Personal career decisions during medical training are not complicated, they are complex

Background

For medical training to be deemed successful, in addition to gaining the skills required to make appropriate clinical decisions, trainees must learn how to make good personal decisions. These decisions may affect satisfaction with career choice, work–life balance, and their ability to maintain/improve clinical performance over time—outcomes that can impact future wellness. Here, the authors introduce a decision-making framework with the goal of improving our understanding of personal decisions.

Methods

Stemming from the business world, the Cynefin framework describes five decision-making domains: clear, complicated, complex, chaotic, and confusion, and a key inference of this framework is that decision-making can be improved by first identifying the decision-making domain. Personal decisions are largely complex—so applying linear decision-making strategies is unlikely to help in this domain.

Results

The available data suggest that the outcomes of personal decisions are suboptimal, and the authors propose three mechanisms to explain these findings: (1) Complex decision is susceptible to attribute substitution where we subconsciously trade these decisions for easier decisions; (2) predictions are prone to cognitive biases, such as assuming our situation will remain constant (linear projection fallacy), believing that accomplishing a goal will deliver lasting happiness (arrival bias), or overestimating benefits and underestimating costs of future tasks (planning fallacy); and (3) complex decisions have an inherently higher failure rate than complicated decisions because they are the result of an ongoing, dynamic person-by-situation interaction and, as such, have more time to fail and more ways to do so.

Discussion

Based upon their view that personal decisions are complex, the authors propose strategies to improve satisfaction with personal decisions, including increasing awareness of biases that may impact personal decisions. Recognising that the outcome of personal decisions can change over time, they also suggest additional interventions to manage these decisions, such as different forms of mentoring.