Complexity, Uncertainty, and Ambiguity in Professional Practice: Re-Engineering the Notion of Expertise in High-Stakes Situations

AM Rounds Slider Master-12By: Sayra Cristancho, PhD, assistant professor, Department of Surgery, and scientist, Centre for Education Research & Innovation, Western University

At 10 years old, I had the dream of becoming an astronaut. Not one who flies space shuttles…I wanted to be a flight surgeon. I dreamed of being in a situation where I had to take control of a health care emergency in space.

At the same time, my country, Colombia, was going through the worst violence and social crisis in its history. Complexity, uncertainty, and ambiguity were the norm of our family life. Watching on TV when a bomb exploded, I always wondered how those first responders managed to handle rescuing people and exposing themselves to another attack.

One was a dream; the other was real life. But what could be more high-stakes and complex for a flight surgeon or a first responder than those situations?

I was trained as an engineer, but I refused to do the pure technology building work of engineering. Why? I remember having an aha moment early in my training. One day I presented the same design for an apparatus to two different clients. They each made a completely different recommendation about it. It was fascinating to see their back and forth and to finally realize that they saw the problem differently.

That situation twisted some gears in my mind. I became more interested in the idea that if people see situations/problems differently–particularly complex and challenging ones–why do we dive so quickly into solving problems? What about the definition of the problem itself? Wouldn’t it make more sense to consider that a problem is actually shaped by how different people perceive a situation? And if that’s so, how does the complexity of a situation influence how we see, think, and feel as part of that situation, alone or as a team?

Systems engineering–what some would refer to as the holistic version of engineering–treats situations as systems. Systems engineering teaches us 3 key tenets: (1) people are embedded in a system; (2) the system owns the problem, not the people; and (3) the definition of a complex problem is dynamic, not fixed. Using the systems engineering lens, my research recently published in Academic Medicine seeks to challenge the assumption that professional experts take the definition of a problem for granted. Using visual methods from systems engineering (i.e., Rich Pictures), my research is beginning to offer a new and different view of how complexity looks and feels to surgeons, a view that reveals much more personal and emotional effects in the clinical domain, which has traditionally emphasized technical prowess over empathy in its self-image.

The complexity, uncertainty, and ambiguity that life constantly presents to us permeate professional practice. As one surgeon in my research drew and described: “This is the pathway to him getting better and getting back to the things he really loves… his daughter, football, hockey… This over here is me. This is me thinking about…he’s a young guy and so. Anyways, when I was younger, I had major heart problems. This is me being defibrillated back into regular rhythm…um, and this is me at a typical sports type thing where I couldn’t do anything and occasionally had to get called into an ambulance. So, knowing that, how much I can empathize with him and his needs.” We need to find ways to better train novices to navigate complexity effectively–particularly the complexity that extends far beyond the professional practice and well into personal/emotional experiences. I believe that my research will offer a much needed re-engineering of the notion of professional expertise in high-stakes situations–a notion that could serve to empower younger generations to be aware of the challenges but still pursue their professional dreams more purposefully.

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