title: Surgical decision making in a teaching hospital: a linguistic analysis.
abstract: BACKGROUND
  The aim of the study was to gain insight in the involvement of non-operating surgeons in intraoperative surgical decision making at a teaching hospital. The decision to proceed to clip and cut the cystic duct during laparoscopic cholecystectomy was investigated through direct observation of team work.
  
  
  METHODS
  Eleven laparoscopic cholecystectomies performed by consultant surgeons and specialty trainees at a London teaching hospital were audio and video recorded. Talk among the surgical team was transcribed and subjected to linguistic analysis, in conjunction with observational analysis of the video material, sequentially marking the unfolding operation.
  
  
  RESULTS
  Two components of decision making were identified, participation and rationalization. Participation refers to the degree to which agreement was sought within the surgical team prior to clipping the cystic duct. Rationalization refers to the degree to which the evidential grounds for clipping and cutting were verbalized.
  
  
  CONCLUSIONS
  The decision to clip and cut the cystic duct was jointly made by members of the surgical team, rather than a solitary surgeon in the majority of cases, involving verbal explication of clinical reasoning and verbal agreement. The extent of joint decision making appears to have been mitigated by two factors: trainee's level of training and duration of the case.
authors.affiliation: Institute of Education, University of London, London, UK. j.bezemer@ioe.ac.uk.
authors.forename: Jeff
authors.initials: J
authors.lastname: Bezemer
authors.affiliation: Department of Surgery, Imperial College London, London, UK.
authors.forename: Ged
authors.initials: G
authors.lastname: Murtagh
authors.affiliation: Leeds Institute of Medical Education, University of Leeds, Leeds, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cope
authors.affiliation: Department of Surgery, Imperial College London, London, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000523:psychology*; D000066491:Clinical Decision-Making / Q000379:methods*; D003299:Cooperative Behavior; D003549:Cystic Duct / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D007400:Interprofessional Relations; D007432:Intraoperative Period; D008037:Linguistics; D008131:London; D010348:Patient Care Team; D011908:Rationalization; D014705:Verbal Behavior; D014741:Video Recording
keywords: clinical judgement; communication; decision making; non-technical skills