‘Junior doctor decision making: isn’t that an oxymoron?’ A qualitative analysis of junior doctors’ ward-based decision-making

Abstract

Unacceptable levels of adverse healthcare events, combined with changes to training, have put the spotlight on junior doctor decision-making. This study aimed to describe the decisions made by junior doctors and the contextual factors influencing how decisions were made and justified. Stimulated recall interviews with 20 junior doctors across five hospitals in SW England were undertaken to co-construct accounts of observers (researchers) and performers (junior doctors), enabling deep insights into individual capability and support needs. Decisions identified included prioritisation of patients and of tasks, and whether and when to intervene clinically. There were a surprising number of ‘inherited decisions’, made by somebody else but enacted by the junior doctor. Through their decisions, participants sought various outcomes, including impressing senior staff. Two contrasting theoretical lenses that focused on the individual decision-maker and the healthcare system enabled creative ideas about supporting education and training to emerge as recommendations.

Keywords:

• learning in the professions
• workplace learning
• vocational education and training
• organisations
• leadership of VET