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Decision making in urological surgery



Non-technical skills are important behavioural aspects that a urologist must be fully competent at to minimise harm to patients. The majority of surgical errors are now known to be due to errors in judgment and decision making as opposed to the technical aspects of the craft.

Evidence acquisition

The authors reviewed the published literature regarding decision-making theory and in practice related to urology as well as the current tools available to assess decision-making skills. Limitations include limited number of studies, and the available studies are of low quality.

Evidence synthesis

Decision making is the psychological process of choosing between alternative courses of action. In the surgical environment, this can often be a complex balance of benefit and risk within a variable time frame and dynamic setting. In recent years, the emphasis of new surgical curriculums has shifted towards non-technical surgical skills; however, the assessment tools in place are far from objective, reliable and valid. Surgical simulators and video-assisted questionnaires are useful methods for appraisal of trainees.


Well-designed, robust and validated tools need to be implemented in training and assessment of decision-making skills in urology. Patient safety can only be ensured when safe and effective decisions are made.

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Prokar Dasgupta acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College, London, and King’s College Hospital, NHS Foundation Trust. He also acknowledges the support of the MRC Centre for Transplantation and programme grants from Olympus, The London Deanery and The School of Surgery, London.

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Correspondence to Kamran Ahmed.

Additional information

Kamran Ahmed and Hamid Abboudi contributed equally to this manuscript.

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Abboudi, H., Ahmed, K., Normahani, P. et al. Decision making in urological surgery. Int Urol Nephrol 44, 701–710 (2012).

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  • Decision making
  • Skills
  • Urology
  • Training
  • Assessment