Article review: Macrocognition in novices and experts in the ED
Expert physicians: These are the ones who effortlessly handle a busy Emergency Department while juggling patient load, learners and consultants.
- How do they make decisions?
- How do they get there?
This article 1 studied macrocognition differences between novices and experts in the Emergency Department.
Qualitative study using semistructured interviews with novices (first year residents) and experts (more than 5 years in practice). Questions probe specifically for critical decision making cues.
What were the results?
Between the 5 novices and 6 experts, their differences are summarized:
|Encompassing View||Maintain overview of department||Difficuly integrating data from various sources|
|Sense-making Skills||Recognize patterns and maintain an open frame||Seek confirmation to fit diagnosis and have difficulty in gray zones|
|Anticipation||Anticipate and mitigate potential problems||Adhere to diagnosis too early and tightly|
|System||Know and work around the system||Do not know policies well|
|Manage time||Can judge how long things take||Lose track of time, particular in procedures|
|Communication||Have developed skilled communication||May struggle with communication|
How would I apply this in teaching?
- Set time frame for procedures
- Explain hospital policies
- Discuss potentially difficult interactions beforehand
- Ensure learners feel safe to ask questions
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