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

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

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

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

5. How Doctors Think Gather Information Gather Information

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

7. 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

8. How Doctors Think Decision Decision Differential diagnosis Differential diagnosis

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

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

11. 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

12. Emergency Physicians Gather Information Gather Information Gather Information

13. Emergency Physicians Gather Information Gather Information Gather Information Interrupt for Treatment

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

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

16. 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

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

18. 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

19. 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

20. 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

21. Novice Overwhelmed Overwhelmed

22. Novice Organization Structure

23. Novice Overwhelmed Overwhelmed Meaningless Data Meaningless Data Organization Structure

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

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

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

27. Intermediate Paralysis Paralysis Fear of Mistakes Fear of Mistakes Consequences of Error Consequences of Error

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

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

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

31. 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

32. Summary Novice Novice Intermediate Intermediate