This PhD thesis addresses the question of how we define, measure and
improve surgical judgment and decision making, and how junior surgeons may be
trained in these skills. The introduction to the thesis outlines the importance of
surgical decision making, and the rationale for undertaking this research. An overview
of relevant cognitive psychology research is presented, and the methodologies used in
the experimental chapters of the thesis are described in detail. The introduction
concludes with a systematic review of published empirical work on surgical decision
making.
The first two empirical studies are qualitative in nature, using interviews and
simulation. They address how we define surgical decisions and their relationship to
the process of care, including how surgeons subjectively view their own decision
making, and whether we can we draw inferences from observation of the process in
action.
Subsequent experimental chapters focus on the measurement of the quality of
judgments of risk – a pre-decisional process in which likely outcomes of surgery are
evaluated and estimated. Judgment analysis methodology is used to measure
surgeons’ performance at estimating surgical risks, with evaluation of whether the
method shows construct validity, and whether feedback derived from judgment
analysis tasks can be used as a teaching tool.
The final empirical section of the thesis develops the theme of training junior
surgeons in understanding risk and becoming better decision-makers. The process of
developing, piloting, implementing and evaluating of a course module aiming to
improve surgical trainees’ approaches to decision making is presented.
Finally the discussion reflects on the strengths and weaknesses of the studies,
and outlines the implications of the work for clinical practice, training of junior
surgeons, and future research.