HUMAN EXPERTISE / SURGICAL DECISIONS
Behind every
decision.
A world of
expertise.
Exploring how surgeons recognize what matters, navigate uncertainty, and decide when to act.
Explore the mission ↓and Naturalistic Decision-making
01 / THE MISSION
Make the thinking
visible.
Clinical records tell us what happened. ASCEND asks how the decision took shape.
In difficult acute cholecystitis, surgeons weigh more than disease severity. Physiological reserve, reversibility, patient priorities, technical difficulty, and access to source control all enter the picture.
Our planned international interview study reconstructs these moments in detail: what surgeons noticed, what they expected, which actions seemed possible, and when their understanding changed.
Moderate or severe acute calculous cholecystitis
Initial management decisions in Tokyo Guidelines 2018 Grade II or III disease.
02 / THE APPROACH
A closer look at
expertise in action.
Naturalistic decision-making examines judgment in complex, changing environments. Explore the questions guiding our enquiry.
A QUESTION TO RECONSTRUCT THE MOMENT
What caught your attention?
Explore the clinical cues, prior experience, and unexpected details that shape the surgeon’s initial understanding.
Conceptual guide · not a clinical algorithmThe Critical Decision Method structures the actual-incident interview, supported by selected applied cognitive task analysis techniques. The recognition-primed decision model informs interpretation alongside other explanations, including deliberate comparison, guidelines, and team discussion.
03 / THE SURGEON’S PERSPECTIVE
Your experience.
Examined in depth.
Designed for practicing attending and consultant surgeons who independently contribute to initial management decisions.
One English-language interview
Actual difficult incident reconstructed
Short fictional vignette exercises planned
Completed interviews anticipated
Revisit the moment.
Explore the reasoning.
Recall a difficult moderate or severe case from the preceding 12 months. Together, we build a timeline and explore the key decision points before moving to fictional clinical scenarios.
- 01
Map the context
Your practice, available services, and demanding judgments.
- 02
Reconstruct one incident
What you knew at the time, the cues you used, and how the plan evolved.
- 03
Explore changing conditions
Fictional vignettes introduce clinical updates and changes in service availability.
- 04
Reflect on the workload
Brief ratings after each completed vignette describe its subjective demands.
04 / THE HUMAN FACTOR
Understanding
the cognitive load.
The unweighted NASA Task Load Index (Raw TLX) captures six dimensions of the experience of responding to a vignette.
These ratings describe subjective vignette workload. They do not measure clinical competence, decision accuracy, or workload during actual patient care.
Mental demand
Physical demand
Temporal demand
Performance
Effort
Frustration
05 / BEFORE YOU TAKE PART
A thoughtful study.
A clear commitment.
Who is the study designed for?+
Practicing attending or consultant surgeons in general, acute care, emergency, or hepatopancreatobiliary surgery who independently contribute to initial management of acute calculous cholecystitis and have managed a difficult moderate or severe case within the previous 12 months. The initial interviews are in English.
Is this a performance assessment?+
No. The study aims to explain decision processes and contextual constraints. It will not grade individual decisions, rank surgeons or institutions, establish treatment superiority, or produce a prescriptive treatment algorithm.
What about recording and confidentiality?+
The planned interview is audio-recorded with explicit consent; there is no video recording. Participants are asked to omit patient and colleague identifiers and exact dates. Identifying details are removed or generalized before analysis. Permission to use deidentified quotations is requested separately.
What does participation involve?+
One voluntary, unpaid interview of approximately 75–90 minutes, with an optional brief clarification contact. You may skip questions or ratings, pause, or stop. The protocol provides a 14-day window to request removal of your interview and ratings, subject to the participant information provided at consent.
What will ASCEND produce?+
Planned outputs include an explanatory cognitive task model, a table of cognitive demands, an anonymized thematic account, and descriptive vignette and workload summaries. These may inform future educational and research questions; educational or patient-outcome benefits are not established by this study.
THE NEXT STEP
Bring your perspective
to the conversation.
Contact the study team to learn more about ASCEND
and planned participation.
Study in preparation · Enquiries welcome
Recruitment is subject to ethics approval and final participant materials.
RESEARCH FOUNDATIONS
Explore the ideas behind ASCEND +
Expertise in contextKlein and colleagues’ Decision Making in Action (1993) and Klein’s recognition-primed decision model frame the study of experienced judgment in dynamic environments.
Naturalistic decision-making in health careFalzer (2018) examines the complexity of applying evidence and expertise in clinical practice. DOI: 10.1177/1555343418773915.
Subjective workloadHart and Staveland (1988) developed NASA-TLX. ASCEND plans an unweighted Raw TLX assessment of vignette tasks.
Future educational questionsThe supplied work on error recovery and naturalistic decision-making in sport informs questions about adaptation, shared understanding, and learning. ASCEND does not test these training interventions.
Study procedures summarized from the supplied protocol dated 4 November 2026.