Lea Lea Harper, Janeve Desy, Melinda Davis, Sarah Weeks, Kevin McLaughlin
{"title":"医学培训期间的个人职业决定并不复杂,而是很复杂。","authors":"Lea Lea Harper, Janeve Desy, Melinda Davis, Sarah Weeks, Kevin McLaughlin","doi":"10.1111/medu.15466","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>For medical training to be deemed successful, in addition to gaining the skills required to make appropriate clinical decisions, trainees must learn how to make good personal decisions. These decisions may affect satisfaction with career choice, work–life balance, and their ability to maintain/improve clinical performance over time—outcomes that can impact future wellness. Here, the authors introduce a decision-making framework with the goal of improving our understanding of personal decisions.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Stemming from the business world, the Cynefin framework describes five decision-making domains: <i>clear</i>, <i>complicated</i>, <i>complex</i>, <i>chaotic</i>, and <i>confusion</i>, and a key inference of this framework is that decision-making can be improved by first identifying the decision-making domain. Personal decisions are largely complex—so applying linear decision-making strategies is unlikely to help in this domain.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The available data suggest that the outcomes of personal decisions are suboptimal, and the authors propose three mechanisms to explain these findings: (1) Complex decision is susceptible to attribute substitution where we subconsciously trade these decisions for easier decisions; (2) predictions are prone to cognitive biases, such as assuming our situation will remain constant (linear projection fallacy), believing that accomplishing a goal will deliver lasting happiness (arrival bias), or overestimating benefits and underestimating costs of future tasks (planning fallacy); and (3) complex decisions have an inherently higher failure rate than complicated decisions because they are the result of an ongoing, dynamic person-by-situation interaction and, as such, have more time to fail and more ways to do so.</p>\n </section>\n \n <section>\n \n <h3> Discussion</h3>\n \n <p>Based upon their view that personal decisions are complex, the authors propose strategies to improve satisfaction with personal decisions, including increasing awareness of biases that may impact personal decisions. Recognising that the outcome of personal decisions can change over time, they also suggest additional interventions to manage these decisions, such as different forms of mentoring.</p>\n </section>\n </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Personal career decisions during medical training are not complicated, they are complex\",\"authors\":\"Lea Lea Harper, Janeve Desy, Melinda Davis, Sarah Weeks, Kevin McLaughlin\",\"doi\":\"10.1111/medu.15466\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>For medical training to be deemed successful, in addition to gaining the skills required to make appropriate clinical decisions, trainees must learn how to make good personal decisions. These decisions may affect satisfaction with career choice, work–life balance, and their ability to maintain/improve clinical performance over time—outcomes that can impact future wellness. Here, the authors introduce a decision-making framework with the goal of improving our understanding of personal decisions.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Stemming from the business world, the Cynefin framework describes five decision-making domains: <i>clear</i>, <i>complicated</i>, <i>complex</i>, <i>chaotic</i>, and <i>confusion</i>, and a key inference of this framework is that decision-making can be improved by first identifying the decision-making domain. Personal decisions are largely complex—so applying linear decision-making strategies is unlikely to help in this domain.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The available data suggest that the outcomes of personal decisions are suboptimal, and the authors propose three mechanisms to explain these findings: (1) Complex decision is susceptible to attribute substitution where we subconsciously trade these decisions for easier decisions; (2) predictions are prone to cognitive biases, such as assuming our situation will remain constant (linear projection fallacy), believing that accomplishing a goal will deliver lasting happiness (arrival bias), or overestimating benefits and underestimating costs of future tasks (planning fallacy); and (3) complex decisions have an inherently higher failure rate than complicated decisions because they are the result of an ongoing, dynamic person-by-situation interaction and, as such, have more time to fail and more ways to do so.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Discussion</h3>\\n \\n <p>Based upon their view that personal decisions are complex, the authors propose strategies to improve satisfaction with personal decisions, including increasing awareness of biases that may impact personal decisions. 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Personal career decisions during medical training are not complicated, they are complex
Background
For medical training to be deemed successful, in addition to gaining the skills required to make appropriate clinical decisions, trainees must learn how to make good personal decisions. These decisions may affect satisfaction with career choice, work–life balance, and their ability to maintain/improve clinical performance over time—outcomes that can impact future wellness. Here, the authors introduce a decision-making framework with the goal of improving our understanding of personal decisions.
Methods
Stemming from the business world, the Cynefin framework describes five decision-making domains: clear, complicated, complex, chaotic, and confusion, and a key inference of this framework is that decision-making can be improved by first identifying the decision-making domain. Personal decisions are largely complex—so applying linear decision-making strategies is unlikely to help in this domain.
Results
The available data suggest that the outcomes of personal decisions are suboptimal, and the authors propose three mechanisms to explain these findings: (1) Complex decision is susceptible to attribute substitution where we subconsciously trade these decisions for easier decisions; (2) predictions are prone to cognitive biases, such as assuming our situation will remain constant (linear projection fallacy), believing that accomplishing a goal will deliver lasting happiness (arrival bias), or overestimating benefits and underestimating costs of future tasks (planning fallacy); and (3) complex decisions have an inherently higher failure rate than complicated decisions because they are the result of an ongoing, dynamic person-by-situation interaction and, as such, have more time to fail and more ways to do so.
Discussion
Based upon their view that personal decisions are complex, the authors propose strategies to improve satisfaction with personal decisions, including increasing awareness of biases that may impact personal decisions. Recognising that the outcome of personal decisions can change over time, they also suggest additional interventions to manage these decisions, such as different forms of mentoring.
期刊介绍:
Medical Education seeks to be the pre-eminent journal in the field of education for health care professionals, and publishes material of the highest quality, reflecting world wide or provocative issues and perspectives.
The journal welcomes high quality papers on all aspects of health professional education including;
-undergraduate education
-postgraduate training
-continuing professional development
-interprofessional education