Using simulation to instruct emergency medicine residents in cognitive forcing strategies
Recent literature defines certain cognitive errors that emergency physicians will likely encounter. The authors have utilized simulation and debriefing to teach the concepts of metacognition and error avoidance. The authors conducted a qualitative study of an educational intervention at Lehigh Valle...
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| Veröffentlicht in: | Academic Medicine 2004-05, Vol.79 (5), p.438-446 |
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| creator | Bond, William F Deitrick, Lynn M Arnold, Darryl C Kostenbader, Marianne Barr, Gavin C Kimmel, Saron R Worrilow, Charles C |
| description | Recent literature defines certain cognitive errors that emergency physicians will likely encounter. The authors have utilized simulation and debriefing to teach the concepts of metacognition and error avoidance.
The authors conducted a qualitative study of an educational intervention at Lehigh Valley Hospital during academic year 2002-03. Fifteen emergency medicine residents--eight from postgraduate year three (PGY3) and seven from postgraduate year two (PGY2)--experienced a difficult simulator lab scenario designed to lead them into a cognitive error trap. The debriefing was a PowerPoint with audio format CD-ROM with a didactic on succinylcholine (15 minutes) and cognitive forcing strategies (30 minutes). After debriefing, residents were interviewed by an ethnographer with an 11-question (15-minute) interview and completed an eight-question written survey.
The residents ranked this experience second only to direct patient care for educational effectiveness. Survey results (Likert scale, 1 = disagree completely to 5 = agree completely) included "Improved my ability to use succinylcholine" (mean = 4.73), "Improved my ability to diagnose and treat hyperkalemia" (mean = 4.6), and "Cognitive forcing strategies is a useful educational effort" (mean = 4.33). The major interview themes that evolved were that the simulation lab was a positive experience; succinylcholine knowledge was gained; mistakes caused reflection/motivation; the lab was stressful; attending feedback was desired; the lab was realistic; and cognitive forcing strategies were discussed. When asked what they learned, more of the PGY3s commented on cognitive strategies or heuristic techniques (six out of eight), whereas the PGY2s commented on knowledge gained about succinylcholine (five out of seven) and only one PGY2 mentioned cognitive strategies.
Pilot data suggest that metacognitive strategies can be taught to residents, though they may be better understood by upper-level residents. |
| doi_str_mv | 10.1097/00001888-200405000-00014 |
| format | Article |
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The authors conducted a qualitative study of an educational intervention at Lehigh Valley Hospital during academic year 2002-03. Fifteen emergency medicine residents--eight from postgraduate year three (PGY3) and seven from postgraduate year two (PGY2)--experienced a difficult simulator lab scenario designed to lead them into a cognitive error trap. The debriefing was a PowerPoint with audio format CD-ROM with a didactic on succinylcholine (15 minutes) and cognitive forcing strategies (30 minutes). After debriefing, residents were interviewed by an ethnographer with an 11-question (15-minute) interview and completed an eight-question written survey.
The residents ranked this experience second only to direct patient care for educational effectiveness. Survey results (Likert scale, 1 = disagree completely to 5 = agree completely) included "Improved my ability to use succinylcholine" (mean = 4.73), "Improved my ability to diagnose and treat hyperkalemia" (mean = 4.6), and "Cognitive forcing strategies is a useful educational effort" (mean = 4.33). The major interview themes that evolved were that the simulation lab was a positive experience; succinylcholine knowledge was gained; mistakes caused reflection/motivation; the lab was stressful; attending feedback was desired; the lab was realistic; and cognitive forcing strategies were discussed. When asked what they learned, more of the PGY3s commented on cognitive strategies or heuristic techniques (six out of eight), whereas the PGY2s commented on knowledge gained about succinylcholine (five out of seven) and only one PGY2 mentioned cognitive strategies.
