Document Detail

When surgeons face intraoperative challenges: a naturalistic model of surgical decision making.
MedLine Citation:
PMID:  23331980     Owner:  NLM     Status:  In-Data-Review    
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.
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.
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.
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.
Sayra M Cristancho; Meredith Vanstone; Lorelei Lingard; Marie-Eve Lebel; Michael Ott
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  205     ISSN:  1879-1883     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  156-62     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Department of Surgery, Department of Medical Biophysics, Centre for Education Research & Innovation, Western University, London, ON, Canada. Electronic address:
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