What’s Behind the Scenes? Exploring the Unspoken Dimensions of Complex and Challenging Surgical Situations

Abstract

Findings show that analysis of surgeons' drawings is an effective means of gaining insight into surgeons' perceptions. The findings refine the common belief that procedural complexity is what makes a surgery challenging for expert surgeons. Focusing exclusively on the procedure during training may put trainees at risk of missing the "big picture." Understanding the multidimensionality of medical challenges and having a language to discuss these both verbally and visually will facilitate teaching around challenging situations.

Mapping a surgeon's becoming with Deleuze

“…Our research approach, described in fuller detail elsewhere,2 19 involved the participation of five surgeons from different specialties. Postoperatively, surgeons were invited to draw their experience of a surgery they had just conducted and how it evolved.…”

“…In our previous studies, we developed a framework to conduct a content analysis of the maps and interviews produced by participants,2 19 as follows. The pictures were aesthetically analysed to identify the individual images, and to consider them in terms of their arrangement on the page and their visual connection with other images.…”

“…According to their own narratives, surgeons appear to labour under expectations of being ‘super’-men and ‘super’-women. This weighs heavily on some, who feel intimidated by such excessive anticipation of heroic salvation, prevented from displaying weakness or uncertainty, distanced from candid exchanges with their team members and alienated from their own experiences 2. The hero archetype clearly is also inconsistent with directives for collaborative and even coproductive work arrangements with patients and other clinicians 3.…”

Putting the puzzle together: the role of ‘problem definition’ in complex clinical judgement

“…In our previous work we combined rich pictures with interviews to uncover the evolving and emerging non-procedural dimensions of complex and challenging situations in expert practice. 20,21 In this paper, we performed a secondary analysis on our original dataset to explore the notion of 'problem definition' in real-world clinical judgement. This secondary analysis employed the analytical steps used in our original study but focused on the systems thinking's notion of 'emergence' as the sensitising concept for analysis.…”

What can we learn from asoft sister? A complementary lens to the systems engineering approach in medical education research

“…One needs the other in order to maintain the focus on the big picture. Pursuing such a big picture view urges an appreciation of both what constitutes a problem for different people, and how the environmental conditions afford and constrain potential solutions . Research questions spanning issues ranging from how clinicians conceptualise complexity, professionalism, ethics, clinical reasoning, teamwork – as examples of complex phenomena in medical education research – to designing curricular interventions can be approached using the complementary nature of soft and hard systems engineering.…”