Skip to main content
Top
Published in: International Journal of Emergency Medicine 1/2020

Open Access 01-12-2020 | Emergency Medicine | Educational advances in emergency medicine

How to think like an emergency care provider: a conceptual mental model for decision making in emergency care

Author: Nasser Hammad Al-Azri

Published in: International Journal of Emergency Medicine | Issue 1/2020

Login to get access

Abstract

Background

General medicine commonly adopts a strategy based on the analytic approach utilizing the hypothetico-deductive method. Medical emergency care and education have been following similarly the same approach. However, the unique milieu and task complexity in emergency care settings pose a challenge to the analytic approach, particularly when confronted with a critically ill patient who requires immediate action. Despite having discussions in the literature addressing the unique characteristics of medical emergency care settings, there has been hardly any alternative structured mental model proposed to overcome those challenges.

Methods

This paper attempts to address a conceptual mental model for emergency care that combines both analytic as well as non-analytic methods in decision making.

Results

The proposed model is organized in an alphabetical mnemonic, A–H. The proposed model includes eight steps for approaching emergency cases, viz., awareness, basic supportive measures, control of potential threats, diagnostics, emergency care, follow-up, groups of particular interest, and highlights. These steps might be utilized to organize and prioritize the management of emergency patients.

Discussion

Metacognition is very important to develop practicable mental models in practice. The proposed model is flexible and takes into consideration the dynamicity of emergency cases. It also combines both analytic and non-analytic skills in medical education and practice.

