Advances in Health Sciences Education, Jul 1, 2023
Preparing novice physicians for an unknown clinical future in healthcare is challenging. This is ... more Preparing novice physicians for an unknown clinical future in healthcare is challenging. This is especially true for emergency departments (EDs) where the framework of adaptive expertise has gained traction. When medical graduates start residency in the ED, they must be supported in becoming adaptive experts. However, little is known about how residents can be supported in developing this adaptive expertise. This was a cognitive ethnographic study conducted at two Danish EDs. The data comprised 80 h of observations of 27 residents treating 32 geriatric patients. The purpose of this cognitive ethnographic study was to describe contextual factors that mediate how residents engage in adaptive practices when treating geriatric patients in the ED. Results showed that all residents fluidly engaged in both adaptive and routine practices, but they were challenged when engaging in adaptive practices in the face of uncertainty. Uncertainty was often observed when residents' workflows were disrupted. Furthermore, results highlighted how residents construed professional identity and how this affected their ability to shift between routine and adaptive practices. Residents reported that they thought that they were expected to perform on par with their more experienced physician colleagues. This negatively impacted their ability to tolerate uncertainty and hindered the performance of adaptive practices. Thus, aligning clinical uncertainty with the premises of clinical work, is imperative for residents to develop adaptive expertise.
Background: Competency-based education has been shown to enhance clinical skills, improve patient... more Background: Competency-based education has been shown to enhance clinical skills, improve patient care, and reduce number of complications resulting in a better return on investments. Residents constitute an important workforce at many hospitals. Yet, the effect of training on residents' contribution to production in patient care is scarcely studied. This study evaluated the effects of early competency-based procedural training on residents' contribution to patient care in central venous catheterization and spinal and epidural anesthesia. Methods: The design was a non-randomized cohort study of first-year anesthesiology residents. The intervention group received additional early focused skills training while three control groups received traditional competencybased education. The residents' contributions to patient care were compared between the intervention group (n = 20), a historical control group (n = 19), and between a contemporary control group (n = 7) and a historical control group (n = 7) from different departments. The residents' vs specialists' procedural production share was compared between years within each study group. We calculated specialist time saved compared to the time spent providing additional skills training in the intervention group. Results: We found statistically significant increases in residents' vs specialists' share of total production after the intervention for epidural anesthesia: 2015: 0.51 (0.23, 0.70) to 2017: 0.94 (0.78, 1.05), p = 0.011 and central venous catheterization: 2015: 0.30 (0.23, 0.36) to 2016: 0.46 (0.35, 0.55), p = .008; and to 2017: 0.64 (0.50, 0.79), p = 0.008. Comparison between residents and specialists on production of the three procedures before and after the intervention showed a surplus of 21 h of freed specialist time per year. Conclusions: Early procedural training results in more productive residents and freed specialist time for additional supervision, other clinical tasks or research. This provides empirical support for a positive correlation between early focused training and increased independent production among residents.
Advances in Health Sciences Education, Nov 23, 2022
Background Residents must develop the knowledge and skills to handle an everchanging and demandin... more Background Residents must develop the knowledge and skills to handle an everchanging and demanding clinical workplace which requires a high degree of adaptability. To address this need, adaptive expertise has been suggested as an important framework for health professions education. However, research on the development of adaptive expertise has yet to explore how workplace supervision impacts residents'development. This study sought to investigate how clinical supervision might support the development of adaptive expertise. Methods The present study used a focused ethnography in two emergency departments. We observed 75 supervising situations with the 27 residents resulting in 116 pages of eld notes. The majority of supervision was provided by senior physicians, but also included other healthcare professionals. Results We found that supervision could serve two purposes: closure or discovery. Supervision aimed at discovery included practices that re ected instructional approaches said to promote adaptive expertise, such as productive struggle. Supervison aimed at closure included practices which re ected instructional approaches said to be important for e cient and safe patient care, such as verifying information. Our results suggest that supervision is a shared practice and responsibility. Conclusion We argue that setting and aligning expectations before engaging in supervision is important. Furthermore, results demonstrated that supervision aimed towards discovery was not signi cantly more time consuming, and a feasible mode of supervision in appropriate situations.
