Understanding the Cognition and Decision Making of Community Anesthesiologists

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The investigators propose to conduct a 3-site prospective observational mixed-methods study using clinical vignettes and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of non-depolarizin...

The investigators propose to conduct a 3-site prospective observational mixed-methods study using clinical vignettes and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of non-depolarizing neuromuscular blockade (NMB) at the end of general endotracheal anesthesia cases. The objectives of this initial study is to begin to understand: When and why do community anesthesiologists choose to reverse NMB? What are the decision preferences of community anesthesiologists with regard to their decisions to reverse NMB, and what are the clinician and clinical case factors that influence those decisions? What are the operational knowledge gaps of anesthesia professionals with regard to their ability to follow best-practice evidence for the reversal of NMB? More generally, the program objective is to refine and validate a novel methodology to delineate clinicians' decision making strategies and triggers. 2.1.2. Study Hypotheses For this initial study, the investigators hypothesize that: The clinical vignette-based decision threshold method will describe the distribution of values of clinical variables (i.e., decision thresholds) for community anesthesiologists' decision to reverse NMB. There will be measurable differences in participant demographics and practice attributes between those who closely follow evidence-based expectations for reversal of NMB and those who do not. The investigators expect community practitioners who do not reverse NMB in accordance with current best evidence to be older, to not be fellowship trained or subspecialty certified, and to practice in lower acuity settings. This will be a three-site prospective observational simulation study of 36 experienced community anesthesiologists using clinical vignettes and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of neuromuscular blockade (NMB) at the end of general endotracheal anesthesia cases. Case presentations to participants will be randomly assigned to vignettes using a Latin Square design. Cognitive interview transcript coders and analysts will be blinded to the identity and attributes of the participants.

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