Just finished a stretch on teaching service.

A common goal among residents at this point in the year: improve decision making.

PGY-1s want to be more independent.
PGY-2s are preparing to be senior team leaders.
PGY-3s are transitioning to post-residency practice.

#meded
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Decision making is made difficult when there is:
- limited or dynamic information
- time pressure
- uncertainty in the possible outcomes
- emotion that occupies our bandwidth (will come back to this)
among other factors...

This may sound familiar on the wards.

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Beyond ‘read more, see more, reflect more,’ what are helpful tips for trainees to improve decision making? #meded

A few thoughts:

1. Do not focus on the outcome and whether your decision is right or wrong (we often can’t predict this). This can be paralyzing.

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2. Instead, make your best judgment based on the available information, weigh the harms and benefits, and commit to a decision (rather than avoiding or deferring to others).

3. Listen for agreement or disagreement. Disagreement is good.

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4. Disagreement might indicate there was an error in decision making, but learning from error is the best way to improve.

5. Disagreement might also indicate a difference in perspective—also good. We should avoid groupthink. Many calls in medicine are a coin-flip anyway.

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6. Don’t let fear or anxiety of being wrong deter you from making decisions.

7. Emotion may play the biggest role in decision making.

It directs effort in thinking. It influences cognitive biases. It occupies working memory, leaving little room for information processing.

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8. Check in with your emotions (and other team members).

Fatigue, stress, anxiety, anger, burnout—all of these may limit effective decision making.

The outcomes of decisions are also emotional. It is especially important to check in with each other after bad outcomes.

/end