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Purpose <p>Surgical trainees begin to develop safe surgical clinical decision-making (CDM) skills in residency. This study aimed to characterize how residents define good and bad CDM and how they seek to develop skills in CDM during residency.</p> Methods <p>The authors conducted a qualitative study of general surgery residents at all levels of training. Recruitment began with residents at the authors’ institution and proceeded in a snowball fashion. Virtual semi-structured interviews were conducted utilizing an interview guide designed to explore residents’ perspectives on developing CDM. Interviews were transcribed and analyzed by the research team using a phenomenography approach.</p> Results <p>21 residents from 8 US programs participated. (12 female, 9 male, 7 PGY1-2, 14 PGY3-5). Good CDM was described as dynamic and able to handle ambiguity. Bad CDM resulted from failures to gather information, unawareness of missing information, or the impact of cognitive biases. Residents described utilizing various strategies to advance their CDM skills: absorbing practice patterns from seniors/faculty, discussions with peers and seniors, and accumulating clinical experience. Residents identified direct communication from attendings and tracking of patients’ conditions through cues in the clinical environment as corrective or affirmative feedback on their clinical decisions.</p> Conclusion <p>This study explored the ways in which general surgery residents interpret their clinical environment, extract knowledge from their experiences, and refine their understanding of patient disease to improve their skills in CDM. Residents reported using several principles of self-regulated learning, which are teachable and have the potential to accelerate the development of clinical decision-making skills.</p>

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Residents as surgical sponges: the absorptive and accumulative process of learning clinical decision-making skills during general surgery residency

  • 期刊论文

  • 发表日期：

    2025年7月8日

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  • Ingrid A. Woelfel,
  • Theresa N. Wang,
  • Ruth Ackah,
  • Brian Carter,
  • Nancy Schindler,
  • Emily Huang

摘要

Purpose

Surgical trainees begin to develop safe surgical clinical decision-making (CDM) skills in residency. This study aimed to characterize how residents define good and bad CDM and how they seek to develop skills in CDM during residency.

Methods

The authors conducted a qualitative study of general surgery residents at all levels of training. Recruitment began with residents at the authors’ institution and proceeded in a snowball fashion. Virtual semi-structured interviews were conducted utilizing an interview guide designed to explore residents’ perspectives on developing CDM. Interviews were transcribed and analyzed by the research team using a phenomenography approach.

Results

21 residents from 8 US programs participated. (12 female, 9 male, 7 PGY1-2, 14 PGY3-5). Good CDM was described as dynamic and able to handle ambiguity. Bad CDM resulted from failures to gather information, unawareness of missing information, or the impact of cognitive biases. Residents described utilizing various strategies to advance their CDM skills: absorbing practice patterns from seniors/faculty, discussions with peers and seniors, and accumulating clinical experience. Residents identified direct communication from attendings and tracking of patients’ conditions through cues in the clinical environment as corrective or affirmative feedback on their clinical decisions.

Conclusion

This study explored the ways in which general surgery residents interpret their clinical environment, extract knowledge from their experiences, and refine their understanding of patient disease to improve their skills in CDM. Residents reported using several principles of self-regulated learning, which are teachable and have the potential to accelerate the development of clinical decision-making skills.