Morra Michael, Braund Heather, Hall Andrew K, Szulewski Adam
School of Medicine Queen's University Kingston Ontario Canada.
Office of Professional Development and Educational Scholarship Faculty of Health Sciences Faculty of Education Queen's University Kingston Ontario Canada.
AEM Educ Train. 2021 Aug 1;5(4):e10693. doi: 10.1002/aet2.10693. eCollection 2021 Aug.
In the emergency department (ED), chest radiographs (CXRs) provide essential information for clinical diagnostic reasoning. Errors in interpretation by emergency physicians can lead to negative patient outcomes. To aid in teaching this important skill, an understanding of cognitive processes and cognitive load (CL) in CXR interpretation in emergency medicine (EM) personnel is warranted.
This study adopted a concurrent mixed-methods research design. Participant groups included medical students (M), junior (J) and senior (S) EM residents, and attending emergency physicians (P) in the ED at an academic hospital. To elucidate cognitive processes, a real-time cognitive task analysis during CXR interpretation was performed. Interviews were audio recorded, transcribed verbatim, and analyzed thematically. The interview was followed by a questionnaire, where participants rated their CL, stress, and confidence level.
Levels of CL (M vs. S and M vs. P, p = 0.002; J vs. S, p= 0.004; J vs. P, p = 0.005) and stress (J vs. P, p = 0.002) decreased, while confidence levels increased (M vs. S, p = 0.006; J vs. S, p ≤ 0.001; J vs. P, p= 0.003) as experience level increased. Qualitative analysis of interviews revealed four themes: checking behavior, information reduction, pattern recognition versus systematic viewing, and recognizing scope of practice. Experts commonly utilized checking behavior (e.g., comparison to prior radiographs) and deprioritized task irrelevant data. Experts used a general overview technique as their initial approach as opposed to a systematic viewing approach, and they more readily recognized an EM physicians' scope of practice in this task.
This study characterized differences in cognition that led to increased CL, stress, and lower level of confidence in EM learners during CXR interpretation and provided insight into expertise development in this important skill.
在急诊科，胸部X光片（CXR）为临床诊断推理提供重要信息。急诊医生的解读错误可能导致患者出现不良后果。为了帮助教授这一重要技能，有必要了解急诊医学（EM）人员在解读CXR时的认知过程和认知负荷（CL）。
本研究采用了同步混合方法研究设计。参与组包括医学生（M）、初级（J）和高级（S）EM住院医师，以及一家学术医院急诊科的主治急诊医生（P）。为了阐明认知过程，在解读CXR期间进行了实时认知任务分析。访谈进行了录音，逐字转录，并进行了主题分析。访谈之后是一份问卷，参与者对他们的CL、压力和信心水平进行评分。
随着经验水平的提高，CL水平（M与S以及M与P，p = 0.002；J与S，p = 0.004；J与P，p = 0.005）和压力（J与P，p = 0.002）降低，而信心水平提高（M与S，p = 0.006；J与S，p≤0.001；J与P，p = 0.003）。访谈的定性分析揭示了四个主题：检查行为、信息简化、模式识别与系统观察，以及认识实践范围。专家通常采用检查行为（例如，与先前的X光片进行比较），并将与任务无关的数据降为次要。专家使用总体概述技术作为他们的初始方法，而不是系统观察方法，并且他们更能轻易地认识到急诊医生在这项任务中的实践范围。
本研究描述了在解读CXR期间导致EM学习者CL增加、压力增大和信心水平较低的认知差异，并为这一重要技能的专业发展提供了见解。