Constructing Virtual Environments for Visual Explorers
Springer eBooks, 2002
Note: OCR errors may be found in this Reference List extracted from the full text article. ACM ha... more Note: OCR errors may be found in this Reference List extracted from the full text article. ACM has opted to expose the complete List rather than only correct and linked references. ... Davis, EG and Swezey, RW (1983) Human factors guidelines in computer graphics: a ...
Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and... more Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has used dual-process theory to explain the cognitive processes involved in how physicians acquire experiences that help them develop CDM. However, less is known about how CDM is shaped by the physicians' situated cognition in the clinical environment. This is especially challenging for novice physicians, as they need to be adaptive to compensate for the lack of experience. The adaptive expert framework has been used to explain how novice physicians learn, but it has not yet been explored, how adaptive expertise is linked to clinical decision-making amongst novice physicians. This study aimed to analyse how residents utilize and develop adaptive expert cognition in a natural setting. By describing cognitive processes through verbalization of thought processes, we sought to explore their CDM strategies considering the adaptive expert framework. We used concurrent and retrospective think-aloud interviews in a natural setting of an emergency department (ED) at a university hospital, to query residents about their reasoning during a patient encounter. We analysed data using protocol analysis to map cognitive strategies from these verbalizations. Subsequently in a narrative analysis, we compared these strategies with the literature on adaptive expertise. Fourteen interviews were audio recorded over the course for 17 h of observation. We coded 78 informational concepts and 46 cognitive processes. The narrative analysis demonstrated how epistemic distance was prevalent in the initial CDM process and self-regulating processes occurred during hypothesis testing. However, residents who too quickly moved on to hypothesis testing tended to have to redirect their hypothesis more often, and thus be more laborious in their CDM. Uncertainty affected physicians' CDM when they did not reconcile their professional role with being allowed to be uncertain. This allowance is an important feature of orientation to new knowledge as it facilitates the evaluation of what the physician does not know. For the resident to learn to act as an adaptive decision-maker, she relied on contextual support. The professional role was crucial in decisional competency. This supports current literature, which argues that role clarification helps decisional competency. This study adds that promoting professional development by tolerating uncertainty may improve adaptive decisional competency.
In this article, we present a case study of residents' clinical experiences and communication in ... more In this article, we present a case study of residents' clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents' social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient conversations as participants who jointly produce and are produced by patients' and nurses' storylines about who should take responsibility for treatment.
Virtual Space : Spatiality in Virtual Inhabited 3D Worlds
... It thus extends the basic principles of psychological and linguistic space experi-ence presen... more ... It thus extends the basic principles of psychological and linguistic space experi-ence presented by ... While the shaping of virtual spaces of course provides additional possibilities and levels of ... not necessarily have to respect gravity, and in walking through the landscape the point ...
The semiosis of family conflict: A case study of home-based psychotherapy
Culture and Psychology, Mar 1, 2011
This is a case study of a blended family undergoing home-based psychotherapy. The study uses soci... more This is a case study of a blended family undergoing home-based psychotherapy. The study uses sociocultural theory (Vygotsky) and semiotic cultural psychology (Valsiner) in order to understand the appropriation and usage of signs as regulators of behavior. Furthermore, the article draws upon Foucault’s genealogical approach and Rose’s notion of Psydiscourse. It is argued that this approach is fruitful for understanding psychotherapy as a governing discourse that influences contemporary families. Technologies of the self, such as psychotherapy and signs like ‘time-out’ and ‘stop,’ are used by family members in attempts to break a cycle of conflict—violence but they also exacerbate negative emotions, which we see in the case of conflict. The article develops a critique of the practice of punishment and reward. By analyzing psychotherapy as signs and technologies of the self impacting family life, we start understanding the barriers to well-being in families and individual lives.
