0.0005）。
决策策略可能会随着临床经验的增加而演变，从主要使用基于规则的方法转变为更多地使用直觉或分析方法，具体取决于临床情况的熟悉程度和紧迫性。基于规则的策略仍然对于提供基于证据的护理很重要，特别是对于经验不足的临床医生，对于医生比外科医生更为重要，这可能是由于医学问题的指南更易获得和适用。麻醉师和重症监护医生比医生更倾向于采用分析型决策；这种观察结果可能归因于在护理环境中更易获得和使用客观数据。作为非技术技能和人为因素更广泛培训的一部分，提高受训者对医学决策模型及其潜在陷阱的认识，可能有助于减少因发病率、死亡率和诉讼而导致的医疗差错负担。
