Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

BACKGROUND: Training surgeons in vital decision-making skills remains unstructured. We aimed to map a process of care from the perspective of surgical decision making and test whether it could be deconstructed into an accessible format for trainees. METHODS: Semistructured interviews were conducted with 10 experienced surgeons by using symptomatic gallstones as a clinical exemplar. Data were analyzed by 2 independent reviewers to identify decisions, cues, and decision rules, with further thematic analysis of selected decisions. RESULTS: Eighteen specific decisions were identified in 6 or more transcripts, with significant interreviewer reliability (Spearman's rho = .65, P = .004, n = 17, 1 outlier excluded). These were arranged to form a "decision map." Two main decision strategies were described. CONCLUSIONS: We identified and mapped the decisions made in the care of patients with symptomatic gallstone disease. The interpretation of competency at any procedure should include the surgeon's ability to make appropriate decisions at all stages of patient care.

Original publication




Journal article


Am J Surg

Publication Date





689 - 696


Cholecystectomy, Laparoscopic, Clinical Competence, Decision Making, Decision Support Techniques, Gallstones, General Surgery, Humans, Interviews as Topic, Practice Patterns, Physicians'