"Bringing decison-making under the spotlight"
Smarter Decision-making for Surgeons
by Dr Uttam Shiralker
How are good decisions made? How can we optimize our decision-making? Decision-making is a key professional activity that determines surgical outcomes and has a significant effect on a surgeon’s well-being. Yet it remains woefully neglected in surgical training, to the ongoing detriment of patients, professionals and organisations.
‘Surgical Metacognition: Smarter Decision-making for Surgeons’ is a ground-breaking introduction to a new field. The book introduces surgeons to the mental processes that underpin surgical performance, and how we can use this knowledge to improve surgical practice in and outside the operating theatre.
Discover why bad decisions happen to good surgeons and how experts avoid traps to make timely decisions.
The first step, and focus of this book, is to understand ‘metacognition’ (‘thinking about thinking’) in order to improve self-awareness, decision-making and communication. With many realworld surgical examples, the book reviews the thought process of decision-making from recent research. These advances have already transformed other professions – including business management, the military, sport and aviation – and it is time for surgeons to capitalize on this knowledge, to achieve and teach better decision-making and higher levels of expertise.
The conventional image of a surgeon is of an actor rather than thinker. This perception is inaccurate as surgeons don’t think any less. They may appear to think less because their thoughts are visual or tactile instead of verbal; but it is still ‘thinking.’ Although it is not true that surgeons think less, it may be the case that they tend to use less metacognition.
Although the word ‘metacognition ‘may appear unfamiliar, we all use metacognition routinely. Metacognition is ‘thinking about thinking.’ It is to understand how you think and how to control thinking. In short, metacognition is your ability to manage your thinking.
It is not a chance observation that experts exhibit better metacognitive skills than nonexperts. What we don’t know so far is if having metacognitive skills makes someone expert or if one gains such skills after becoming an expert; a ‘chicken or egg’ conundrum!
You would expect, since good decision-making is central to surgery, there is plenty of information on how to take it. Unfortunately, there isn’t much information, and whatever little information there is, it is about what decision to make rather than how to make a good decision!
Surgical decisions have increased in complexity over the years due to technological advances, changes in service delivery and patient expectations. This increased complexity also increases our need to have a clearer understanding of surgical decision-making to successfully manage increasing complexity.
Over the years, as surgery has become increasingly dependent on ‘data’ and computers, intuitive thinking has become less and less a part of the surgical profession. Despite this, intuition is as essential as ever, and this balance needs to be redressed so that we can improve surgical decision-making.
Excerpts from Surgical Metacognition
Surgical psychology is a proficiency that uses psychological knowledge and skills to address the optimal performance and well-being of surgeons. It also involves developmental and social aspects of surgical practice and culture.
Essentially, it applies the principles of psychology to surgical performance. It does this by identifying the strengths and limitations of performance and facilitating coaching and/or workshops that focus on optimising decision-making, operative skills and job satisfaction.