This month JC is looking for a few seasoned experts to assist us with understanding the processes of effective decision making in the context of a demanding ED environment. Having performed a mind-numbing literature review on the topic, it appears that a preponderance of research has been done in other decision-dense high-risk occupations such as firefighting, law enforcement and the military. That stated, EM cognitive researchers such as Wears and Croskerry  have been instrumental in advancing our understanding of cognitive reasoning and all of the vulnerabilities present in the unique context of the emergency department. 

Malcom Gladwell in his New Yorker article Complexity and the Ten Thousand Hour Rule suggests that a minimum of 10,000 hours is needed before attaining expertise. Interns, don't despair!  Although it may take some time to get to what Mr. Gladwell describes as an almost invariably correct first impression in his book Blink, we will attempt to provide you with some suggestions that will keep you out of trouble and help expedite  advancing your skill-set as a burgeoning EM expert. 

Another topic that we will be discussing, video ethnography, is pretty exciting and relatively new to EM . Technology has evolved and we are able to study complex decision making unobtrusively, in real-time and context. Cognitive researchers appear to be pretty enthusiastic about this type of qualitative research. The IHI has supported Kaiser Permanente's video ethnography initiatives and they have published data that suggests a favorable impact on patient care that you should review.

Croskerry P. ED cognition: any decision by anyone at any time. CJEM. 2014 Jan;16(1):13-9. 

Schubert CC et al Characterizing novice-expert differences in macrocognition: an exploratory study of cognitive work in the emergency department. Ann Emerg Med. 2013 Jan;61(1):96-109 

Pelaccia T et al From Context Comes Expertise: How Do Expert Emergency Physicians Use Their Know-Who to Make Decisions? Ann Emerg Med. 2016 Jun;747-51 (Wears, R Editorial Visualizing Expertise in Context)