- 作者：Sayra M. Cristancho ; Ph.D.a ; Sayra.Cristancho@schulich.uwo.ca ; Meredith Vanstone ; Ph.D.b ; Lorelei Lingard ; Ph.D.b ; Marie-Eve LeBel ; M.D.a ; Michael Ott ; M.D.a
- 关键词：Intraoperative challenges ; Decision making ; Reconciliation
- 刊名：The American Journal of Surgery
- 出版年：2013
- 出版时间：February, 2013
- 年：2013
- 卷：205
- 期：2
- 页码：156-162
- 全文大小：269 K
class=""h4"">Background
Surgery is an environment in which being an expert requires the ability to manage the unexpected. This feature has necessitated a shift in surgical decision-making research. The present study explores the processes by which surgeons assess and respond to nonroutine challenges in the operating room.class=""h4"">Methods
We used a grounded theory methodology supported on intraoperative observations and postoperative interviews with 7 faculty surgeons from various specialties. A total of 32 cases were purposively sampled to compile a dataset of challenging situations.
class=""h4"">Results
Thematic data analysis yielded 3 main themes that were linked in a cyclic model: assessing the situation, the reconciliation cycle, and implementing the planned course of action. These elements were connected through 2 points of transition (ie, active and confirmatory reconciliation), during which time the surgeons continue to act although they may change the course of their action.
class=""h4"">Conclusions
The proposed model builds on existing theories of naturalistic decision making from other high-stakes environments. This model elaborates on a theoretic language that accounts for the unique aspects of surgery, making it useful for teaching in the operating room.