Description #
There are 2 components to knowing how to perform a procedure: 1) cognitive understanding of the procedure (i.e. indications, contraindications, complications, ordered steps) and 2) the psychomotor coordination and technical skill of performing the procedure itself. The unit will be organized into phases, moving from purely cognitive to progressively more psychomotor skill acquisition.
Phase1: Pre-course reading materials to include indications, contraindications, complications, ordered steps of each procedure.
Phase 2: Instructor demonstrates performance of the procedure. The learner then performs the procedure on a simulation model with supervision and feedback from the instructor.
Phase 3: Human Patient Simulator and Simman simulation scenarios. The learner must now manage the resuscitation of a critically ill patient in parallel with clinical decision-making, team leadership, and appropriate timing of the procedure during real-time patient encounters.
This unit focuses on Phase 3.
Learning Objectives #
At the end of this unit, learners should be able to lead the resuscitation of a critically ill patient in parallel with prioritization and performance of life-saving procedures.
Lecture on Demand #
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Article 1 #
The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them.
Croskerry, Pat, MD, PhD
Academic Medicine. 78(8):775-780, August 2003. In the area of patient safety, recent attention has focused on diagnostic error. The reduction of diagnostic error is an important goal because of its associated morbidity and potential preventability. A critical subset of diagnostic errors arises through cognitive errors, especially those associated with failures in perception, failed heuristics, and biases; collectively, these have been referred to as cognitive dispositions to respond (CDRs). Historically, models of decision-making have given insufficient attention to the contribution of such biases, and there has been a prevailing pessimism against improving cognitive performance through debiasing techniques. Recent work has catalogued the major cognitive biases in medicine; the author lists these and describes a number of strategies for reducing them (“cognitive debiasing”). Principle among them is metacognition, a reflective approach to problem solving that involves stepping back from the immediate problem to examine and reflect on the thinking process. Further research effort should be directed at a full and complete description and analysis of CDRs in the context of medicine and the development of techniques for avoiding their associated adverse outcomes. Considerable potential exists for reducing cognitive diagnostic errors with this approach. The author provides an extensive list of CDRs and a list of strategies to reduce diagnostic errors.
Article 2 #
Profiles in patient safety: A “perfect storm” in the emergency department.
Acad Emerg Med. 2007 Aug;14(8):743-9. Epub 2007 May 30.
Campbell SG, Croskerry P, Bond WF.
Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. emsgc@cdha.nshealth.ca
Correct and rapid diagnosis is pivotal to the practice of emergency medicine, yet the chaotic and ill-structured emergency department environment is fertile ground for the commission of diagnostic error. Errors may result from specific error-producing conditions (EPCs) or, more frequently, from an interaction between such conditions. These EPCs are often expedient and serve to shorten the decision making process in a high-pressure environment. Recognizing that they will inevitably exist, it is important for clinicians to understand and manage their dangers. The authors present a case of delayed diagnosis resulting from the interaction of a number of EPCs that produced a “perfect” situation to produce a missed or delayed diagnosis. They offer practical suggestions whereby clinicians may decrease their chances of becoming victims of these influences. PMID: 17538077 [PubMed – indexed for MEDLINE]
Article 3 #
Achieving quality in clinical decision making cognitive strategies and detection of bias.
Acad Emerg Med. 2002 Nov;9(11):1184-204.
Division of Emergency Medicine, Dalhousie University Medical School, Halifax, Nova Scotia Canada.
Clinical decision making is a cornerstone of high-quality care in emergency medicine. The density of decision making is unusually high in this unique milieu, and a combination of strategies has necessarily evolved to manage the load. In addition to the traditional hypothetico-deductive method, emergency physicians use several other approaches, principal among which are heuristics. These cognitive short-cutting strategies are especially adaptive under the time and resource limitations that prevail in many emergency departments (EDs), but occasionally they fail. When they do, we refer to them as cognitive errors. They are costly but highly preventable. It is important that emergency physicians be aware of the nature and extent of these heuristics and biases, or cognitive dispositions to respond (CDRs). Thirty are catalogued in this article, together with descriptions of their properties as well as the impact they have on clinical decision making in the ED. Strategies are delineated in each case, to minimize their occurrence. Detection and recognition of these cognitive phenomena are a first step in achieving cognitive de-biasing to improve clinical decision making in the ED.