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Updated: Sep 9, 2025
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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Using Video Ethnography and Stimulated Recall Interviews to Describe the Diagnostic Process in the Emergency
Milisa Manojlovich1, Caitlin Cassady2, Sarah J Parker2
1University of Michigan, School of Nursing, Ann Arbor, Michigan, USA.
Summary
Physicians
Area of Science:
- Medical education and cognitive science
- Human factors in healthcare
- Emergency medicine research
Background:
- Physician diagnostic processes are complex and difficult to study due to unobservable cognitive elements.
- Emergency departments (EDs) present unique challenges for diagnosis, including time pressure and information constraints.
- Understanding physician cognition is crucial for reducing diagnostic errors in fast-paced environments.
Purpose of the Study:
- To describe the evolution of the diagnostic process for clinicians in pediatric and adult emergency departments.
- To explore the cognitive and contextual factors influencing diagnosis in real-time ED settings.
Main Methods:
- A qualitative video ethnography study design was employed.
- 11 physicians wore head-mounted cameras during patient care in ED settings.
- Stimulated recall interviews were conducted to elicit physicians' thought processes during diagnosis.
Main Results:
- Four key themes emerged: communication quality, complex and distributed cognition, the role of artifacts, and balancing efficiency with safety.
- Quality communication was found to facilitate information flow.
- Cognition was observed to be complex and distributed among patients and the ED team.
- Artifacts can support the diagnostic process, and a balance between efficiency and safety is necessary.
Conclusions:
- Video ethnography with stimulated recall offers valuable insights into physicians' cognitive processes during diagnosis.
- This approach provides a foundation for identifying areas to improve diagnostic accuracy and patient safety in EDs.
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