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Exploring procedure-based management reasoning: a case of tension pneumothorax
Raj C Singaraju1, Steven J Durning1, Alexis Battista1
1Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Diagnosis (Berlin, Germany)
|August 4, 2022
Summary
Physicians
Area of Science:
- Medical Education
- Cognitive Science
- Clinical Reasoning
Background:
- Management reasoning is less explored than diagnostic reasoning.
- Understanding management reasoning can enhance medical education and patient care.
- This study explores procedure-based management reasoning.
Observation:
- Physicians managed a simulated patient with acute decompensation in a time-pressured scenario.
- A think-aloud protocol was used post-scenario for real-time reflection.
- Transcripts were analyzed using constant comparative method for thematic evaluation.
Findings:
- Management reasoning involves patient factors (acuity, preferences), physician factors (errors, anxiety, metacognition, monitoring, threshold to treat), and environmental factors (resources).
- Physicians consistently focused on prognosis, suggesting a need for planning and prediction skills in procedural management.
- Concerns about errors were noted, potentially linked to procedural focus and limited expertise.
Implications:
- Management reasoning is complex and context-dependent, aligning with Situation Awareness and Situated Cognition.
- Competency in procedural management may require enhanced planning and prediction abilities.
- Addressing physician concerns about errors is crucial for improving management reasoning training.
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