Department of Surgery, University Hospital Geelong, Geelong, Victoria, Australia.
Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
ANZ J Surg. 2022 Sep;92(9):2088-2093. doi: 10.1111/ans.17955. Epub 2022 Aug 8.
This paper describes the development of learning from novice to expert in Stage 4: Clinical Decision Making (CDM) in surgery: Postoperative reflection and review. It also outlines some or the assessment and teaching approaches suitable to facilitate that transition in skill level.
This paper is drawn from a much broader study of learning and teaching CDM, that used qualitative methodology based on Constructivist and Grounded Theory. Data was collected in individual interviews and focus groups. Using thematic analysis the data were analysed to identify key ideas. All participants worked in the Department of Surgery at one large regional hospital in Victoria.
For each stage there is a sequence of learning beginning from relying on external resources, gradually developing internal resources to guide and direct the learner's CDM. Those internal resources built through experience include multisensory and kinaesthetic memories that expand to facilitate the ability to cope with complexity.
Armed with the mind-map and rubric table included in this paper it should be possible for any senior clinician or teacher to diagnose their trainees' progression in Stage 4 CDM. This will enable them to tailor their teaching to best match the capabilities of the trainee and to enable to be more effectively targeted.
CDM can be taught and both trainees and senior clinicians can benefit from understanding the processes involved.
本文描述了从新手到专家在第 4 阶段（手术中的临床决策制定（CDM））的学习过程：术后反思和回顾。它还概述了一些适合促进技能水平转变的评估和教学方法。
本文取自对 CDM 的学习和教学的更广泛研究，该研究使用了基于建构主义和扎根理论的定性方法。数据通过个人访谈和焦点小组收集。使用主题分析对数据进行分析以确定关键思想。所有参与者都在维多利亚州一家大型地区医院的外科部门工作。
每个阶段都有一系列学习开始，从依赖外部资源逐渐发展到内部资源来指导和指导学习者的 CDM。这些通过经验建立的内部资源包括多感官和动觉记忆，这些记忆会扩展以促进应对复杂性的能力。
有了本文中包含的思维导图和评分表，任何资深临床医生或教师都应该能够诊断他们的受训者在第 4 阶段 CDM 中的进展。这将使他们能够根据受训者的能力来调整教学，使教学更有针对性。
CDM 可以被教授，受训者和资深临床医生都可以从理解所涉及的过程中受益。
