Clarke J R
Surgery. 1982 Aug;92(2):153-8.
Five surgical management problems amenable to solution by decision analysis were developed to test the decision-making skills, or surgical judgment, of residents in three university-based surgical training programs. Incorporated within the problems were indicators of textbook knowledge, basic computational ability and the ability to integrate probabilistic information in a logical decision-making process. Seventy-two residents representing 65% of those in the 5-year programs participated. Correct answers were determined by 50 senior surgeons and independently supported by the surgical literature and decision analyses. The percentage of correct surgical decisions averaged 72 +/- 3% until after the chief residency year, when it rose to 87 +/- 6%. Among the residents still in training, correct clinical decisions were associated with more accurate estimates of textbook information. The clinical recommendations of senior surgeons were consistent with the solutions of the problems by formal decision analysis in 92 +/- 2% of cases; the clinical recommendations of residents were consistent in 77 +/- 2% of cases. Decision analyses with appropriate use of textbook information could improve the accuracy of the residents' clinical recommendations. Decision analysis without accurate information resulted in inferior decision making for one of the management problems. Decision analysis can supplement, but not replace, the acquisition of scientific knowledge in the education of surgical residents.
开发了五个适合通过决策分析解决的外科管理问题，以测试三所大学外科培训项目中住院医师的决策技能或外科判断力。这些问题包含了教科书知识、基本计算能力以及在逻辑决策过程中整合概率信息的能力指标。来自五年制项目中65%的72名住院医师参与其中。正确答案由50名资深外科医生确定，并得到外科文献和决策分析的独立支持。直到住院总医师年之后，正确外科决策的百分比平均为72±3%，之后升至87±6%。在仍在培训的住院医师中，正确的临床决策与对教科书信息更准确的估计相关。资深外科医生的临床建议在92±2%的病例中与通过正式决策分析得出的问题解决方案一致；住院医师的临床建议在77±2%的病例中一致。合理运用教科书信息进行决策分析可以提高住院医师临床建议的准确性。对于其中一个管理问题，没有准确信息的决策分析会导致较差的决策。在外科住院医师的教育中，决策分析可以补充但不能取代科学知识的获取。