Conclusion

Combining various clinical reasoning provides better opportunity, particularly for trainees and novices, to develop their experience and learn new skills. This mental model could be also of help for seasoned practitioners in their teaching, audits, and review of emergency cases.
Literature
1.
go back to reference Wears RL. Introduction: the approach to the emergency department patient. In: Wolfson AB, Hendey GW, Hendry PL, et. al. (eds). Harwood-Nuss’ Clinical Practice of Emergency Medicine. 4th edition. Lippincott Williams & Wilkins. 2005. Wears RL. Introduction: the approach to the emergency department patient. In: Wolfson AB, Hendey GW, Hendry PL, et. al. (eds). Harwood-Nuss’ Clinical Practice of Emergency Medicine. 4th edition. Lippincott Williams & Wilkins. 2005.
2.
go back to reference Groopman J. How doctors think. Boston: Houghton Mifflin Company; 2007. Groopman J. How doctors think. Boston: Houghton Mifflin Company; 2007.
3.
go back to reference Geary U, Kennedy U. Clinical decision making in emergency medicine. Emergencias. 2010;22:56–60. Geary U, Kennedy U. Clinical decision making in emergency medicine. Emergencias. 2010;22:56–60.
4.
go back to reference Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med. 2002;9(11):1184–204.CrossRef Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med. 2002;9(11):1184–204.CrossRef
5.
go back to reference Stiell A, Forster AJ, Stiell IG, et al. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ. 2003;169(10):1023–8.PubMedPubMedCentral Stiell A, Forster AJ, Stiell IG, et al. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ. 2003;169(10):1023–8.PubMedPubMedCentral
6.
go back to reference Kovacs G, Croskerry P. Clinical decision making: an emergency medicine perspective. Acad Emergency Med. 1999;6(9):947–52.CrossRef Kovacs G, Croskerry P. Clinical decision making: an emergency medicine perspective. Acad Emergency Med. 1999;6(9):947–52.CrossRef
7.
go back to reference Burns K. Mental models and normal errors. In: Montgomery H, Lipshitz R, Brehmer B, editors. How Professionals Make Decisions. New Jersey: Lawrence Erlbaum Associates; 2005. Burns K. Mental models and normal errors. In: Montgomery H, Lipshitz R, Brehmer B, editors. How Professionals Make Decisions. New Jersey: Lawrence Erlbaum Associates; 2005.
8.
go back to reference Gambrill E. Critical Thinking in clinical practice: improving the quality of judgments and decisions. 2nd ed. New Jersey: Wiley & Sons; 2005. Gambrill E. Critical Thinking in clinical practice: improving the quality of judgments and decisions. 2nd ed. New Jersey: Wiley & Sons; 2005.
9.
go back to reference Elstein AS, Schwarz A. Clinical problem solving and diagnostic decision making: selective review of the cognitive literature. BMJ. 2002;324:729–32.CrossRef Elstein AS, Schwarz A. Clinical problem solving and diagnostic decision making: selective review of the cognitive literature. BMJ. 2002;324:729–32.CrossRef
10.
go back to reference Croskerry P. Critical thinking and decisionmaking: avoiding the perils of thin-slicing. Ann Emergency Med. 2006;48(6):720–2.CrossRef Croskerry P. Critical thinking and decisionmaking: avoiding the perils of thin-slicing. Ann Emergency Med. 2006;48(6):720–2.CrossRef
11.
go back to reference Xiao Y, Hunter WA, Mackenzie CF, Jefferies NJ. Task complexity in emergency medical care and its implications for team coordination. Hum Factors. 1996;38(4):636–45.CrossRef Xiao Y, Hunter WA, Mackenzie CF, Jefferies NJ. Task complexity in emergency medical care and its implications for team coordination. Hum Factors. 1996;38(4):636–45.CrossRef
12.
go back to reference Dailey RH. Approach to the patient in the emergency department. In: Rosen P, editor. Emergency medicine: concepts and clinical practice. St. Louis: Mosby; 2010. p. 137–50. Dailey RH. Approach to the patient in the emergency department. In: Rosen P, editor. Emergency medicine: concepts and clinical practice. St. Louis: Mosby; 2010. p. 137–50.
13.
go back to reference Lockey AS, Hardern RD. Decision making by emergency physicians when assessing cardiac arrest patients on arrival to hospital. Resuscitation. 2001;50(1):51–6.CrossRef Lockey AS, Hardern RD. Decision making by emergency physicians when assessing cardiac arrest patients on arrival to hospital. Resuscitation. 2001;50(1):51–6.CrossRef
14.
go back to reference Endsley MR. Design and evaluation for situation awareness enhancement. In: Proceedings of the Human Factors Society 32nd Annual Meeting. Santa Monica, CA: Human factors Society; 1998. p. 97–101. Endsley MR. Design and evaluation for situation awareness enhancement. In: Proceedings of the Human Factors Society 32nd Annual Meeting. Santa Monica, CA: Human factors Society; 1998. p. 97–101.
15.
go back to reference Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care. 2004;13(Suppl 1):i80–4.CrossRef Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care. 2004;13(Suppl 1):i80–4.CrossRef
16.
go back to reference McIlvaine WB. Situational awareness in the operating room: a primer for the anesthesiologist. Seminars Anesthesia Perioperative Med Pain. 2007;26:167–72.CrossRef McIlvaine WB. Situational awareness in the operating room: a primer for the anesthesiologist. Seminars Anesthesia Perioperative Med Pain. 2007;26:167–72.CrossRef
17.
go back to reference Wright MC, Taekman JM, Endsley MR. Objective measures of situation awareness in a simulated medical environment. Qual Saf Health Care. 2004;13(Suppl 1):i65–71.CrossRef Wright MC, Taekman JM, Endsley MR. Objective measures of situation awareness in a simulated medical environment. Qual Saf Health Care. 2004;13(Suppl 1):i65–71.CrossRef
