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.
Study method
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:
| Experts | Novice | |
| 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?
Specifically for junior trainees, I might:
- Set time frame for procedures
- Explain hospital policies
- Discuss potentially difficult interactions beforehand
- Ensure learners feel safe to ask questions
1.
Schubert C, Denmark T, Crandall B, Grome A, Pappas J. Characterizing novice-expert differences in macrocognition: an exploratory study of cognitive work in the emergency department. Ann Emerg Med. 2013;61(1):96-109. [PubMed]
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