Pelaccia Thierry, Tardif Jacques, Triby Emmanuel, Charlin Bernard
Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France.
Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France.
Acad Emerg Med. 2017 Jul;24(7):785-795. doi: 10.1111/acem.13209. Epub 2017 Jun 12.
Making diagnostic and therapeutic decisions is a critical activity among physicians. It relies on the ability of physicians to use cognitive processes and specific knowledge in the context of a clinical reasoning. This ability is a core competency in physicians, especially in the field of emergency medicine where the rate of diagnostic errors is high. Studies that explore medical decision making in an authentic setting are increasing significantly. They are based on the use of qualitative methods that are applied at two separate times: 1) a video recording of the subject's actual activity in an authentic setting and 2) an interview with the subject, supported by the video recording. Traditionally, activity is recorded from an "external perspective"; i.e., a camera is positioned in the room in which the consultation takes place. This approach has many limits, both technical and with respect to the validity of the data collected.
The article aims at 1) describing how decision making is currently being studied, especially from a qualitative standpoint, and the reasons why new methods are needed, and 2) reporting how we used an original, innovative approach to study decision making in the field of emergency medicine and findings from these studies to guide further the use of this method. The method consists in recording the subject's activity from his own point of view, by fixing a microcamera on his temple or the branch of his glasses. An interview is then held on the basis of this recording, so that the subject being interviewed can relive the situation, to facilitate the explanation of his reasoning with respect to his decisions and actions.
We describe how this method has been used successfully in investigating medical decision making in emergency medicine. We provide details on how to use it optimally, taking into account the constraints associated with the practice of emergency medicine and the benefits in the study of clinical reasoning.
The "own-point-of-view" video technique is a promising method to study clinical decision making in emergency medicine. It is a powerful tool to stimulate recall and help physicians make their reasoning explicit, thanks to a greater psychological immersion.
做出诊断和治疗决策是医生的一项关键活动。这依赖于医生在临床推理过程中运用认知过程和特定知识的能力。这种能力是医生的核心能力，尤其是在诊断错误率较高的急诊医学领域。在真实场景中探索医疗决策的研究正在显著增加。这些研究基于定性方法的运用，该方法分两个不同阶段实施：1）对受试者在真实场景中的实际活动进行视频记录；2）在视频记录的辅助下对受试者进行访谈。传统上，活动是从“外部视角”进行记录的，即摄像机放置在进行会诊的房间内。这种方法在技术方面以及所收集数据的有效性方面都存在诸多局限。
本文旨在 1）描述当前如何研究决策制定，特别是从定性角度，以及为何需要新方法；2）报告我们如何采用一种原创、创新的方法来研究急诊医学领域的决策制定，以及这些研究的结果如何进一步指导该方法的应用。该方法包括通过将微型摄像机固定在受试者的太阳穴或眼镜腿上，从受试者自身的视角记录其活动。然后基于此记录进行访谈，以便接受访谈的受试者能够重温当时的情景，从而便于其解释关于自身决策和行动的推理过程。
我们描述了该方法如何成功用于调查急诊医学中的医疗决策制定。我们详细说明了如何在考虑到急诊医学实践相关限制以及临床推理研究中的益处的情况下，对其进行优化使用。
“自身视角”视频技术是研究急诊医学临床决策制定的一种有前景的方法。由于更强的心理沉浸感，它是激发回忆并帮助医生清晰阐述其推理过程的有力工具。
