Exploration of expert decision making in emergency medicine

Lowe, David John (2020) Exploration of expert decision making in emergency medicine. MD thesis, University of Glasgow.

Abstract

The Emergency Department (ED) is a challenging environment to deliver high quality and safe care. Clinicians are continuously challenged by uncontrolled volume, uncertain acuity, limited information compounded by constant time pressure. Within this environment experts successfully navigate these challenges and resolve complexity. These highly calibrated clinicians have acquired procedural, technical and cognitive skills to predict, mitigate and resolve clinical problems for individual patients to multi-trauma resuscitations. Expert Decision Making in this domain remains opaque but exploring and understanding these tacit skills has the opportunity to bridge the novice to expert divide with appropriate educational interventions and improve safety and performance in the ED.

This thesis presents a series of three interlinked studies designed to explore expert decision making in Emergency Medicine (EM). This is supported by a narrative review of the literature relating to EM as a foundation, on which I then set out my epistemological stance and justify my selection of methods.

The first study examines the perspective of Foundation Doctors and the challenges they face working in the ED. Using an electronic survey their experience of clinical decision making, the opportunities to optimise their decision making by training and enhanced understanding of expert (Consultant) Decision making are explored.

The second study explores how expert decision makers based in three health boards describe their decision making using semi-structured interviews. Interpretative phenomenological analysis enables the cognitive constructs deployed by fifteen Consultants in EM to be explored.

The final study uses Video Reflexive Phenomenology as method to triangulate and refine the data developed during study 2. In this study ten consultants from the ED in the Royal Infirmary in Edinburgh select and then review a challenging clinical event.

I will then propose a model of Expert Decision Making that has been developed and refined during the course of the studies. The strengths and limitations, implications and finally recommendations for future study will then be shared.

• Item Type: Thesis (MD)
• Qualification Level: Postdoctoral
• Additional Information: Due to copyright issues this thesis is not available for viewing. Programme advisors: Gordon Ramage ; Marcello Pasquale Riggio.
• Keywords: Emergency medicine, decision making, expertise.
• Subjects: R Medicine > R Medicine (General)
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Supervisor's Name: Ker, Prof. Jean and Kinsella, Prof. John
• Date of Award: 2020
• Depositing User: Dr David J Lowe
• Unique ID: glathesis:2020-81516
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 03 Aug 2020 13:40
• Last Modified: 03 Aug 2020 13:40
• URI: https://theses.gla.ac.uk/id/eprint/81516

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