behind the curtain surgical judgment beyond cognition
TRANSCRIPT
Attention Threshold
Novice
Primary activity
Spare capacity
Expert
Primary activity
Spare capacity
Kahneman (1973)
Attention Threshold
Effortful
Primary activity
Spare capacity
Automatic
Primary activity
Spare capacity
Slowing Down
“It’s the routine cases…that’s what happened here. It was an easy case. We were chatting and obviously not being as diligent as we should have been.”
Senior Surgeon, Interview
Drifting
Slowing Down
“…my efforts during these moments of crises were consumed with the anxiety I was feeling and intermixed with feelings of inadequacy, uncertainty, reputation and ego.”
Senior Surgeon
Emotional
“I almost crashed into four parked cars before I got out of the parking garage that day. I was so distraught … like I am not a guy that cries, but…”
(I-001)
Slowing Down “…And then the staff showed up just outside the operating room to see how things were going, and I can see the fellow getting completely nervous and then completely changing and telling me “go faster”, “come on, you have to grab it”, when beforehand we were just going at a normal sort of slow pace... he got nervous, to the point that we ended putting the kidney upside down. So we had to take all the stitches out, and put it back in again. ”
(P008)
Ministry of Research and Innovation Early Researcher Award
Royal College of Physicians
and Surgeons of Canada Medical Education Research Grant
Physicians Services Incorporated
Health Professional Research Grant
THE MINDFUL SURGEON
Glenn Regehr Helen MacRae Lorelei Lingard
Annie Leung Shelly Luu Nathan Zilbert Jenny Jin Lisa Mark Carween Mui Jacob Gallinger Priyanka Patel Laurent St. Martin Sandra deMontbrun Shira Gold
Tina Martimianakis Simon Kitto Steven Gallinger Lucas Murnaghan Tulin Cil Vicki LeBlanc
Emotional
“I almost crashed into four parked cars before I got out of the parking garage that day. I was so distraught … like I am not a guy that cries, but…”
(I-001)
Was it my fault?
“Did I goof something or did I miss something? Is it a technical problem? So I relive the operation and I go through the critical parts of the operation.”
(I-003)
Short Term
“I’m going to learn from this. I’m not going to dismiss it and say, “Well, it’s the patient’s fault” or “It’s the nurse’s fault”, sort of learn from it whatever the problem was and move on.”
(I-003)
Long Term
“I think that each mistake I make, or each complication I have, or each patient I bury, I think has taken a little wee piece out of me.”
(I-008)