Clinical and operative decision-making in paediatric surgical practice

Abstract High-quality clinical and operative decision-making is the main factor that distinguishes the expert surgeon from the ordinary surgeon. It is critical for paediatric surgical trainees to become competent in their clinical assessment of children, and to be able to develop a sound management plan based on that assessment. Historically, surgical teaching has tended to focus on the technical aspects and skills required to conduct operative procedures rather than on clinical decision-making (or even the nuances of higher cognitive operative decision-making). An understanding of the complexities around decision-making helps trainees learn how and why they make the decisions they make, and provides them with the tools to review and improve their clinical performance. The model described in this chapter assists the clinician in managing the limitations posed by incomplete information, contradictory information, and clinical uncertainty. It explains the continuum between analytical deductive clinical reasoning and intuitive pattern recognition, as well as the wide range of factors that influence clinical assessment in its broader sense.