- How do they make decisions?
- How do they get there?
This article studied macro-cognition differences between novices and experts in the Emergency Department.
What was the 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:
How would I apply this in teaching?
Specifically for junior trainees, I might:
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
The difference between learner and expert is a very rich and robust area of medical education and is perhaps nowhere better exemplified than in the works Surgical Intuition: What it is and how to get it and (especially) its companion book Surgical Scripts [Abernathy and Hamm].
ReplyDeleteIn the latter title are reproduced perhaps thirty [parallel] verbatim transcripts of case scenarios ("think-alouds") presented [separately] to experienced attending surgeons, PG5, PG3, and PG1 residents.
That is to say all were walked through the same case scenarios, their comments were recorded, transcribed and reproduced next to each other for the text.. and have been evaluated and annotated by the cognitive psychologist of the team [Hamm, PhD.] [Note coauthor Charles Abernathy, renowned surgeon and educator, is now deceased]
This little educational gem is not to be missed in my opinion - for a further quality I've not yet mentioned (for it's title says it:)
Except the concept of "surgical scripts" is too restrictive for us. We want "illness scripts"
Briefly: A "script" is a kind of mental shorthand for how expert physicians think about illness.
The typical script for acute appendicitis goes something like this:
Anorexia precedes dull periumbilical pain by 2-6 hours +/- some nausea. Over next 4-12 hrs pain increases and migrates to RLQ +/- f/c/n/v, etc.
These "scripts" are not necessarily overt constructs in learners minds (or in experts)...but they can be...
[Sorry about the extended comment. Obviously I get a little excited by this topic. You can find Surgical Scripts easily enough...Good luck with the parent volume (But Wow if you like SS!...)]
Agreed that illness scripts are a great way of differentiating different levels of learners. It's also a been a tool to help novice learners about how to clinically reason a problem. Here's a great review in Med Education by Charlin et al., who then took built on this framework to develop the "script concordance test". It's what I think will replace the standard multiple-choice testing model currently used. Thanks for your enthusiastic comment. I share your enthusiasm.
DeleteIllness Scripts
http://www.ncbi.nlm.nih.gov/pubmed/18045370
Script Concordance Test
http://www.ncbi.nlm.nih.gov/pubmed/22626047