R. Bollig1, M. Knight2,4, E. Heidel1, P. Miller3, P. Terry2, M. Goldman1, B. J. Daley1 4King University,Department Of Behavioral And Health Sciences,Knoxville, TN, USA 1University Of Tennessee Medical Center, Knoxville,Trauma & Critical Care Surgery/General Surgery/Graduate School Of Medicine,Knoxville, TN, USA 2University Of Tennessee,Department Of Public Health,Knoxville, TN, USA 3Wake Forest Baptist Health,General Surgery,Winston Salem, NC, USA
Introduction: Information regarding effects of standardized patient care protocols on critical thinking skills is inconclusive. These protocols are designed to promote patient safety, service quality, and cost-effectiveness. We evaluated analytical skills of surgical residents and fellows in relation to various ‘pathways.’ Our hypothesis was participants would ‘default to a protocol’, instead of critical thinking in critical care scenarios.
Methods: After IRB approval, we developed a 14 question, multiple-choice survey for residents and fellows. The questions were validated by experts, and focused on common scenarios encountered in the ICU. The questions evaluated decisions to ‘follow the protocol’ for the given stem, either as a distractor or the correct answer. Critical thinking was defined as answering the question correctly. The questions were distributed to residents and fellows at three regional institutions. Data was analyzed using frequency statistics and paired samples t-tests. An alpha of .05 assumed significance.
Results: A total of 342 residents and fellows were emailed surveys. When choosing the correct answer, 81.3% of the time, critical thinking was used. When the incorrect answer was chosen, it was attributed to not thinking critically 66% of the time. Ultimately, participants chose to incorrectly follow the protocol 34.3% of the time.
Conclusion: This study shows a trend for trainees to follow a protocol as a reflex, without critical assessment or decision making. Our findings cast doubt on the use of protocols in training residents and fellows. As surgical educators, we cannot allow learners to defer critical thinking abilities in favor of easy established protocols.