TY - JOUR
T1 - Starting to Think Like an Expert
T2 - An Analysis of Resident Cognitive Processes During Simulation-Based Resuscitation Examinations
AU - Szulewski, Adam
AU - Braund, Heather
AU - Egan, Rylan
AU - Gegenfurtner, Andreas
AU - Hall, Andrew K.
AU - Howes, Daniel
AU - Dagnone, Damon
AU - van Merrienboer, Jeroen J. G.
N1 - Funding Information:
Author contributions: AS conceived the study, obtained research funding, and collected the data. AS, RE, AKH, DH, and DD designed the research protocol. All authors contributed to data analysis and interpretation. AS and HB drafted the article, and all authors contributed substantially to its revision. AS takes responsibility for the paper as a whole. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (seewww.icmje.org). This work was supported by a grant from the Kingston Resuscitation Institute.
Publisher Copyright:
© 2019 American College of Emergency Physicians
PY - 2019/11
Y1 - 2019/11
N2 - Study objective: Simulation is commonly used to teach crisis resource management skills and assess them in emergency medicine residents. However, our understanding of the cognitive processes underlying crisis resource management skills is limited because these processes are difficult to assess and describe. The objective of this study is to uncover and characterize the cognitive processes underlying crisis resource management skills and to describe how these processes vary between residents according to performance in a simulation-based examination.Methods: Twenty-two of 24 eligible emergency medicine trainees from 1 tertiary academic center completed 1 or 2 resuscitation-based examinations in the simulation laboratory. Resident performance was assessed by a blinded expert using an entrustment-based scoring tool. Participants wore eye-tracking glasses that generated first-person video that was used to augment subsequent interviews led by an emergency medicine faculty member. Interviews were audio recorded and then transcribed. An emergent thematic analysis was completed with a codebook that was developed by 4 research assistants, with subsequent analyses conducted by the lead research assistant with input from emergency medicine faculty. Themes from high- and low-performing residents were subsequently qualitatively compared.Results: Higher-performing residents were better able to anticipate, selectively attend to relevant information, and manage cognitive demands, and took a concurrent (as opposed to linear) approach to managing the simulated patient.Conclusion: The results provide new insights into residents' cognitive processes while managing simulated patients in an examination environment and how these processes vary with performance. More work is needed to determine how best to apply these findings to improve crisis resource management education.
AB - Study objective: Simulation is commonly used to teach crisis resource management skills and assess them in emergency medicine residents. However, our understanding of the cognitive processes underlying crisis resource management skills is limited because these processes are difficult to assess and describe. The objective of this study is to uncover and characterize the cognitive processes underlying crisis resource management skills and to describe how these processes vary between residents according to performance in a simulation-based examination.Methods: Twenty-two of 24 eligible emergency medicine trainees from 1 tertiary academic center completed 1 or 2 resuscitation-based examinations in the simulation laboratory. Resident performance was assessed by a blinded expert using an entrustment-based scoring tool. Participants wore eye-tracking glasses that generated first-person video that was used to augment subsequent interviews led by an emergency medicine faculty member. Interviews were audio recorded and then transcribed. An emergent thematic analysis was completed with a codebook that was developed by 4 research assistants, with subsequent analyses conducted by the lead research assistant with input from emergency medicine faculty. Themes from high- and low-performing residents were subsequently qualitatively compared.Results: Higher-performing residents were better able to anticipate, selectively attend to relevant information, and manage cognitive demands, and took a concurrent (as opposed to linear) approach to managing the simulated patient.Conclusion: The results provide new insights into residents' cognitive processes while managing simulated patients in an examination environment and how these processes vary with performance. More work is needed to determine how best to apply these findings to improve crisis resource management education.
KW - CRISIS-RESOURCE-MANAGEMENT
KW - EYE-TRACKING
KW - MEDICINE
KW - PERFORMANCE
U2 - 10.1016/j.annemergmed.2019.04.002
DO - 10.1016/j.annemergmed.2019.04.002
M3 - Article
C2 - 31080034
SN - 0196-0644
VL - 74
SP - 647
EP - 659
JO - Annals of Emergency Medicine
JF - Annals of Emergency Medicine
IS - 5
ER -