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Takahashi M. Protecting sleep for the well-being of physicians and their patients. INDUSTRIAL HEALTH 2024; 62:285-286. [PMID: 39343607 PMCID: PMC11462402 DOI: 10.2486/indhealth.62_500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
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Schmidt L, Zabelberg S, Schlatter S, Adams I, Douplat M, Perchet C, Lilot M, Rey AE, Mazza S. The impact of shift work on pain recognition, a robust ability among intensive care nurses. Eur J Pain 2023; 27:1203-1215. [PMID: 37434490 DOI: 10.1002/ejp.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Pain empathy is essential for high-quality of care. The cognitive ability to identify and understand the pain in others remains underexplored in the context of hospital shift work. This study aimed to observe the early subliminal ability to detect pain in other faces and to investigate pain intensity evaluations during day and night shifts. METHODS Twenty-one nurses (31 ± 7 years, 20 women) from cardio-paediatric intensive care participated in this study. Eighteen nurses completed all testing in the morning and evening hours, before and after the 12-hour day and night shift. In the first test, the nurses had to decide if facial stimuli presented subliminally showed pain or not. During the second test, they consciously determined the intensity of the painful faces on a numerical scale. Sleep, sleepiness and empathy were also measured. RESULTS Recognition accuracy and pain sensitivity remained stable over time, only sensitivity increased following the work shift (F(1,15) = 7.10, p = 0.018). Intensity ratings remained stable. Sleepiness at the end of the night shift was negatively correlated with accuracy (ρ = -0.51, p = 0.018) and positively correlated with prior night shifts (ρ = -0.50, p = 0.022). CONCLUSION The judgement of facial pain expressions seems robust across shift types, only individual factors such as sleepiness interfere with pain recognition. Pain sensitivity may be enhanced during working hours. SIGNIFICANCE STATEMENT Some professions need to know how to assess pain 24/7 and a lack of sleep can disrupt the cognitive processes necessary for this assessment. Night shifts provoke a bias in pain management, and sleep deprivation, a decrease in pain evaluation. By conducting a repeated measure study in the field that applied a different paradigm (subliminal recognition of facial cues) we add evidence to the understanding of pain recognition and the impact of sleep deprivation on the early processing of pain in others.
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Affiliation(s)
- Laura Schmidt
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
| | | | - Sophie Schlatter
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
| | - Inga Adams
- Universität zu Köln, Psychologie, Cologne, Germany
| | - Marion Douplat
- Hospices Civils de Lyon, Département des Urgences, Hôpital Lyon Sud, Lyon, France
| | - Caroline Perchet
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Hôpital Louis Pradel, Groupement Hospitalier Est, Lyon, France
| | - Amandine Eve Rey
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Stéphanie Mazza
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
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Zhang D, Gu D, Rao C, Zhang H, Su X, Chen S, Ma H, Zhao Y, Feng W, Sun H, Zheng Z. Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study. BMJ Qual Saf 2023; 32:192-201. [PMID: 35649696 DOI: 10.1136/bmjqs-2021-014244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND With increasing surgical workload, it is common for cardiac surgeons to perform coronary artery bypass grafting (CABG) after other procedures in a workday. To investigate whether prior procedures performed by the surgeon impact the outcomes, we compared the outcomes between CABGs performed first versus those performed after prior procedures, separately for on-pump and off-pump CABGs as they differed in technical complexity. METHODS We conducted a retrospective cohort study of patients undergoing isolated CABG in China from January 2013 to December 2018. Patients were categorised as undergoing on-pump and off-pump CABGs. Outcomes of the procedures performed first in primary surgeons' daily schedule (first procedure) were compared with subsequent ones (non-first procedure). The primary outcome was an adverse events composite (AEC) defined as the number of adverse events, including in-hospital mortality, myocardial infarction, stroke, acute kidney injury and reoperation. Secondary outcomes were the individual components of the primary outcome, presented as binary variables. Mixed-effects models were used, adjusting for patient and surgeon-level characteristics and year of surgery. RESULTS Among 21 866 patients, 10 109 (16.1% as non-first) underwent on-pump and 11 757 (29.6% as non-first) off-pump CABG. In the on-pump cohort, there was no significant association between procedure order and the outcomes (all p>0.05). In the off-pump cohort, non-first procedures were associated with an increased number of AEC (adjusted rate ratio 1.29, 95% CI 1.13 to 1.47, p<0.001), myocardial infarction (adjusted OR (ORadj) 1.43, 95% CI 1.13 to 1.81, p=0.003) and stroke (ORadj 1.73, 95% CI 1.18 to 2.53, p=0.005) compared with first procedures. These increases were only found to be statistically significant when the procedure was performed by surgeons with <20 years' practice or surgeons with a preindex volume <700 cases. CONCLUSIONS For a technically challenging surgical procedure like off-pump CABG, prior workload adversely affected patient outcomes.
