UROLOGY – ORIGINAL PAPER Decision making in urological surgery Hamid Abboudi • Kamran Ahmed • Pasha Normahani • May Abboudi • Roger Kirby • Ben Challacombe • Mohammed Shamim Khan • Prokar Dasgupta Received: 11 November 2011 / Accepted: 25 November 2011 / Published online: 26 February 2012 Ó Springer Science+Business Media, B.V. 2012 Abstract Context Non-technical skills are important behav- ioural 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 psycho- logical 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. Conclusion Well-designed, robust and validated tools need to be implemented in training and assess- ment of decision-making skills in urology. Patient safety can only be ensured when safe and effective decisions are made. Keywords Decision making Á Skills Á Urology Á Training Á Assessment ‘It is the mental processes involved in an operation that not a few fail. The capacity for forming a ready judgment … must follow each movement of the surgeon’s scalpel’ (Sir Frederick Treves, 1891). Introduction Decision making is the process of choosing between alternative courses of action. Important characteristics of the decision-making process include ascertaining Kamran Ahmed and Hamid Abboudi contributed equally to this manuscript. H. Abboudi Á K. Ahmed Á P. Normahani Á M. Abboudi Á B. Challacombe Á M. S. Khan Á P. Dasgupta MRC Centre for Transplantation, NIHR Biomedical Research Centre, King’s Health Partners, King’s College London, London, UK H. Abboudi Á K. Ahmed (&) Á P. Normahani Á M. Abboudi Á B. Challacombe Á M. S. Khan Á P. Dasgupta Department of Urology, Guy’s Hospital, St Thomas Street, London SE1 9RT, UK e-mail: k.ahmed@imperial.ac.uk R. Kirby The Prostate Centre, 32 Wimpole Street, London W1G 8GT, UK 123 Int Urol Nephrol (2012) 44:701–710 DOI 10.1007/s11255-011-0101-0