Conceptualizations of anaesthetists' clinical reasoning expertise: protocol for a systematic review and qualitative thematic synthesis.

Abstract

Background: Expertise involves a high level of knowledge or skill in a specific area. Medical expertise encompasses knowledge, technical skills, and socio-cognitive skills like clinical reasoning, essential for accurate diagnosis and treatment. Although traditionally seen as technicians, anaesthesiologists are vital cognitive experts in the operating room, where situational awareness and decision-making are crucial in high-risk, fast-paced situations prone to cognitive bias. Properly defining the cognitive aspects of anaesthetic expertise is challenging, hindering research and educational consistency. This study aims to identify, appraise, and synthesize how expertise within clinical reasoning among anaesthetists is conceptualized in the literature.

Methods: We will search Medline, Embase, and Cochrane databases for peer-reviewed papers up to July 1, 2024, focusing on anaesthesiology, expertise, and clinical reasoning. Our searches will include related terms and citations. According to the PRISMA flow chart, two reviewers will independently screen titles, abstracts, and full texts against inclusion criteria, excluding papers focusing solely on technical expertise. A third reviewer will resolve any disagreements. Information on references, article type, research area, anaesthetic field, and conceptualizations of clinical reasoning expertise will be extracted using a standardized form. To achieve an operational synthesis, a two-stage qualitative analysis will be conducted. The first stage involves a comprehensive semantic analysis to identify patterns and thematic clusters. The second stage follows the Thomas and Harden approach for formal thematic synthesis, using codes to develop categories that lead to descriptive themes. The resulting multi-layered tree structure will ultimately enable generating analytical themes.

Discussion: A clear concept synthesis of clinical reasoning expertise among anaesthetists could enhance research, education, and guidelines, thereby improving patient safety. The proposed systematic review and qualitative thematic synthesis aims to clarify this complex concept by analysing data from diverse scientific literature. A broad research strategy will be employed, followed by rigorous qualitative analysis, including semantic analysis and thematic synthesis, to capture the multifaceted nature of clinical reasoning. This study will be the first to propose a global approach, facilitating improved pedagogical interventions and integrating insights into AI models for enhanced training and clinical decision-making.

Systematic review registration: PROSPERO registration number CRD42024510184.