Pilot data suggest that metacognitive strategies can be taught to residents, though they may be better understood by upper-level residents.</description><identifier>ISSN: 1040-2446</identifier><identifier>DOI: 10.1097/00001888-200405000-00014</identifier><identifier>PMID: 15107283</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Educational Measurement - methods ; Emergency Medicine - education ; Female ; Humans ; Internship and Residency - methods ; Kidney Failure, Chronic - therapy ; Patient Simulation ; Pennsylvania ; Pilot Projects ; Problem Solving ; Qualitative Research ; Renal Dialysis - methods</subject><ispartof>Academic Medicine, 2004-05, Vol.79 (5), p.438-446</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-e91164102fcbc28eed4077c4353afd2d12d22a3ea495cb3fcb7ccb40187a179e3</citedby><cites>FETCH-LOGICAL-c361t-e91164102fcbc28eed4077c4353afd2d12d22a3ea495cb3fcb7ccb40187a179e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15107283$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bond, William F</creatorcontrib><creatorcontrib>Deitrick, Lynn M</creatorcontrib><creatorcontrib>Arnold, Darryl C</creatorcontrib><creatorcontrib>Kostenbader, Marianne</creatorcontrib><creatorcontrib>Barr, Gavin C</creatorcontrib><creatorcontrib>Kimmel, Saron R</creatorcontrib><creatorcontrib>Worrilow, Charles C</creatorcontrib><title>Using simulation to instruct emergency medicine residents in cognitive forcing strategies</title><title>Academic Medicine</title><addtitle>Acad Med</addtitle><description>Recent literature defines certain cognitive errors that emergency physicians will likely encounter. The authors have utilized simulation and debriefing to teach the concepts of metacognition and error avoidance.
The authors conducted a qualitative study of an educational intervention at Lehigh Valley Hospital during academic year 2002-03. Fifteen emergency medicine residents--eight from postgraduate year three (PGY3) and seven from postgraduate year two (PGY2)--experienced a difficult simulator lab scenario designed to lead them into a cognitive error trap. The debriefing was a PowerPoint with audio format CD-ROM with a didactic on succinylcholine (15 minutes) and cognitive forcing strategies (30 minutes). After debriefing, residents were interviewed by an ethnographer with an 11-question (15-minute) interview and completed an eight-question written survey.
The residents ranked this experience second only to direct patient care for educational effectiveness. Survey results (Likert scale, 1 = disagree completely to 5 = agree completely) included "Improved my ability to use succinylcholine" (mean = 4.73), "Improved my ability to diagnose and treat hyperkalemia" (mean = 4.6), and "Cognitive forcing strategies is a useful educational effort" (mean = 4.33). The major interview themes that evolved were that the simulation lab was a positive experience; succinylcholine knowledge was gained; mistakes caused reflection/motivation; the lab was stressful; attending feedback was desired; the lab was realistic; and cognitive forcing strategies were discussed. When asked what they learned, more of the PGY3s commented on cognitive strategies or heuristic techniques (six out of eight), whereas the PGY2s commented on knowledge gained about succinylcholine (five out of seven) and only one PGY2 mentioned cognitive strategies.
Pilot data suggest that metacognitive strategies can be taught to residents, though they may be better understood by upper-level residents.</description><subject>Aged</subject><subject>Educational Measurement - methods</subject><subject>Emergency Medicine - education</subject><subject>Female</subject><subject>Humans</subject><subject>Internship and Residency - methods</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Patient Simulation</subject><subject>Pennsylvania</subject><subject>Pilot Projects</subject><subject>Problem Solving</subject><subject>Qualitative Research</subject><subject>Renal Dialysis - methods</subject><issn>1040-2446</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkD1PwzAQhj2AaCn8BeSJLeCvxMmIKr6kSix0YLIc5xIZJU6xHaT-e9w2wC3WvXruTn4QwpTcUVLJe5KKlmWZMUIEyVOXHRJxhpY0BRkToligyxA-U1zInF-gBc0pkazkS_SxDdZ1ONhh6nW0o8NxxNaF6CcTMQzgO3BmjwdorLEOsIdgG3AxJAqbsXM22m_A7ejNcVH0OkJnIVyh81b3Aa7nd4W2T4_v65ds8_b8un7YZIYXNGZQUVoISlhrasNKgEYQKY3gOddtwxrKGsY0By2q3NQ8UdKYWqQvS01lBXyFbk97d378miBENdhgoO-1g3EKSiaSyrxMYHkCjR9D8NCqnbeD9ntFiTqoVL8q1Z9KdVSZRm_mG1OdTPwPzh75D0Gucuo</recordid><startdate>20040501</startdate><enddate>20040501</enddate><creator>Bond, William F</creator><creator>Deitrick, Lynn M</creator><creator>Arnold, Darryl