Modern surgical education has evolved from a traditional apprenticeship model to competency-based training. Intra-operative decision making (IODM), an important surgical competence, can have profound impacts on patients’ surgical outcomes. Making proper decisions intra-operatively under uncertainty and pressure is a harsh challenge for all surgeons. Simulation-based trainings allow trainees to gain experience in performing operations independently. However, there is little evidence for the effectiveness of IODM training by using simulation. The purposes of this research were to explore influencing factors on IODM and create a new IODM model, to design a training course for enhancing surgical trainees’ skill in such decision making, and to evaluate its feasibility.
By using mixed method research with the various qualitative approaches of systematic review, interviews, and observations in the UK and Taiwan, exploring surgeons’ perspectives of influencing factors on IODM and using simulation for training IODM, a new IODM model and a framework for IODM training have been created, and a training course for enhancing IODM skills has been designed. This is the first study related to IODM with the views of both Western and Eastern surgeons. Explicitly stressing the importance of ‘the values of ensuring patient benefit and safety’ and ‘reflection all the time’ in surgical training could be a good strategy for teaching IODM. The new model of doing IODM and the new assessment tool for evaluating IODM created in this study could provide a structure for teaching and evaluating surgeons’ IODM skills in simulated and clinical settings. The feasibility of an innovative IODM training course which was based on the framework for IODM training with simulation base design was successfully tested and it will soon be implemented on a large scale for investigating its short-term and long-term effects in the future.