title: When surgeons face intraoperative challenges: a naturalistic model of surgical decision making.
abstract: 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.
authors: Department of Surgery, Department of Medical Biophysics, Centre for Education Research & Innovation, Western University, London, ON, Canada. Sayra.Cristancho@schulich.uwo.ca
authors: Sayra M
authors: SM
authors: Cristancho
authors: Meredith
authors: M
authors: Vanstone
authors: Lorelei
authors: L
authors: Lingard
authors: Marie-Eve
authors: ME
authors: LeBel
authors: Michael
authors: M
authors: Ott
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009873:Operating Rooms; D010820:Physicians; D011340:Problem Solving; D013043:Specialties, Surgical; D013514:Surgical Procedures, Operative