Samost-Williams Aubrey, Thomas Eric J, Lounsbury Olivia, Tannenbaum Scott I, Salas Eduardo, Bell Sigall K
Anesthesiology, Critical Care, and Pain Medicine, 12340 The University of Texas Health Science Center at Houston , Houston, TX, USA.
Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Diagnosis (Berl). 2024 Oct 21;12(1):25-34. doi: 10.1515/dx-2024-0115. eCollection 2025 Feb 1.
The ambulatory diagnostic process is potentially complex, resulting in faulty communication, lost information, and a lack of team coordination. Patients and families have a unique position in the ambulatory diagnostic team, holding privileged information about their clinical conditions and serving as the connecting thread across multiple healthcare encounters. While experts advocate for engaging patients as diagnostic team members, operationalizing patient engagement has been challenging. The team science literature links improved team performance with shared mental models, a concept reflecting the team's commonly held knowledge about the tasks to be done and the expertise of each team member. Despite their proven potential to improve team performance and outcomes in other settings, shared mental models remain underexplored in healthcare. In this manuscript, we review the literature on shared mental models, applying that knowledge to the ambulatory diagnostic process. We consider the role of patients in the diagnostic team and adapt the five-factor model of shared mental models to develop a framework for patient-clinician diagnostic shared mental models. We conclude with research priorities. Development, maintenance, and use of shared mental models of the diagnostic process amongst patients, families, and clinicians may increase patient/family engagement, improve diagnostic team performance, and promote diagnostic safety.
门诊诊断过程可能很复杂，会导致沟通不畅、信息丢失以及团队协作不足。患者及其家属在门诊诊断团队中具有独特地位，掌握有关其临床状况的重要信息，并充当多次医疗接触之间的连接线。虽然专家主张让患者成为诊断团队成员，但实现患者参与却颇具挑战。团队科学文献将团队绩效的提升与共享心智模型联系起来，这一概念反映了团队对要完成的任务以及每个团队成员专业知识的共同认知。尽管共享心智模型在其他环境中已被证明具有提升团队绩效和成果的潜力，但在医疗保健领域仍未得到充分探索。在本手稿中，我们回顾了关于共享心智模型的文献，并将这些知识应用于门诊诊断过程。我们考虑了患者在诊断团队中的角色，并调整了共享心智模型的五因素模型，以构建患者 - 临床医生诊断共享心智模型的框架。最后我们提出了研究重点。患者、家属和临床医生之间诊断过程共享心智模型的开发、维护和使用可能会提高患者/家属的参与度，改善诊断团队绩效，并促进诊断安全。
