Session Design Submission Review

No

Yes

Clinical reasoning (CR) has been described as a core professional practice in medicine and a key component of all aspects of patient care (Young et al. 2022). Historically, research in CR was based on cognitive psychology theories that view reasoning as a process where information is received, processed and weighed within and individual’s mind, then used to select actions. This led to the articulation of cognitive frameworks like illness scripts and schemas that focus on diagnostic reasoning, in an effort to identify biases that lead to medical errors and threats to patient safety (Connor et al., 2020). These frameworks have been the basis on which CR is taught in many specialties of medicine.

Perhaps because of this focus on diagnostic over therapeutic decision making, surgical disciplines have largely been absent from this scholarship. Despite this, productive advances in our understanding of how surgeons make decisions have emerged, both pre-operatively and in the operating room, and during routine and non-routine cases (Cristancho et al. 2013, Cristancho et al. 2016,  Moulton et al. 2010, Zilbert et al. 2015). A central component of this research acknowledges that the context in which reasoning occurs (which surgeon, in what OR, with which team, and for which patient) is essential to understanding and teaching how to make the ‘optimal decision’. Recently, to better account for how clinicians and their environments interact and shape one another, a similar shift in the clinical reasoning literature has occurred. This perspective, adopted from the field of ecological psychology, seeks to understand reasoning as interactive and relational between an individual, their context, and the task at hand (Watsjold et al. 2022). In this lens, a surgeon brings particular effectivities (e.g. their knowledge and technical skills) to the clinical task, and the environment provides affordances (e.g. the patient’s anatomy, tools to complete the surgical procedure, and the staff available to assist) that interact to determine what can be achieved, thereby guiding or constraining a surgeon’s clinical reasoning in that specific context. Importantly, the ecological psychology view of clinical reasoning has not been applied to the surgical context.

In this workshop, we aim to introduce participants to this ecological perspective on clinical reasoning and discuss its relevance to research and teaching of clinical reasoning in surgery. Specific issues related to clinical reasoning in surgery will be reviewed, such as the role of anatomy knowledge in surgical decision making, the implication of skilled vs. unskilled assistants, planned vs. unplanned operative challenges, and the selection of specific surgical tools and operative approaches. Our goal is to demonstrate how this framework can be used in a practical way to guide teaching related to pre-operative planning, intraoperative decision making, and post-operative reflection for surgical trainees. In addition, we hope to engage in a discussion about how this framework can be used to ask novel questions about surgical reasoning, in hopes of establishing a research agenda for the future. We will review research methodologies that can help address these questions and will look to establish research collaborations with those who are interested to move knowledge in this area forward in the future.

90-minute workshop

Yes

Yes

Identify the tenants of an Ecological Psychology Framework on Clinical Reasoning (EPFCR)

Articulate how EPFCR can be applied to the surgical context

Develop teaching strategies using EPFCR to guide surgical trainees pre- operative planning, intraoperative decision making, and post-operative reflection

Formulate a research agenda utilizing the ecological psychology framework to investigate novel questions related to clinical reasoning in surgery

Appraise various research methodologies in terms of their applicability for this research area and establish research collaborations to carry out this scholarly work