Expert and competent non-expert visual cues during simulated diagnosis in intensive care

The aim of this study was to examine the information acquisition strategies of expert and competent non-expert intensive care physicians during two simulated diagnostic scenarios involving respiratory distress in an infant. Specifically, the information acquisition performance of six experts and 12 competent non-experts was examined using an eye-tracker during the initial 90 s of the assessment of the patient. The results indicated that, in comparison to competent non-experts, experts recorded longer mean fixations, irrespective of the scenario. When the dwell times were examined against specific areas of interest, the results revealed that competent non-experts recorded greater overall dwell times on the nurse, where experts recorded relatively greater dwell times on the head and face of the manikin. In the context of the scenarios, experts recorded differential dwell times, spending relatively more time on the head and face during the seizure scenario than during the coughing scenario. The differences evident between experts and competent non-experts were interpreted as evidence of the relative availability of task-specific cues or heuristics in memory that might direct the process of information acquisition amongst expert physicians. The implications are discussed for the training and assessment of diagnostic skills.

[1]  T. Gog,et al.  In the eyes of the beholder: How experts and novices interpret dynamic stimuli , 2010 .

[2]  Derek T. Y. Mann,et al.  Perceptual-cognitive expertise in sport: a meta-analysis. , 2007, Journal of sport & exercise psychology.

[3]  E. Brunswik.  Representative design and probabilistic theory in a functional psychology. , 1955, Psychological review.

[4]  Mark W. Wiggins,et al.  Cue-Utilisation Typologies and Pilots’ Pre-Flight and In-Flight Weather Decision-Making , 2014 .

[5]  Ben W. Morrison,et al.  Measuring Relative Cue Strength as a Means of Validating an Inventory of Expert Offender Profiling Cues , 2013 .

[6]  J. Shanteau.  Psychological characteristics and strategies of expert decision makers , 1988 .

[7]  P. Croskerry.  The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them , 2003, Academic medicine : journal of the Association of American Medical Colleges.

[8]  G. Dinant,et al.  Gut Feelings as a Third Track in General Practitioners’ Diagnostic Reasoning , 2010, Journal of General Internal Medicine.

[9]  Ben J. Searle,et al.  Cue Utilization and Broad Indicators of Workplace Expertise , 2014 .

[10]  Fernand Gobet,et al.  The Mechanism of the Einstellung (Set) Effect , 2010 .

[11]  Gary Klein,et al.  Naturalistic Decision Making , 2008, Hum. Factors.

[12]  Gerd Gigerenzer,et al.  Heuristic decision making in medicine , 2012, Dialogues in clinical neuroscience.

[13]  John Sweller,et al.  Cognitive Load During Problem Solving: Effects on Learning , 1988, Cogn. Sci..

[14]  R. Hamm.  Figure and ground in physician misdiagnosis: metacognition and diagnostic norms , 2014, Diagnosis.

[15]  D. Kahneman,et al.  Conditions for intuitive expertise: a failure to disagree. , 2009, The American psychologist.

[16]  Vimla L. Patel,et al.  Knowledge Based Solution Strategies in Medical Reasoning , 1986, Cogn. Sci..

[17]  K. A. Ericsson,et al.  Long-term working memory. , 1995, Psychological review.

[18]  John R. Anderson.  Acquisition of cognitive skill. , 1982 .

[19]  Peter J Pronovost,et al.  Reducing medical errors and adverse events. , 2012, Annual review of medicine.

[20]  Mark W. Wiggins,et al.  The role of cue utilisation and adaptive interface design in the management of skilled performance in operations control , 2014 .

[21]  Mark W. Wiggins.  Cue-based processing and human performance , 2006 .

[22]  Christine E. Earley.  Knowledge Acquisition in Auditing: Training Novice Auditors to Recognize Cue Relationships in Real Estate Valuation , 2001 .

[23]  Pat Croskerry,et al.  Clinical cognition and diagnostic error: applications of a dual process model of reasoning , 2009, Advances in health sciences education : theory and practice.

[24]  Thorsten Pachur,et al.  Memory-based Decision-making with Heuristics: Evidence for a Controlled Activation of Memory Representations , 2011, Journal of Cognitive Neuroscience.

[25]  Jonathan Sherbino,et al.  The Etiology of Diagnostic Errors: A Controlled Trial of System 1 Versus System 2 Reasoning , 2014, Academic medicine : journal of the Association of American Medical Colleges.

[26]  David O'Hare,et al.  Weatherwise: Evaluation of a Cue-Based Training Approach for the Recognition of Deteriorating Weather Conditions during Flight , 2003, Hum. Factors.

[27]  Pat Croskerry,et al.  Checklists to Reduce Diagnostic Errors , 2011, Academic medicine : journal of the Association of American Medical Colleges.

[28]  David O'Hare,et al.  An Objective Approach to Identifying Diagnostic Expertise Among Power System Controllers , 2013, Hum. Factors.

[29]  B. Abernethy,et al.  Anticipation in squash: differences in advance cue utilization between expert and novice players. , 1990, Journal of sports sciences.

[30]  Thomas Loveday,et al.  The Capability of Static and Dynamic Features to Distinguish Competent From Genuinely Expert Practitioners in Pediatric Diagnosis , 2013, Hum. Factors.

[31]  Vimla L. Patel,et al.  The general and specific nature of medical expertise: A critical look. , 1991 .

[32]  David O'Hare,et al.  Expertise in aeronautical weather-related decision making: A cross-sectional analysis of general aviation pilots , 1995 .

[33]  Pat Croskerry,et al.  A universal model of diagnostic reasoning. , 2009, Academic medicine : journal of the Association of American Medical Colleges.