Eye of the beholder: Risk calculators and barriers to adoption in surgical trainees. Surgery 2018 Nov;164(5):1117-1123
Date
08/29/2018Pubmed ID
30149939Pubmed Central ID
PMC8383120DOI
10.1016/j.surg.2018.07.002Scopus ID
2-s2.0-85052232880 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
BACKGROUND: Accurate risk assessment before surgery is complex and hampered by behavioral factors. Underutilized risk-based decision-support tools may counteract these barriers. The purpose of this study was to identify perceptions of and barriers to the use of surgical risk-assessment tools and assess the importance of data framing as a barrier to adoption in surgical trainees.
METHODS: We distributed a survey and risk assessment activity to surgical trainees at four training institutions. The primary outcomes of this study were descriptive risk assessment practices currently performed by residents, identifiable influences and obstacles to adoption, and the variability of preference sets when comparing modified System Usability Scores of a current risk calculator to a purpose-built calculator revision. Risk calculator comparison responses were compared with simple and multivariable regression to identify predictors for preferentiality.
RESULTS: We collected responses from 124 surgical residents (39% response rate). Participants endorsed familiarity with direct verbal communication (100%), sketch diagrams (87%), and brochures (59%). The most contemporary risk communication frameworks, such as best-worst case scenario framing (38%), case-specific risk calculators (43%), and all-procedure calculators (52%) were the least familiar. Usage favored traditional models of communication with only 26% of residents regularly using a strategy other than direct verbal discussion or anatomic sketch diagrams. Barriers limiting routine use included lack of electronic and clinical workflow integration. The mean modified System Usability Scores domain scores were widely dispersed for all domains, and no domain demonstrated one calculator's superiority over another.
CONCLUSION: Risk assessment tools are underutilized by trainees. Of importance, preference sets of clinicians appear to be unpredictable and may benefit more from a customizable, bespoke approach.
Author List
Leeds IL, Rosenblum AJ, Wise PE, Watkins AC, Goldblatt MI, Haut ER, Efron JE, Johnston FMAuthor
Matthew I. Goldblatt MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultClinical Competence
Clinical Decision-Making
Decision Support Techniques
Female
General Surgery
Humans
Internship and Residency
Male
Postoperative Complications
Preoperative Care
Risk Assessment
Risk Factors
Surgical Procedures, Operative
Surveys and Questionnaires