Computational Statistics & Data Analysis, Aug 1, 2003
The visual exploration of large databases raises a number of unresolved inference problems and ca... more The visual exploration of large databases raises a number of unresolved inference problems and calls for new interaction patterns between multiple disciplines-both at the conceptual and technical level. We present an approach that is based on the interaction of four disciplines: database systems, statistical analyses, perceptual and cognitive psychology, and scientific visualization. At the conceptual level we offer perceptual and cognitive insights to guide the information visualization process. We then choose cluster surfaces to exemplify the data mining process, to discuss the tasks involved, and to work out the interaction patterns.
In this case study of a Danish elite handball team, we explore team learning processes in order t... more In this case study of a Danish elite handball team, we explore team learning processes in order to examine to what extent team members’ development of expertise is a shared deliberate practice. By drawing from theoretical frameworks on expertise and deliberate practice (Ericsson, 2006) and team cognition (Salas, Fiore, and Letsky, 2012), we aim to answer what characterizes efficient and successful handball team training.The case study involved participant observation and interviews, and it included the female first team in a Danish handball club Randers HK. The team is amongst the best three teams in Denmark. In particular, the case studyfound that important factors for shared deliberate practice are concentration, feedback and role modeling. There are four theoretical findings. 1. Deliberate practice in team sport is a shared activity. 2. Both structured tactical training and match training are deliberate practices. 3. Concentration mediates team cognitive skills. 4. Feedback and r...
Tillid og team er blevet behandlet særdeles indgående i organisationslitteraturen, især som særsk... more Tillid og team er blevet behandlet særdeles indgående i organisationslitteraturen, især som særskilte emner. Denne artikel argumenterer for, at teamtillid kan defineres som et teams’ forventning om, at man kan placere noget værdifuld – ressourcer, helbred og i yderste konsekvens teamets eller individers overlevelse – i en anden parts varetægt. Hermed betones, at teamtillid er et refleksivt anliggende, hvor man løber en risiko i forhold til andre individer, grupper eller ting. Denne artikel undersøger tillid i arbejdsteam og beskriver fire dimensioner ved teamtillid: Fortrolighed, personlig tillid og systemtillid (Luhmann) samt psykologisk sikkerhed (Edmondson). Artiklen udvikler en matrix til analyse af disse fire forskellige dimensioner ved teamtillid på tre niveauer: Dyaden, intra-team og inter-team.
Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and... more Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has used dual-process theory to explain the cognitive processes involved in how physicians acquire experiences that help them develop CDM. However, less is known about how CDM is shaped by the physicians' situated cognition in the clinical environment. This is especially challenging for novice physicians, as they need to be adaptive to compensate for the lack of experience. The adaptive expert framework has been used to explain how novice physicians learn, but it has not yet been explored, how adaptive expertise is linked to clinical decision-making amongst novice physicians. This study aimed to analyse how residents utilize and develop adaptive expert cognition in a natural setting. By describing cognitive processes through verbalization of thought processes, we sought to explore their CDM strategies considering the adaptive expert framework. We used concurrent and retrospective think-aloud interviews in a natural setting of an emergency department (ED) at a university hospital, to query residents about their reasoning during a patient encounter. We analysed data using protocol analysis to map cognitive strategies from these verbalizations. Subsequently in a narrative analysis, we compared these strategies with the literature on adaptive expertise. Fourteen interviews were audio recorded over the course for 17 h of observation. We coded 78 informational concepts and 46 cognitive processes. The narrative analysis demonstrated how epistemic distance was prevalent in the initial CDM process and self-regulating processes occurred during hypothesis testing. However, residents who too quickly moved on to hypothesis testing tended to have to redirect their hypothesis more often, and thus be more laborious in their CDM. Uncertainty affected physicians' CDM when they did not reconcile their professional role with being allowed to be uncertain. This allowance is an important feature of orientation to new knowledge as it facilitates the evaluation of what the physician does not know. For the resident to learn to act as an adaptive decision-maker, she relied on contextual support. The professional role was crucial in decisional competency. This supports current literature, which argues that role clarification helps decisional competency. This study adds that promoting professional development by tolerating uncertainty may improve adaptive decisional competency.
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