The development of practical wisdom among training doctors ; key internal and external influences

Abstract

Good judgement and the ability to make complex decisions are key attributes of a skilled professional. The study aims were to understand how training doctors develop practical wisdom through investigating their approach to difficult decision making, understanding the influences on the development of these skills, and identifying potential interventions that may help develop these skills further. The background literature explores current understanding of professional development and clinical thinking frameworks. Methodology The study adopted an approach of social constructivism, constructing an understanding of the process of developing practical wisdom. The study investigated training doctors at different stages of their career. Qualitative interviews were used to explore the approaches doctors take to difficult decision making as well as the key training influences in learning these skills. Results Thematic data analysis has led to the construction of a conceptual model which sets out the development of practical wisdom among training doctors. This model describes a process of gaining experience in decision making, moderated by key external and internal influences. The important roles of self-efficacy, agency (relational) and structure are highlighted as key enablers of this process. Discussion There has been limited study of doctors and their decision making, particularly in relation to complex decisions. The implications of this model are considered in relation to postgraduate training of doctors. The importance of training doctors as self-regulated learners in learning environments that support their development is highlighted. Aspects of the clinical learning environment (structure) such as rotation structures, the culture, supervision and feedback can all be enhanced. Self-efficacy and relational agency, alongside other internal influences, are key factors in accelerating development of practical wisdom that can be improved with targeted interventions.