18.
go back to reference Croskerry P. Cognitive forcing strategies in clinical decisionmaking. Annals of Emergency Medicine. 2003;41(1):110–20.CrossRef Croskerry P. Cognitive forcing strategies in clinical decisionmaking. Annals of Emergency Medicine. 2003;41(1):110–20.CrossRef
19.
go back to reference Bond S, Cooper S. Modelling emergency decisions: recognition-primed decision making. The literature in relation to an ophthalmic critical incident. J Clin Nurs. 2006;15:1023–32.CrossRef Bond S, Cooper S. Modelling emergency decisions: recognition-primed decision making. The literature in relation to an ophthalmic critical incident. J Clin Nurs. 2006;15:1023–32.CrossRef
20.
go back to reference Sandhu H, Carpenter C. Clinical decisionmaking: opening the black box of cognitive reasoning. Ann Emerg Med. 2006;48(6):713–9.CrossRef Sandhu H, Carpenter C. Clinical decisionmaking: opening the black box of cognitive reasoning. Ann Emerg Med. 2006;48(6):713–9.CrossRef
21.
go back to reference Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Edu. 2007;41(12):1140–5. Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Edu. 2007;41(12):1140–5.
22.
go back to reference Sklar DP, Hauswald M, Johnson DR. Medical problem solving and uncertainty in the emergency department. Ann Emerg Med. 1991;20(9):987–91.CrossRef Sklar DP, Hauswald M, Johnson DR. Medical problem solving and uncertainty in the emergency department. Ann Emerg Med. 1991;20(9):987–91.CrossRef
23.
go back to reference Szolovits P, Pauker S. Categorical and probabilistic reasoning in medical diagnosis. Artif Intell. 1978;11:115–44.CrossRef Szolovits P, Pauker S. Categorical and probabilistic reasoning in medical diagnosis. Artif Intell. 1978;11:115–44.CrossRef
24.
go back to reference Mattu A, Goyal D. Emergency medicine: avoiding the pitfalls and improving the outcomes. Massachusetts: Blackwell Publishing; 2007.CrossRef Mattu A, Goyal D. Emergency medicine: avoiding the pitfalls and improving the outcomes. Massachusetts: Blackwell Publishing; 2007.CrossRef
25.
go back to reference Frank LR, Jobe KA. Admission & discharge decisions in emergency medicine. Philadelphia: Hanley & Belfus; 2001. Frank LR, Jobe KA. Admission & discharge decisions in emergency medicine. Philadelphia: Hanley & Belfus; 2001.
26.
go back to reference Croskerry P, Campbell S, Forster AJ. Discharging safely from the emergency department. In Croskerry P. Patient safety in emergency medicine. Philadelphia: Wolters Kluwer; 2009. Croskerry P, Campbell S, Forster AJ. Discharging safely from the emergency department. In Croskerry P. Patient safety in emergency medicine. Philadelphia: Wolters Kluwer; 2009.
27.
go back to reference Garmel GM. Approach to the emergency patient. In: Mahadevan SV, Garmel GM, editors. An introduction to clinical emergency medicine. Cambridge: Cambridge University Press; 2005. Garmel GM. Approach to the emergency patient. In: Mahadevan SV, Garmel GM, editors. An introduction to clinical emergency medicine. Cambridge: Cambridge University Press; 2005.
28.
go back to reference Croskerry P, Sinclair D. Emergency medicine: a practice prone to error? CJEM. 2001;3(4):271–6.CrossRef Croskerry P, Sinclair D. Emergency medicine: a practice prone to error? CJEM. 2001;3(4):271–6.CrossRef
29.
go back to reference Wald DA, Choo EK. Providing feedback in the emergency department. In: Rogers RL, Mattu A, Winters M, Martinez J, editors. Practical teaching in emergency medicine. West Sussex: Wiley-Blackwell; 2009. p. 60–71.CrossRef Wald DA, Choo EK. Providing feedback in the emergency department. In: Rogers RL, Mattu A, Winters M, Martinez J, editors. Practical teaching in emergency medicine. West Sussex: Wiley-Blackwell; 2009. p. 60–71.CrossRef
30.
go back to reference Ark TK, Brooks LR, Eva KW. Giving learners the best of both worlds: do clinical teachers need to guard against teaching pattern recognition to novices? Acad Med. 2006;81(4):405–9.CrossRef Ark TK, Brooks LR, Eva KW. Giving learners the best of both worlds: do clinical teachers need to guard against teaching pattern recognition to novices? Acad Med. 2006;81(4):405–9.CrossRef
31.
go back to reference Eva KW, Hatala RM, Leblanc VR, et al. Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information. Med Educ. 2007;41(12):1152–8.CrossRef Eva KW, Hatala RM, Leblanc VR, et al. Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information. Med Educ. 2007;41(12):1152–8.CrossRef
32.
go back to reference Snowden DJ, Boone ME. A leader’s framework for decision making. Harv Bus Rev. 2007;85(1):68–76.PubMed Snowden DJ, Boone ME. A leader’s framework for decision making. Harv Bus Rev. 2007;85(1):68–76.PubMed
33.
go back to reference Burdick WP. Emergency medicine’s role in the education of medical students: directions for change. Ann Emerg Med. 1991;20(6):688–91.CrossRef Burdick WP. Emergency medicine’s role in the education of medical students: directions for change. Ann Emerg Med. 1991;20(6):688–91.CrossRef
Metadata
Title
How to think like an emergency care provider: a conceptual mental model for decision making in emergency care
Author
Nasser Hammad Al-Azri
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 1/2020
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1186/s12245-020-00274-0

Other articles of this Issue 1/2020

International Journal of Emergency Medicine 1/2020 Go to the issue