A. E. Kanters1, S. P. Shubeck1, G. Sandhu1, C. C. Greenberg2, J. B. Dimick1 1University Of Michigan,General Surgery,Ann Arbor, MI, USA 2University Of Wisconsin,Madison, WI, USA
Introduction: Although the quality of an operation depends heavily on operative technique, there’s very little evidence illuminating how surgeons arrive at their intraoperative decisions. Surgical training largely follows an apprenticeship model. This model of learning has the potential to perpetuate surgical knowledge grounded in anecdote rather than surgical literature. The objective of this study was to determine the extent to which practicing surgeons justify their technical decisions based on their experience or based on evidence.
Methods: This qualitative study evaluated 10 video coaching conversations between 20 bariatric surgeons at the Michigan Bariatric Surgery Collaborative meeting in October 2015. Using grounded theory approach, the coaching dyads were coded in an iterative process with comparative analysis in order to identify emerging themes. We focused on how participants justified specific surgical techniques and decisions as these topics were a common theme identified in each of the coaching transcripts.
Results: Three major themes emerged during analysis. (1) Most commonly, we found individuals reported modifications in surgical technique after a particularly negative postoperative complication for a single patient. For example, one surgeon reported, “Why did this leak? I had no reason…so that’s when I started to just say, ‘I’m just going to over sew everybody.’” (2) Alternatively, participants were noted to defend use of certain techniques or surgical decisions based on their perceived expert opinion of others. For example, individual surgeons often refer to how they were trained or how they witnessed another surgeon in the field perform a procedure as their impetus for modifying their own technique. (3) Finally, there was a notable lack of referring to evidence in surgical literature or educational programming as a motivation for changing surgical technique.
Conclusion: In this qualitative analysis of coaching conversations we found that practicing surgeons most often justify their surgical decisions with anecdotal evidence and “lessons learned”, rather than deferring to surgical literature to motivate their behaviors. This either represents a lack of evidence or poor uptake of existing data.