C</creator><creator>Kostenbader, Marianne</creator><creator>Barr, Gavin C</creator><creator>Kimmel, Saron R</creator><creator>Worrilow, Charles C</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040501</creationdate><title>Using simulation to instruct emergency medicine residents in cognitive forcing strategies</title><author>Bond, William F ; Deitrick, Lynn M ; Arnold, Darryl C ; Kostenbader, Marianne ; Barr, Gavin C ; Kimmel, Saron R ; Worrilow, Charles C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-e91164102fcbc28eed4077c4353afd2d12d22a3ea495cb3fcb7ccb40187a179e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Aged</topic><topic>Educational Measurement - methods</topic><topic>Emergency Medicine - education</topic><topic>Female</topic><topic>Humans</topic><topic>Internship and Residency - methods</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Patient Simulation</topic><topic>Pennsylvania</topic><topic>Pilot Projects</topic><topic>Problem Solving</topic><topic>Qualitative Research</topic><topic>Renal Dialysis - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bond, William F</creatorcontrib><creatorcontrib>Deitrick, Lynn M</creatorcontrib><creatorcontrib>Arnold, Darryl C</creatorcontrib><creatorcontrib>Kostenbader, Marianne</creatorcontrib><creatorcontrib>Barr, Gavin C</creatorcontrib><creatorcontrib>Kimmel, Saron R</creatorcontrib><creatorcontrib>Worrilow, Charles C</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Academic Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bond, William F</au><au>Deitrick, Lynn M</au><au>Arnold, Darryl C</au><au>Kostenbader, Marianne</au><au>Barr, Gavin C</au><au>Kimmel, Saron R</au><au>Worrilow, Charles C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Using simulation to instruct emergency medicine residents in cognitive forcing strategies</atitle><jtitle>Academic Medicine</jtitle><addtitle>Acad Med</addtitle><date>2004-05-01</date><risdate>2004</risdate><volume>79</volume><issue>5</issue><spage>438</spage><epage>446</epage><pages>438-446</pages><issn>1040-2446</issn><abstract>Recent literature defines certain cognitive errors that emergency physicians will likely encounter. The authors have utilized simulation and debriefing to teach the concepts of metacognition and error avoidance.
The authors conducted a qualitative study of an educational intervention at Lehigh Valley Hospital during academic year 2002-03. Fifteen emergency medicine residents--eight from postgraduate year three (PGY3) and seven from postgraduate year two (PGY2)--experienced a difficult simulator lab scenario designed to lead them into a cognitive error trap. The debriefing was a PowerPoint with audio format CD-ROM with a didactic on succinylcholine (15 minutes) and cognitive forcing strategies (30 minutes). After debriefing, residents were interviewed by an ethnographer with an 11-question (15-minute) interview and completed an eight-question written survey.
The residents ranked this experience second only to direct patient care for educational effectiveness. Survey results (Likert scale, 1 = disagree completely to 5 = agree completely) included "Improved my ability to use succinylcholine" (mean = 4.73), "Improved my ability to diagnose and treat hyperkalemia" (mean = 4.6), and "Cognitive forcing strategies is a useful educational effort" (mean = 4.33). The major interview themes that evolved were that the simulation lab was a positive experience; succinylcholine knowledge was gained; mistakes caused reflection/motivation; the lab was stressful; attending feedback was desired; the lab was realistic; and cognitive forcing strategies were discussed. When asked what they learned, more of the PGY3s commented on cognitive strategies or heuristic techniques (six out of eight), whereas the PGY2s commented on knowledge gained about succinylcholine (five out of seven) and only one PGY2 mentioned cognitive strategies.
Pilot data suggest that metacognitive strategies can be taught to residents, though they may be better understood by upper-level residents.</abstract><cop>United States</cop><pmid>15107283</pmid><doi>10.1097/00001888-200405000-00014</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Educational Measurement - methods Emergency Medicine - education Female Humans Internship and Residency - methods Kidney Failure, Chronic - therapy Patient Simulation Pennsylvania Pilot Projects Problem Solving Qualitative Research Renal Dialysis - methods |
| title | Using simulation to instruct emergency medicine residents in cognitive forcing strategies |
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