Intra-operative decision making by ophthalmic surgeons.

PURPOSE: Research on surgical decision making and risk management usually focuses on peri-operative care, despite the magnitude and frequency of intra-operative risks. The aim of this study was to examine ophthalmic surgeons' intra-operative decisions and risk management strategies in order to explore differences in cognitive processes. METHOD: Critical decision method interviews were conducted with 12 consultant ophthalmologists who recalled cases and selected important decisions during the operations. These decisions were then discussed in detail in relation to decision making style and risk management. Transcripts were coded according to decision making strategy (analytical, recognition primed decision, creative and rule-based) and risk management (threats, risk assessment and risk tolerance). RESULTS: The key decision in each case was made using either a rapid, intuitive mode of thinking (n=6, 50%) or a more deliberate comparison of alternative courses of action (n=6, 50%). Rule-based or creative decision making was not used. Risk management involved the perception of threats and assessment of threat impact but was also influenced by personal risk tolerance. Risk tolerance seemed to play a major role during situations requiring a stopping rule. Risk management did not appear to be influenced by time pressure. CONCLUSIONS: Surgeons described making key intra-operative decisions using either an intuitive or an analytical mode of thinking. Ophthalmic surgeons' risk assessment, risk tolerance and decision strategies appear to be influenced by personality.

Surgeons' intraoperative decision making and risk management.

BACKGROUND: Surgical research on decision making and risk management usually focuses on perioperative care, despite the magnitude and frequency of intraoperative risks. The aim of this study was to examine surgeons' intraoperative decisions and risk management strategies to explore differences in cognitive processes. METHOD: Critical decision method interviews were conducted with 24 consultant surgeons who recalled cases and selected important decisions during the operations. These decision were then discussed in detail in relation to decision-making style and risk management. RESULTS: The key decision in each case was made using either a rapid, intuitive mode (46%) or a more deliberate comparison of alternative courses of action (50%). Decision strategy was not related to surgical approach (endoscopic vs open), context (elective vs emergency), perceived time pressure, or situational threats. Risk management involved perceiving threats and assessing impact but also indicated the role of personal risk tolerance. CONCLUSIONS: Surgeons described making key intraoperative decisions using either an intuitive or an analytic mode of thinking. Surgeons' risk assessment, risk tolerance, and decision strategies appear to be influenced by their personalities.

Implicit perceptions of risk and anxiety and pilot involvement in hazardous events.

OBJECTIVE: The aim of the studies was to examine the role of implicit processes in aeronautical risk perception and risk taking. BACKGROUND: Aeronautical decision making consists of both explicit processes (e.g., comparing options, seeking information) and implicit, or intuitive, processes (e.g., immediate affective reactions). The present studies utilized a novel methodology, adapted from studies in social cognition, to examine the relationship between general aviation pilots' implicit reactions toward risk and their involvement in hazardous events. METHOD: The Implicit Association Test was used to measure pilots' (Study 1: N= 23; Study 2: N= 32) implicit associations between good and bad weather conditions and perceptions of risk and anxiety. RESULTS: There was a relationship between the pilots' implicit perceptions and previous involvement in hazardous aeronautical events as measured by D. R. Hunter's (1995, 2002) Hazardous Events Scale. The more weather-related hazardous events the pilots had been involved in, the less they associated implicit risk with adverse weather (Study 1) and the less implicitly anxious they were toward adverse weather (Study 2). CONCLUSION: The results show a relationship between implicit associations and risk-taking behavior. APPLICATION: Pilots may be involved in risk-taking behavior because they perceive less risk in, and are implicitly less afraid of, hazardous conditions.

Risk tolerance and pilot involvement in hazardous events and flight into adverse weather.

INTRODUCTION: According to Lopes [Lopes, L.L. (1987). Between hope and fear: The psychology of risk. Advances in Experimental Social Psychology, 20, 255-295] tolerance of risk may be governed by sensitivity to either the opportunities for gain or threats of loss involved. METHODS: In the initial study, qualified pilots were presented with 36 written flight scenarios that varied in the levels of opportunity and threat present. The pilots rated the likelihood that they would undertake each flight. Pilots were largely risk averse, as their ratings were all significantly influenced by threat. RESULTS: The pilots whose ratings were significantly influenced by opportunity had been involved in more hazardous aviation incidents than the other pilots. In the final study, 32 qualified pilots completed both the risk tolerance measure and a simulated flight into adverse weather. The pilots who continued flying into adverse weather were less risk averse compared to the pilots who diverted. This further highlighted the link between risk tolerance and risk-taking, and suggested that some pilots may fly into adverse weather because of a greater tolerance of risk. IMPACT ON INDUSTRY: The studies provide evidence that a measure of risk tolerance can predict potential accident involvement amongst general aviation pilots.