title: Intra-operative decision making by ophthalmic surgeons.
abstract: OBJECTIVE
  Research on surgical decision making and risk management usually focuses on peri-operative care, despite the magnitude and frequency of intra-operative risks. The aim of this study was to examine ophthalmic surgeons' intra-operative decisions and risk management strategies in order to explore differences in cognitive processes.
  
  
  METHODS
  Critical decision method interviews were conducted with 12 consultant ophthalmologists who recalled cases and selected important decisions during the operations. These decisions were then discussed in detail in relation to decision making style and risk management. Transcripts were coded according to decision making strategy (analytical, recognition primed decision, creative and rule-based) and risk management (threats, risk assessment and risk tolerance).
  
  
  RESULTS
  The key decision in each case was made using either a rapid, intuitive mode of thinking (n=6, 50%) or a more deliberate comparison of alternative courses of action (n=6, 50%). Rule-based or creative decision making was not used. Risk management involved the perception of threats and assessment of threat impact but was also influenced by personal risk tolerance. Risk tolerance seemed to play a major role during situations requiring a stopping rule. Risk management did not appear to be influenced by time pressure.
  
  
  CONCLUSIONS
  Surgeons described making key intra-operative decisions using either an intuitive or an analytical mode of thinking. Ophthalmic surgeons' risk assessment, risk tolerance and decision strategies appear to be influenced by personality.
authors.affiliation: Industrial Psychology Research Centre, University of Aberdeen, , Aberdeen, UK.
authors.forename: Keryn
authors.initials: K
authors.lastname: Pauley
authors.forename: Rhona
authors.initials: R
authors.lastname: Flin
authors.forename: Augusto
authors.initials: A
authors.lastname: Azuara-Blanco
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009885:Ophthalmology; D036301:Qualitative Research; D012308:Risk Management; D012606:Scotland; D013222:State Medicine
keywords: Eye (Globe); Treatment Surgery