Medical decision making edited
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The document discusses improving medical decision making training for students and residents. It proposes using simulations of common clinical situations to provide deliberate practice under pressure. Research showed trainees with more ICU experience made fewer errors in simulations. "War games" simulations improved performance for all groups to the level of experts after just three sessions. Critical incident interviews revealed experts primarily use recognition-primed decision making while novices rely more on trial and error. Mandatory simulations were proposed to evaluate basic competencies before residents treat patients independently.
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Medical decision making edited
- 1. Medical Decision Making Jeffrey Young, MD, FACS Professor of Surgery Director, UVA Trauma Center Chief Quality Officer University of Virginia Health System
- 8. Expertise
- 18. Proactive vs. Reactive: The Effect of Experience on Performance in a Critical Care Simulator Jeffrey S Young, MD, Robert L Smith, MD, Jayme B Stokes, MD and Chadrick E Denlinger, MD Presented, Association for Surgical Education, 2005 Published in the American Journal of Surgery, 193(1): 100-104, 2007.
- 21. Demographics * p<0.05 1Y 4.3±3.9 13.9±2.95* 24±5.7 3 GS, 1 EM 32±4.8 4 Expert (>10 weeks ICU experience) 2Y 5.1±2.0 5.4±3.6* 18.2±8.8 4 GS, 1 EM 28±1.6 5 N-I (0-10 weeks ICU experience) AOA Sleep in past 24 hours ICU Weeks Months of Postgraduate Education Residency Age N Group
- 22. Weeks of ICU Experience * p <0.05 # p =0.07 * p <0.05 # p =0.07 21.8±9.9* 3±2.7 3.2±1.3 0.75±0.96* 19.8±2.2# Expert (>10) 4±2.6* 4±2 3.2±1.6 5.6±3.5* 15.2±3.96# N-I (0-10) Proactive Steps Backward Reasoning Forward Reasoning Cognitive Errors Key Clinical Tasks ICU Weeks
- 23. Months of Residency All comparisons not significant . 9.25±6.4 4±2.9 3.3±0.95 1.75±2.2 17.25±3.9 >24 14±14.5 3.2±1.8 3.2±1.8 4.8±5 17.2±4.4 0-24 Proactive Steps Backward Reasoning Forward Reasoning Cognitive Errors Key Clinical Tasks Months Residency
- 25. War Games
- 28. PERFORMANCE OF STUDENTS AND RESIDENTS IN BASIC CLINICAL SCENARIOS: A DISTURBING ANALYSIS Journal of Trauma, 63(3): 556-564, September, 2007
- 35. USE OF “WAR GAMES” TO ENHANCE HIGH-RISK CLINICAL DECISION MAKING IN RESIDENTS AND STUDENTS American Journal of Surgery, June, 2008
- 48. Lessons learned
- 52. Thank you