PDF(Pubmed)
Abstract：
BACKGROUND: Systematic biases in group decision making (i.e., group biases) may result in suboptimal decisions and potentially harm patients. It is not well known how impaired group decision making in patient care may affect medical training. This study aimed to explore medical residents\' experiences and perspectives regarding impaired group decision making and the role of group biases in medical decision making.
METHODS: This study used a qualitative approach with thematic analysis underpinned by a social constructionist epistemology. Semi-structured interviews of medical residents were conducted at a single internal medicine residency program. Residents were initially asked about their experiences with suboptimal medical decision making as a group or team. Then, questions were targeted to several group biases (groupthink, social loafing, escalation of commitment). Interviews were transcribed and transferred to a qualitative data analysis software. Thematic analysis was conducted to generate major themes within the dataset.
RESULTS: Sixteen interviews with residents revealed five major themes: (1) hierarchical influence on group decision making; (2) group decision making under pressure; (3) post-call challenges in decision making; (4) interactions between teamwork and decision making; and (5) personal and cultural influences in group decision making. Subthemes were also identified for each major theme. Most residents were able to recognize groupthink in their past experiences working with medical teams. Residents perceived social loafing or escalation of commitment as less relevant for medical team decision making.
CONCLUSIONS: Our findings provide unique insights into the complexities of group decision making processes in teaching hospitals. Team hierarchy significantly influenced residents\' experiences with group decision making-most group decisions were attributed to consultants or senior team members, while lower ranking team members contributed less and perceived fewer opportunities to engage in group decisions. Other factors such as time constraints on decision making, perceived pressures from other staff members, and challenges associated with post-call days were identified as important barriers to optimal group decision making in patient care. Future studies may build upon these findings to enhance our understanding of medical team decision making and develop strategies to improve group decisions, ultimately leading to higher quality patient care and training.
METHODS: This study used a qualitative approach with thematic analysis underpinned by a social constructionist epistemology. Semi-structured interviews of medical residents were conducted at a single internal medicine residency program. Residents were initially asked about their experiences with suboptimal medical decision making as a group or team. Then, questions were targeted to several group biases (groupthink, social loafing, escalation of commitment). Interviews were transcribed and transferred to a qualitative data analysis software. Thematic analysis was conducted to generate major themes within the dataset.
RESULTS: Sixteen interviews with residents revealed five major themes: (1) hierarchical influence on group decision making; (2) group decision making under pressure; (3) post-call challenges in decision making; (4) interactions between teamwork and decision making; and (5) personal and cultural influences in group decision making. Subthemes were also identified for each major theme. Most residents were able to recognize groupthink in their past experiences working with medical teams. Residents perceived social loafing or escalation of commitment as less relevant for medical team decision making.
CONCLUSIONS: Our findings provide unique insights into the complexities of group decision making processes in teaching hospitals. Team hierarchy significantly influenced residents\' experiences with group decision making-most group decisions were attributed to consultants or senior team members, while lower ranking team members contributed less and perceived fewer opportunities to engage in group decisions. Other factors such as time constraints on decision making, perceived pressures from other staff members, and challenges associated with post-call days were identified as important barriers to optimal group decision making in patient care. Future studies may build upon these findings to enhance our understanding of medical team decision making and develop strategies to improve group decisions, ultimately leading to higher quality patient care and training.
摘要：
背景：群体决策中的系统偏见(即，群体偏见)可能导致次优决策，并可能伤害患者。尚不清楚患者护理中受损的群体决策如何影响医疗培训。本研究旨在探讨医疗居民关于受损群体决策以及群体偏见在医疗决策中的作用的经验和观点。
方法：本研究采用了以社会建构主义认识论为基础的主题分析的定性方法。在单一内科住院医师计划中对医疗住院医师进行了半结构化访谈。最初，居民被问及他们作为一个团体或团队做出次优医疗决策的经历。然后，问题针对几个群体偏见(群体思维，社会游荡，承诺的升级)。将访谈转录并转移到定性数据分析软件。进行了主题分析，以在数据集中生成主要主题。
结果：对居民的16次访谈揭示了五个主要主题：（1）对群体决策的分层影响；（2）压力下的群体决策；（3）决策中的通话后挑战；（4）团队合作与决策之间的互动；（5）群体决策中的个人和文化影响。还为每个主要主题确定了次主题。大多数居民能够在过去与医疗团队合作的经历中认识到群体思维。居民认为社会游荡或承诺升级与医疗团队决策不太相关。
结论：我们的发现为教学医院群体决策过程的复杂性提供了独特的见解。团队层次显著影响居民的群体决策经验-大多数群体决策归因于顾问或高级团队成员，而排名较低的团队成员贡献较少，参与群体决策的机会也较少。其他因素，如决策的时间限制，感知到来自其他工作人员的压力，并确定了与呼叫后天数相关的挑战是患者护理中最佳群体决策的重要障碍。未来的研究可能会建立在这些发现的基础上，以增强我们对医疗团队决策的理解，并制定改善群体决策的策略。最终导致更高质量的患者护理和培训。
方法：本研究采用了以社会建构主义认识论为基础的主题分析的定性方法。在单一内科住院医师计划中对医疗住院医师进行了半结构化访谈。最初，居民被问及他们作为一个团体或团队做出次优医疗决策的经历。然后，问题针对几个群体偏见(群体思维，社会游荡，承诺的升级)。将访谈转录并转移到定性数据分析软件。进行了主题分析，以在数据集中生成主要主题。
结果：对居民的16次访谈揭示了五个主要主题：（1）对群体决策的分层影响；（2）压力下的群体决策；（3）决策中的通话后挑战；（4）团队合作与决策之间的互动；（5）群体决策中的个人和文化影响。还为每个主要主题确定了次主题。大多数居民能够在过去与医疗团队合作的经历中认识到群体思维。居民认为社会游荡或承诺升级与医疗团队决策不太相关。
结论：我们的发现为教学医院群体决策过程的复杂性提供了独特的见解。团队层次显著影响居民的群体决策经验-大多数群体决策归因于顾问或高级团队成员，而排名较低的团队成员贡献较少，参与群体决策的机会也较少。其他因素，如决策的时间限制，感知到来自其他工作人员的压力，并确定了与呼叫后天数相关的挑战是患者护理中最佳群体决策的重要障碍。未来的研究可能会建立在这些发现的基础上，以增强我们对医疗团队决策的理解，并制定改善群体决策的策略。最终导致更高质量的患者护理和培训。
