Sayra M Cristancho1, Tavis Apramian2, Meredith Vanstone3, Lorelei Lingard4, Michael Ott5, Thomas Forbes6, Richard Novick7. 1. Department of Surgery and Centre for Education Research & Innovation, University of Western Ontario, London, Ontario, Canada. Electronic address: sayra.cristancho@schulich.uwo.ca. 2. Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada. 3. Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. 4. Department of Medicine and Centre for Education Research & Innovation, University of Western Ontario, London, Ontario, Canada. 5. Division of General Surgery, Department of Surgery, University of Western Ontario, London, Ontario, Canada. 6. Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 7. Department of Critical Care, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences and Surgery, University of Calgary, Calgary, Alberta, Canada.
Abstract
BACKGROUND: Education researchers are studying the practices of high-stake professionals as they learn how to better train for flexibility under uncertainty. This study explores the "Reconciliation Cycle" as the core element of an intraoperative decision-making model of how experienced surgeons assess and respond to challenges. METHODS: We analyzed 32 semistructured interviews using constructivist grounded theory to develop a model of intraoperative decision making. Using constant comparison analysis, we built on this model with 9 follow-up interviews about the most challenging cases described in our dataset. RESULTS: The Reconciliation Cycle constituted an iterative process of "gaining" and "transforming information." The cyclical nature of surgeons' decision making suggested that transforming information requires a higher degree of awareness, not yet accounted by current conceptualizations of situation awareness. CONCLUSIONS: This study advances the notion of situation awareness in surgery. This characterization will support further investigations on how expert and nonexpert surgeons implement strategies to cope with unexpected events.
BACKGROUND: Education researchers are studying the practices of high-stake professionals as they learn how to better train for flexibility under uncertainty. This study explores the "Reconciliation Cycle" as the core element of an intraoperative decision-making model of how experienced surgeons assess and respond to challenges. METHODS: We analyzed 32 semistructured interviews using constructivist grounded theory to develop a model of intraoperative decision making. Using constant comparison analysis, we built on this model with 9 follow-up interviews about the most challenging cases described in our dataset. RESULTS: The Reconciliation Cycle constituted an iterative process of "gaining" and "transforming information." The cyclical nature of surgeons' decision making suggested that transforming information requires a higher degree of awareness, not yet accounted by current conceptualizations of situation awareness. CONCLUSIONS: This study advances the notion of situation awareness in surgery. This characterization will support further investigations on how expert and nonexpert surgeons implement strategies to cope with unexpected events.
Authors: Nick Sevdalis; Rachel Davis; Mary Koutantji; Shabnam Undre; Ara Darzi; Charles A Vincent Journal: Am J Surg Date: 2008-06-16 Impact factor: 2.565
Authors: Patrick Nieboer; Mike Huiskes; Fokie Cnossen; Martin Stevens; Sjoerd K Bulstra; Debbie A D C Jaarsma Journal: Med Educ Date: 2021-11-02 Impact factor: 7.647