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Managing Multiplicity: Conceptualizing Physician Cognition in Multipatient Environments.

Teresa M Chan1, Mathew Mercuri, Kenneth Van Dewark

  • 1T.M. Chan is assistant professor, Division of Emergency Medicine, Department of Medicine, Michael G. DeGroote School of Medicine, program director, Clinician Educator Area of Focused Competence program, and adjunct scientist, McMaster Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada; ORCID: 0000-0001-6104-462X. M. Mercuri is assistant professor, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. K. Van Dewark is clinical instructor, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada. J. Sherbino is associate professor, Division of Emergency Medicine, Department of Medicine, Michael G. DeGroote School of Medicine, and assistant dean of education research, and director, McMaster Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada. A. Schwartz is Michael Reese Endowed Professor of Medical Education, associate head, Department of Medical Education, and research professor, Department of Pediatrics, College of Medicine, University of Illinois at Chicago; ORCID: 0000-0003-3809-6637. G. Norman is professor emeritus, Department of Clinical Epidemiology Biostatistics, and founding member, Program for Education Research and Development, and scientist, McMaster Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada. M. Lineberry is director, Simulation Research, Assessment, and Outcomes, Zamierowski Institute for Experiential Learning, and assistant professor, Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, Kansas.

Academic Medicine : Journal of the Association of American Medical Colleges
|December 7, 2017
PubMed
Summary

Emergency physicians (EPs) develop a three-step cognitive process for prioritizing multiple patients, with attendings creating more complex patient narratives than residents. This framework aids training for busy clinical environments.

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Area of Science:

  • Medical Education
  • Cognitive Science
  • Emergency Medicine

Background:

  • Emergency physicians (EPs) frequently manage multiple patients concurrently, necessitating rapid, time-sensitive prioritization decisions.
  • Cognitive processes underlying physician decision-making in multipatient scenarios remain underexplored.
  • Understanding these processes is crucial for optimizing care in high-acuity environments.

Purpose of the Study:

  • To develop a conceptual framework describing how emergency physicians think and prioritize care when managing multiple patients simultaneously.
  • To investigate the cognitive strategies employed by attending EPs and junior residents in busy, multipatient clinical settings.

Main Methods:

  • A qualitative study utilizing a think-aloud protocol with 10 attending EPs and 10 junior residents.
  • Participants engaged in five simulated multipatient scenarios.
  • Inductive analysis of transcribed interviews, with iterative coding by two independent coders, comparing attending and resident decision-making processes.

Main Results:

  • Both attending EPs and junior residents employed a similar three-component patient prioritization process: cohort overview for strategy, individual chart review for patient story construction, and relative priority list creation.
  • Attending physicians demonstrated a greater capacity for constructing deeper and more complex patient narratives compared to residents.
  • The cognitive task of prioritization was consistently applied across participants.

Conclusions:

  • A conceptual framework for emergency physician prioritization in multipatient environments is proposed.
  • This framework can inform educational strategies for training physicians to enhance efficiency in demanding clinical settings.
  • The findings highlight differences in cognitive complexity between attending and resident physicians in patient prioritization.