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Complex decision making in medical training: key internal and external influences in developing practical wisdom

Lookup NU author(s): Professor Paul PaesORCiD, Professor David Leat, Dr Jane Stewart


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© 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education Context: Good judgement and the ability to make complex decisions are key attributes of a skilled professional. There has been limited study of doctors and their decision making, particularly in relation to making complex decisions. The study aims were to understand how trainee doctors develop practical wisdom through investigating their approach to difficult decision making, understanding the influences on the development of practical wisdom, and identifying potential interventions that may help develop this further. Methods: Constructing an understanding of the process of developing practical wisdom was analysed within a social constructivist frame. The study investigated trainee doctors at different stages of their careers. Qualitative semi-structured interviews were used to explore the approaches doctors take to difficult decision making, as well as the key training influences in learning these skills. Constant comparative analysis was carried out within a grounded theory approach. Results: Key elements emerged from the data regarding the doctors themselves and the environments they worked in that assisted in developing decision making. This led to the construction of a conceptual model setting out the development of practical wisdom among trainee doctors. The model describes a process of gaining experience in decision making, moderated by key external and internal influences. The important roles of self-efficacy and agency (relational) are highlighted as key enablers of the process. Discussion: The implications of this model are considered in relation to postgraduate training of doctors. The importance of training doctors to be self-regulated learners in learning environments that support their development is highlighted. Aspects of the clinical learning environment (structure) such as rotation structures, the culture, supervision and feedback can all be enhanced. Self-efficacy and relational agency, alongside other internal influences, are key factors in accelerating development of practical wisdom. Other studies have shown that these factors can be improved with targeted interventions.

Publication metadata

Author(s): Paes P, Leat D, Stewart J

Publication type: Article

Publication status: Published

Journal: Medical Education

Year: 2019

Volume: 53

Issue: 2

Pages: 165-174

Print publication date: 01/02/2019

Online publication date: 25/11/2018

Acceptance date: 27/09/2018

ISSN (print): 0308-0110

ISSN (electronic): 1365-2923

Publisher: Wiley-Blackwell


DOI: 10.1111/medu.13767


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