Managing Multiplicity: Conceptualizing Physician Cognition in Multipatient Environments

Chan, Teresa M.; Mercuri, Mathew; Dewark, Kenneth Van; Sherbino, Jonathan; Schwartz, Alan; Norman, Geoff; Lineberry, Matthew

doi:10.1097/acm.0000000000002081

Cited by 19 publications

(8 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data also show similar results: as skill level increased, the number of patients discharged increased, representing a clear correlation of experience level and multi-patient care. This difference was less apparent among residents and attending physicians who likely demonstrate very similar approaches to multiple patients (Chan et al, 2018). It should be pointed out that multi-tasking -even when manifested in this serious game simulation -is actually task-switching (Skaugset et al, 2016); VitalSigns had a finite screen space and the game mechanic of only being able to view one patient at a time.…”

Section: Critical Thinking / Multi-tasking Measuresmentioning

confidence: 86%

“…Furthermore, the game employed a multiple choice option for diagnoses, instead of writing a diagnosis de novo, which may lead to a higher correct diagnosis rate (Chang et al, 2017). In addition, the literature on multi-patient environments by Chan et al have shown a similarity in patient approach among residents and experts, which consist of strategies that are quite alike in overall vision, individual patient review, and prioritization at the patient level (Chan et al, 2018). Given the similarity in strategy, it is likely that multi-patient approaches among the residents and attendings worked similarly with the patient portfolio developed to match a typical PED.…”

Section: Accuracy Measuresmentioning

confidence: 99%

“…There was no technical simultaneous care, rather parallel care. As prioritization is a skill in EM requiring experiential learning and apprenticeship to acquire (Chan et al, 2018), approaches to prioritization in care may appear different in the real setting where the task-switching occurs in different geographical locations besides on the screen.…”

Section: Critical Thinking / Multi-tasking Measuresmentioning

confidence: 99%

See 2 more Smart Citations

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

Luu

Talbot

Fung

et al. 2020

Simulation & Gaming

View full text Add to dashboard Cite

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

show abstract

Section: Critical Thinking / Multi-tasking Measuresmentioning

confidence: 86%

Section: Accuracy Measuresmentioning

confidence: 99%

Section: Critical Thinking / Multi-tasking Measuresmentioning

confidence: 99%

See 1 more Smart Citation

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

Luu

Talbot

Fung

et al. 2020

Simulation & Gaming

View full text Add to dashboard Cite

show abstract

“…Based on our secondary analyses, efficiency and accuracy within a simulated clinical setting appear to be intertwined. Chan et al notes that “multipatient management” is not simply multitasking, and that strategies to manage multiple patients in a game setting requires different skill domains (Chan et al, 2018, 2019). Our secondary analyses provide evidence for this assertion, as the efficiency metrics are quite related to the metrics requiring clinical knowledge and application.…”

Section: Discussionmentioning

confidence: 99%

“…Chan et al proposes that trainees require not just “managerial skills” but also the grasp on medical decision-making and case complexity . (Chan et al, 2017, 2018, 2019). Ledrick et al also note that raw multitasking plays a lesser factor than clinical experience among EM resident efficiency in an ED (2009).…”

Section: Discussionmentioning

confidence: 99%

The Association Between Multitasking and Multi-Patient Care Skills in a Simulated Patient Care Video Game Among Second Year Medical Students Based on Specialty Choice

Korand

Fung

Cohen

et al. 2022

Simulation & Gaming

View full text Add to dashboard Cite

Background and Objective Healthcare providers require multitasking and multi-patient care skills, and training programs do not formally incorporate curricula specifically for multitasking skills to trainees. The medical education community is in equipoise on whether multitasking ability is a fixed trait. Furthermore, it is unclear whether multitasking ability affects those who gravitate toward careers that demand it, particularly among medical students deciding on a specialty. We sought to define the association between specialty choice, multitasking abilities and multi-patient care delivery among pre-clinical medical students. For this study, we examined both efficiency and accuracy metrics within multitasking and whether they were different between students choosing specialties. Methods This was a planned cross-sectional sub-study focused on 2nd year medical students (MS-IIs) within a parent study evaluating multi-patient care skills using a serious game (VitalSigns:EDTM) depicting a pediatric emergency department. Subjects completed a Multitasking Ability Test (MTAT) and five VitalSigns:ED gameplays. The predictor variable was specialty choice, categorized into multitasking and non-multitasking groups. Outcome variables measuring efficiency and diagnostic accuracy were obtained from the MTAT and the game. The primary analysis was a Mann–Whitney U test, and secondary analyses employed Spearman Rank correlations. Results Twelve students applied to multitasking specialties and 18 applied to others. Those in the multitasking specialties had faster MTAT completions than the other cohort (29.8 vs. 59.7 sec, 95%CI difference -0.9 to -39.8 sec). Differential diagnoses were higher in multitasking specialties in VitalSigns:ED (2.03 vs. 1.06, 95%CI difference +0.05 to +1.54) but efficiency metrics in the game did not differ. Conclusion Multitasking and multi-patient care performance show some association with preferred specialty choices for MS-IIs prior to clinical exposure.

show abstract

Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department

Chan

Dewark²,

Sherbino

et al. 2018

AEM Education and Training

Self Cite

View full text Add to dashboard Cite

Background: Busy environments, like the emergency department (ED), require teachers to develop instructional strategies for coaching trainees to function within these same environments. Few studies have documented the strategies used by emergency physician (EP)-teachers within these busy, chaotic environments, instead emphasizing teaching in more predictable environments such as the outpatient clinic, hospital wards, or operating room. The authors sought to discover what strategies EP-teachers were using and what trainees recalled experiencing when learning to handle these unpredictable, overcrowded, complex, multipatient environments. Method: An interpretive description study was conducted at multiple teaching hospitals affiliated with McMaster University from July 2014 to May 2015. Participants (10 EP-teachers and 10 junior residents) were asked to recall teaching strategies related to handling ED patient flow. Participants were asked to describe techniques that they used, observed, or experienced as trainees. Two independent coders read through interview transcripts, analyzing these documents inductively and iteratively. Results: Two main types of strategies to teach ED management were discovered: 1) workplace-based methods, including both observation and in situ instruction; and 2) principle-based advice. The most often described techniques were workplace-based methods, which included a variety of in situ techniques ranging from conversations to managerial coaching (e.g., collaborative problem-solving of real-life administrative dilemmas). Conclusions: A mix of strategies are used to teach and coach trainees to handle multipatient environments. Further research is required to determine how to optimize the use of these techniques and innovate new strategies to support the learning of these crucial skills. E mergency department (ED) crowding is a persistent international phenomenon. 1,2 Concurrent management of multiple ill patients is a vital skill in emergency medicine (EM), especially given increasing ED patient volumes 3,4 and acuity. 5,6 Recently, research has led to a proposed conceptual framework for physicians' thinking in such complex multipatient environments; 7 however, there is little formal teaching or faculty development around these skills in EM. 4 With the advent of graduated responsibility models such as

show abstract

Managing Multiplicity: Conceptualizing Physician Cognition in Multipatient Environments

Abstract: The authors propose a conceptual framework for how EPs prioritize care for multiple patients in complex environments. This study may be useful to teachers who train physicians to function more efficiently in busy clinical environments.

Cited by 19 publications

References 45 publications

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

The Association Between Multitasking and Multi-Patient Care Skills in a Simulated Patient Care Video Game Among Second Year Medical Students Based on Specialty Choice

Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department

Contact Info

Product

Resources

About