Clinical decision-making and adaptive expertise in residency: a think-aloud study
Abstract Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has use...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12909-022-03990-8 |
| _version_ | 1797952486794854400 |
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| author | Maria Louise Gamborg Mimi Mehlsen Charlotte Paltved Sigrid Strunge Vetter Peter Musaeus |
| author_facet | Maria Louise Gamborg Mimi Mehlsen Charlotte Paltved Sigrid Strunge Vetter Peter Musaeus |
| author_sort | Maria Louise Gamborg |
| collection | DOAJ |
| description | Abstract Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has used dual-process theory to explain the cognitive processes involved in how physicians acquire experiences that help them develop CDM. However, less is known about how CDM is shaped by the physicians’ situated cognition in the clinical environment. This is especially challenging for novice physicians, as they need to be adaptive to compensate for the lack of experience. The adaptive expert framework has been used to explain how novice physicians learn, but it has not yet been explored, how adaptive expertise is linked to clinical decision-making amongst novice physicians. This study aimed to analyse how residents utilize and develop adaptive expert cognition in a natural setting. By describing cognitive processes through verbalization of thought processes, we sought to explore their CDM strategies considering the adaptive expert framework. We used concurrent and retrospective think-aloud interviews in a natural setting of an emergency department (ED) at a university hospital, to query residents about their reasoning during a patient encounter. We analysed data using protocol analysis to map cognitive strategies from these verbalizations. Subsequently in a narrative analysis, we compared these strategies with the literature on adaptive expertise. Fourteen interviews were audio recorded over the course for 17 h of observation. We coded 78 informational concepts and 46 cognitive processes. The narrative analysis demonstrated how epistemic distance was prevalent in the initial CDM process and self-regulating processes occurred during hypothesis testing. However, residents who too quickly moved on to hypothesis testing tended to have to redirect their hypothesis more often, and thus be more laborious in their CDM. Uncertainty affected physicians’ CDM when they did not reconcile their professional role with being allowed to be uncertain. This allowance is an important feature of orientation to new knowledge as it facilitates the evaluation of what the physician does not know. For the resident to learn to act as an adaptive decision-maker, she relied on contextual support. The professional role was crucial in decisional competency. This supports current literature, which argues that role clarification helps decisional competency. This study adds that promoting professional development by tolerating uncertainty may improve adaptive decisional competency. |
| first_indexed | 2024-04-10T22:47:07Z |
| format | Article |
| id | doaj.art-71134a65e9e14b89ad2433da24979a5c |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-04-10T22:47:07Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-71134a65e9e14b89ad2433da24979a5c2023-01-15T12:14:50ZengBMCBMC Medical Education1472-69202023-01-0123112010.1186/s12909-022-03990-8Clinical decision-making and adaptive expertise in residency: a think-aloud studyMaria Louise Gamborg0Mimi Mehlsen1Charlotte Paltved2Sigrid Strunge Vetter3Peter Musaeus4Centre for Educational Development, Aarhus UniversityDepartment of Psychology, Faculty of Business and Social Sciences, Aarhus UniversityCoporate HR MidtSim & Department of Clinical Medicine, Faculty of Health, Aarhus University, Central Denmark RegionDepartment of Psychology, Faculty of Business and Social Sciences, Aarhus UniversityCentre for Educational Development, Aarhus UniversityAbstract Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has used dual-process theory to explain the cognitive processes involved in how physicians acquire experiences that help them develop CDM. However, less is known about how CDM is shaped by the physicians’ situated cognition in the clinical environment. This is especially challenging for novice physicians, as they need to be adaptive to compensate for the lack of experience. The adaptive expert framework has been used to explain how novice physicians learn, but it has not yet been explored, how adaptive expertise is linked to clinical decision-making amongst novice physicians. This study aimed to analyse how residents utilize and develop adaptive expert cognition in a natural setting. By describing cognitive processes through verbalization of thought processes, we sought to explore their CDM strategies considering the adaptive expert framework. We used concurrent and retrospective think-aloud interviews in a natural setting of an emergency department (ED) at a university hospital, to query residents about their reasoning during a patient encounter. We analysed data using protocol analysis to map cognitive strategies from these verbalizations. Subsequently in a narrative analysis, we compared these strategies with the literature on adaptive expertise. Fourteen interviews were audio recorded over the course for 17 h of observation. We coded 78 informational concepts and 46 cognitive processes. The narrative analysis demonstrated how epistemic distance was prevalent in the initial CDM process and self-regulating processes occurred during hypothesis testing. However, residents who too quickly moved on to hypothesis testing tended to have to redirect their hypothesis more often, and thus be more laborious in their CDM. Uncertainty affected physicians’ CDM when they did not reconcile their professional role with being allowed to be uncertain. This allowance is an important feature of orientation to new knowledge as it facilitates the evaluation of what the physician does not know. For the resident to learn to act as an adaptive decision-maker, she relied on contextual support. The professional role was crucial in decisional competency. This supports current literature, which argues that role clarification helps decisional competency. This study adds that promoting professional development by tolerating uncertainty may improve adaptive decisional competency.https://doi.org/10.1186/s12909-022-03990-8Clinical decision-makingAdaptive expertiseResidentsElderly patientsEmergency medicine |
| spellingShingle | Maria Louise Gamborg Mimi Mehlsen Charlotte Paltved Sigrid Strunge Vetter Peter Musaeus Clinical decision-making and adaptive expertise in residency: a think-aloud study BMC Medical Education Clinical decision-making Adaptive expertise Residents Elderly patients Emergency medicine |
| title | Clinical decision-making and adaptive expertise in residency: a think-aloud study |
| title_full | Clinical decision-making and adaptive expertise in residency: a think-aloud study |
| title_fullStr | Clinical decision-making and adaptive expertise in residency: a think-aloud study |
| title_full_unstemmed | Clinical decision-making and adaptive expertise in residency: a think-aloud study |
| title_short | Clinical decision-making and adaptive expertise in residency: a think-aloud study |
| title_sort | clinical decision making and adaptive expertise in residency a think aloud study |
| topic | Clinical decision-making Adaptive expertise Residents Elderly patients Emergency medicine |
| url | https://doi.org/10.1186/s12909-022-03990-8 |
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