A new study published in Annals of Emergency Medicine helps us better understand the differences between an expert clinician (practicing >5yrs) and 1st year emergency medicine (EM) residents.
Using interviews and qualitative methodology they examined participant responses to a variety of situations and incidents. They performed cognitive task analysis (fancy words for what someone actually does when faced with decisions & situations).
While they found there’s considerable differences between the two groups, they were able to summarize the findings:
- Experts are able to extract relevant information from a large collection of irrelevant data
- Experts focus on assessing the nature of the situation and NOT comparing various course of action (this leads to faster decision making)
- Experts can rapidly alter their diagnostic direction or treatment plan with new/unexpected information; novices are unwilling to accept new information if it disrupts their diagnosis or plan
- Novices rely heavily on objective data independent of the patient’s context
- Experts maintain high levels of spatial, temporal & organizational systems awareness; novices struggle with the “big picture”
What is important from this study is that we learn how novices & experts think. By simply accepting that once “novices” get smarter and more experienced that they’ll think like experts is doing a disservice to our trainees. We must impart early on the approach to thinking and diagnostic reasoning while acknowleding that factual information and experience will come with time.
The authors suggest that “targeted and frequent exposure to critical situations translates knowledge into expertise and bridges the expert-novice gap in clinical decisionmaking”.
We need more research in this field so that we can modify our educational approaches. We should be teaching trainees early on how to think like an expert.