The results highlight that longer time spent on reviewing information on the EHR is potentially associated with decreased ED throughput efficiency. Balancing these competing goals is often a challenge of physicians, and its implications for patient safety is discussed.

Physicians' perception of EHRs is likely to influence their practices. With negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.

We propose a model delineating the role of control, value, and cognitive disequilibrium in elementary students' experience of emotions during mathematics problem solving. We tested this model across 2 studies. In Study 1, using an explanatory mixed-methods design, 136 students from Grades 3 to 6 worked on a complex mathematics problem appropriate for their grade level. A think-aloud protocol was used to capture cognitive processes, and trend analyses were applied to students' transcriptions to assess convergence or divergence of the quantitative results and to provide a richer account of students' experiences. Results revealed that cognitive disequilibrium mediated relations between control and emotions but not value. In addition, curiosity and frustration predicted enactment and metacognitive strategies, which directly predicted mathematics problem-solving achievement. Trend analyses revealed that confusion following a failed attempt at impasse resolution led to frustration for 33% of the instances of a failed attempt. Interestingly, 35% of those instances resulted in students seeking help, and 32% resulted in students trying again or moving on. Additionally, trend analyses provided evidence that curiosity following surprise was a function of high resolution expectancy, whereas confusion following surprise was because of low resolution expectancy or high complexity. In Study 2, a new sample of 80 Grade 5 students completed a multiday complex mathematics problem and self-reported their emotions and cognitive appraisals of control and value (pretest and posttest). Results revealed reciprocal relations between control and curiosity and control and frustration. No reciprocal effects were found for value. Theoretical and practical implications are discussed. Educational Impact and Implications StatementImpasse-related emotions play a critical role in learning tasks, as they act as feedback to students for how well they are comprehending the content and progressing through the task. However, when these emotions are not fully understood, they can cause students to divert valuable cognitive resources away from the learning task, resulting in negative outcomes. Our research provides a useful model for how impasses, emotions, and learning strategies unfold during a learning task, and highlights potential targets for intervention during classroom learning.

Objectives We characterize physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) are explored within the context of organizational complexity for the delivery of care. Methods Two urban clinical sites, including an academic teaching ED, were selected. Fourteen physicians were recruited. Overall, 62 hours of direct clinical observations were conducted characterizing clinical activities (EHR use, team communication, and patient care). Data were analyzed using qualitative open-coding techniques and descriptive statistics. Timeline belts were used to represent temporal events. Results At site 1, physicians, engaged in more team communication, followed by direct patient care. Although physicians spent 61% of their clinical time at workstations, only 25% was spent on the EHR, primarily for clinical documentation and review. Site 2 physicians engaged primarily in direct patient care spending 52% of their time at a workstation, and 31% dedicated to EHRs, focused on chart review. At site 1, physicians showed nonlinear complex workflow patterns with a greater frequency of multitasking and interruptions, resulting in workflow fragmentation. In comparison, at site 2, a less complex environment with a unique patient assignment system, resulting in a more linear workflow pattern. Conclusion The nature of the clinical practice and EHR-mediated workflow reflects the ED work practices. Physicians in more complex organizations may be less efficient because of the fragmented workflow. However, these effects can be mitigated by effort distribution through team communication, which affords inherent safety checks.

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