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Affiliation(s)
- Danwei Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dachuan Gu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenfei Rao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoting Su
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sipeng Chen
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hanping Ma
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Zhao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Feng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hansong Sun
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch of National Center for Cardiovascular Diseases, Zhengzhou, People's Republic of China
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Ardizzone E, Lerchbaumer E, Heinzel JC, Winter N, Prahm C, Kolbenschlag J, Daigeler A, Lauer H. Insomnia-A Systematic Review and Comparison of Medical Resident's Average Off-Call Sleep Times. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4180. [PMID: 36901190 PMCID: PMC10002061 DOI: 10.3390/ijerph20054180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Sleep deprivation is known to have serious consequences, including a decrease in performance, attention and neurocognitive function. It seems common knowledge that medical residents are routinely sleep deprived, yet there is little objective research recording their average sleep times. To discern whether residents may be suffering from the abovementioned side effects, this review aimed to analyze their average sleep times. Thirty papers recording the average sleep time of medical residents were found via a literature search using the key words "resident" and "sleep". An analysis of the mean sleep times cited therein revealed a range of sleep from 4.2 to 8.6 h per night, the median being 6.2 h. A sub-analysis of papers from the USA showed barely any significant differences in sleep time between the specialties, but the mean sleep times were below 7 h. The only significant difference (p = 0.039) was between the mean sleep times of pediatric and urology residents, with the former achieving less sleep. The comparison of methods for data collection showed no significant difference in the sleep times collected. The results of this analysis imply that residents are regularly sleep deprived and may therefore suffer from the abovementioned consequences.
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Affiliation(s)
- Eve Ardizzone
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Emily Lerchbaumer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Johannes C. Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Natalie Winter
- Department of Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Henrik Lauer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
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Abstract
The restorative function of sleep is shaped by its duration, timing, continuity, subjective quality, and efficiency. Current sleep recommendations specify only nocturnal duration and have been largely derived from sleep self-reports that can be imprecise and miss relevant details. Sleep duration, preferred timing, and ability to withstand sleep deprivation are heritable traits whose expression may change with age and affect the optimal sleep prescription for an individual. Prevailing societal norms and circumstances related to work and relationships interact to influence sleep opportunity and quality. The value of allocating time for sleep is revealed by the impact of its restriction on behavior, functional brain imaging, sleep macrostructure, and late-life cognition. Augmentation of sleep slow oscillations and spindles have been proposed for enhancing sleep quality, but they inconsistently achieve their goal. Crafting bespoke sleep recommendations could benefit from large-scale, longitudinal collection of objective sleep data integrated with behavioral and self-reported data.
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Affiliation(s)
- Ruth L F Leong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ,
| | - Michael W L Chee
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ,
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Whelehan DF, Alexander M, Connelly TM, McEvoy C, Ridgway PF. Sleepy Surgeons: A Multi-Method Assessment of Sleep Deprivation and Performance in Surgery. J Surg Res 2021; 268:145-157. [PMID: 34311296 DOI: 10.1016/j.jss.2021.06.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Minimum rest is mandated in high stake industries such as aviation. The current system of healthcare provision permits on-call surgeons to work in sleep deprived states when performing procedures. Fatigue has been demonstrated to negatively affect performance. This study aimed to explore measurements of sleep deprivation and their impact on simulated performance. METHODS This was a single site study conducted between September 2019 and February 2020. Surgical trainee and consultants were conveniently sampled from a single site. All testing was done between 7 AM and 9 AM. Participants completed electroencephalogram testing using a modified Multiple Sleep Latency Test testing for objective sleep measurement, the Pittsburgh Sleep Quality Index, Chalder Fatigue Scale and Epworth Sleepiness Scale for subjective sleep measurement. The Psychomotor Vigilance Task and the SIMENDO simulated tasks were used for standardized performance assessment. RESULTS Surgeons entered sleep in 6 min, on average pre-call. This significantly decreased to an average of 164 s post-call (P = 0.016). Pittsburgh Sleep Quality Index scoring was 5, indicating poor baseline sleep quality. There was higher self-reported fatigue and sleepiness in post-call states. Performance decrements were noted in cognitive performance reaction time and aspects of technical instrument proficiency. CONCLUSIONS Surgeons are objectively sleep deprived pre-call according to internationally recognized guidelines. This sleep deprivation increases significantly in post-call states. Tasks with higher cognitive demands showed greater levels of diminished performance compared to those with lower cognitive demands. Current models of provision of surgical on-call are not conducive to optimizing sleep in surgeons. Prioritization of workload in post-call states, focusing on preserving individuals cognitive resources and utilizing lower cognitively demanding aspects of work is likely to have positive impacts on performance outcomes.
