The Adult Learner Emergency Medicine Gloria J. Kuhn, DO, Ph.D, FACEP Wayne State University USA

Rich Fund of Knowledge Didactic Medical School Medical School Residency Residency Career Career

Sparse Knowledge Experience Medical School Medical School Residency Residency Entire Career Entire Career

Experience Reorganization Reorganization Meaning to Information Meaning to Information Observation Observation Illness scripts Illness scripts Problem-solving Problem-solving

How Doctors Think Gather Information Gather Information

How Doctors Think Thinking Hypothetico-deductive reasoning Hypothetico-deductive reasoning Pattern matching (illness script) Pattern matching (illness script) Combination Combination

How Doctors Think Gather Information Gather Information Thinking Thinking Hypothetico-deductive reasoning Hypothetico-deductive reasoning Pattern matching Pattern matching Combination Combination Form hypothesis Form hypothesis Differential Diagnosis Differential Diagnosis

How Doctors Think Decision Decision Differential diagnosis Differential diagnosis

How Doctors Think Decision Decision Differential diagnosis Differential diagnosis Proof Proof Clinical exam Clinical exam Tests Tests

How Doctors Think Decision Decision Differential diagnosis Differential diagnosis Proof Proof Clinical exam Clinical exam Tests Tests Final / Working Diagnosis Final / Working Diagnosis

How Doctors Think Decision Decision Differential diagnosis Differential diagnosis Proof Proof Clinical exam Clinical exam Tests Tests Final / Working Diagnosis Final / Working Diagnosis Conclude Conclude Treat Treat

Emergency Physicians Gather Information Gather Information Gather Information

Emergency Physicians Gather Information Gather Information Gather Information Interrupt for Treatment

Emergency Physicians Gather Information Gather Information Decision Decision DD DD Gather Information Interrupt for Treatment Decisions on Incomplete data

Emergency Physicians Gather Information Gather Information Decision Decision DD DD Gather Information Interrupt for Treatment Decisions on Incomplete data Multitasking

Emergency Physicians Gather Information Gather Information Decision Decision DD DD Proof Proof Treat Treat Gather Information Interrupt for Treatment Decisions on Incomplete data Multitasking Loss of Orderly Progression Action in Face of Uncertainty

Teaching Emergency Medicine Variety of Patients Decision making in face of uncertainty Decision making in face of uncertainty Action Action Gather data Gather data

Teaching Emergency Medicine Variety of Patients Decision making in face of uncertainty Decision making in face of uncertainty Action Action Gather data Gather data Multi tasking Multi tasking Interruptions Interruptions

Teaching Emergency Medicine Variety of Patients Decision making in face of uncertainty Decision making in face of uncertainty Action Action Gather data Gather data Multi tasking Multi tasking Interruptions Interruptions Structure Structure

Teaching Emergency Medicine Variety of Patients Decision making in face of uncertainty Decision making in face of uncertainty Action Action Gather data Gather data Multi tasking Multi tasking Interruptions Interruptions Structure Structure Discussion Discussion

Novice Overwhelmed Overwhelmed

Novice Organization Structure

Novice Overwhelmed Overwhelmed Meaningless Data Meaningless Data Organization Structure

Novice Overwhelmed Overwhelmed Meaningless Data Meaningless Data Organization Structure Key Features Meaning of Data Illness Scripts

Novice Overwhelmed Overwhelmed Meaningless Data Meaningless Data Action / Data Action / Data Organization Structure Key Features Meaning of Data Illness Scripts Action / Data

Novice Overwhelmed Overwhelmed Meaningless Data Meaningless Data Action / Data Action / Data Organization Structure Key Features Meaning of Data Illness Scripts Action / Data Conclusion

Intermediate Paralysis Paralysis Fear of Mistakes Fear of Mistakes Consequences of Error Consequences of Error

Intermediate Paralysis Paralysis Fear of Mistakes Fear of Mistakes Consequences of Error Consequences of Error Autonomy / Support

Intermediate Paralysis Paralysis Fear of Mistakes Fear of Mistakes Consequences of Error Consequences of Error “Reckless” Actions “Reckless” Actions Autonomy / Support

Intermediate Paralysis Paralysis Fear of Mistakes Fear of Mistakes Consequences of Error Consequences of Error “Reckless” Actions “Reckless” Actions Autonomy / Support Verbal Discussion / Rehearsal

Summary Emergency Medicine Emergency Medicine Rich data base Rich data base Little experience Little experience Illness scripts Illness scripts Steps not Sequential Steps not Sequential Action Patterns Action Patterns

Summary Novice Novice Intermediate Intermediate