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INTRODUCTION

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  • Surgical outcomes may be attributed to reflection on previous positive and adverse experiences

  • Peer collaboration is an essential component for surgeon’s performance analysis

  • Critical observation, planning, and review cultivate judgment in the surgical setting

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Postoperative complications have a profound impact in the surgeon’s learning process. Multiple variables influence the development of good judgment in surgical care. With little formal education in this area, surgeons rely upon previous experience from past complications as a historic “learning tool.” The appropriate critical review of surgical-related complications likely improves judgment in future patient care; such review should be systematic, critical, and objective, and allow for a shorter learning curve and for improved patient safety provided by the future generations of surgeons in training.

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BACKGROUND

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Any clinician would concede that reflection on technical or medical decision errors is not an area of comfortable focus in surgical training. There are, admittedly, few opportunities for immersion into this esoteric concept during the training period. There is, however, among the medical surgical community, an imperative for making sound medical decisions. The practice of surgery is regarded as one that requires consistent need for development of judgment.

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BEHAVIORAL DEVELOPMENT

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Practitioners are frequently reminded of the requirements for knowledge reinforcement, updates, and refinement of current technique. The principle of sound judgment may seem somewhat nebulous, but in reality it is simply a constellation of responsible behaviors. Even with little formal education, there are compulsive means to assist in this endeavor, including collaboration, teamwork, and precedent. Medical professionals often refer to instinct. How is true clinical instinct manifested? Operative physicians claim to make decisions based on surgical instinct. However, what does this really mean and how can this be properly developed? It is recognized that behaviors are commonly a reaction of precedent to past occurrences, experience, and evidence-based data. Of these, anecdotal experience often does prevail, and is typically foremost when reviewing previous complications that have occurred.

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In clinical behavior analysis, the medical decision process exists on multiple care levels.

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Medical Decisions on Multiple Care Levels

  • ✓ Encounters in the emergency department or urgent-care level

  • ✓ Encounters at the time of a new patient consult

  • ✓ Frequency and manner of postoperative care

  • ✓ Clinical decision making as to indications for treating individual patients

  • ✓ Perioperative decision making

  • ✓ Recognition, communication of, and correction of errors, as well as appropriate steps for management

  • ✓ Consideration for clinical venue of treatment (outpatient, inpatient)

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Example of the Current Status in Orthopedic Surgery

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Statistical data highlight the relevance of attention to this area of surgical care. More than 25,000 orthopedic surgeons exist in the United States at present. Currently, orthopedic surgery is 5th in ranking for the number of suits or claims filed with resultant money paid. Of these cases, 52% involve improper performance in surgery, 14% ...

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