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Affiliation(s)
- Dale F Whelehan
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
| | - Michael Alexander
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Tara M Connelly
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Christine McEvoy
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Paul F Ridgway
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
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Whelehan DF, Brown DJ, Ridgway PF. To strive or survive: An exploration of the meaning and inhibitors to thriving in surgical performance. Am J Surg 2021; 222:504-505. [PMID: 33752874 DOI: 10.1016/j.amjsurg.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/12/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Dale F Whelehan
- Discipline of Surgery, School of Medicine, Trinity College Dublin, The University of Dublin, Ireland.
| | - Daniel J Brown
- School of Sport, Health and Exercise Science, University of Portsmouth, United Kingdom
| | - Paul F Ridgway
- Discipline of Surgery, School of Medicine, Trinity College Dublin, The University of Dublin, Ireland
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Whelehan DF, Connelly TM, Ridgway PF. COVID-19 and surgery: A thematic analysis of unintended consequences on performance, practice and surgical training. Surgeon 2021; 19:e20-e27. [PMID: 32807661 PMCID: PMC7396881 DOI: 10.1016/j.surge.2020.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The shift in the national focus and allocation of resources to the management of COVID19 has led to significant changes to surgical practice including the delay of elective surgery. The aim of this study was to explore the implications of such changes on surgeons. METHOD Using a qualitative study design, semi-structured interviews were conducted with general surgery consultants and non-consultant hospital doctors from a major tertiary hospital in the Dublin region between March-May 2020. Data collection proceeded iteratively using a thematic analysis approach with quality controls such as memoing and collaborative analysis. RESULTS Fourteen surgeons (8 male, 6 female) were interviewed. The majority (n = 11, 78.6%) were NCHDs. Significant themes determined included 'impacts' on a variety of constructs such as performance, self-reported fatigue and wellbeing. Training themes elucidated included the effects of the cancellation of elective admissions on reduced operative exposure for trainees. Senior surgical staff were particularly focused on increased complexity in patient management. New policy requirements such as personal protective equipment use and novel rotas have had implications for aspects of work engagement. The pandemic and subsequent national restrictions imposed has afforded opportunities for improved well-being but also resulted in greater solitude in surgeons. CONCLUSIONS Rhetoric surrounding fatigue management and virus control dominates the conversation on the relationship between COVID-19 and surgery. Tipping the balance back to parity of fatigue management with service delivery in surgery will be key for sustainability of the surgical workforce.
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Affiliation(s)
- Dale F Whelehan
- Discipline of Surgery, School of Medicine, Trinity College Dublin, The University of Dublin; Department of Surgery, Tallaght University Hospital, Ireland.
| | - Tara M Connelly
- Discipline of Surgery, School of Medicine, Trinity College Dublin, The University of Dublin; Department of Surgery, Tallaght University Hospital, Ireland
| | - Paul F Ridgway
- Discipline of Surgery, School of Medicine, Trinity College Dublin, The University of Dublin; Department of Surgery, Tallaght University Hospital, Ireland
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If in Doubt Don't Act Out! Exploring Behaviours in Clinical Decision Making by General Surgeons Towards Surgical Procedures. World J Surg 2021; 45:1055-1065. [PMID: 33392706 DOI: 10.1007/s00268-020-05888-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clinical decision-making (CDM) plays an integral role to surgeons work and has ramifications for patient outcomes and experience. The factors influencing a surgeons decision-making and the utility of cognitive decisional short cuts used in CDM known as 'heuristics' remains unknown. The aim of this paper is to explore how general surgeons make decisions in high-stake biliary tract clinical scenarios. METHODS This was a cross sectional survey comprising of two sections-a 'demographics section' and a 'clinical vignettes section'. Participants were recruited by an email distributed by the Royal College of Surgeons in Ireland. Non-parametric testing examined relationships and content analysis was applied for clinical reasoning. RESULTS 73 participants or 37.6% of the overall population completed the survey. 71.4% of these were male. Most (50%) were higher trainees with moderate levels of overall reflective practice in decision-making. A majority of participants chose conservatively in high-stake biliary tract clinical cases with disease factors (43.5%) weighted highest, followed by personal factors (41.1%) and patient factors (15.4%) in clinical reasoning. The presence of a 'hook' associated with commonly used heuristics did not significantly change decision-making behaviour. CONCLUSION In high-stake scenarios, surgeons make conservative clinical decisions, predominantly dominated by disease and personal justifications. The utility of heuristics in lower-stake scenarios should be explored regarding clinical decision-making rationale and outcomes. Practitioners should consider use of patient factors in high-stake decisions to enable shared decision-making when appropriate which can reduce post-decisional regret and support the vision of patient-centred care.
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