You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Using Simulation to Instruct Emergency Medicine Residents in Cognitive Forcing Strategies

Bond, William F. MD; Deitrick, Lynn M. RN, PhD; Arnold, Darryl C.; Kostenbader, Marianne RN; Barr, Gavin C. MD; Kimmel, Saron R. MHA, PhD; Worrilow, Charles C. MD

Academic Medicine:
Special Theme Research Report

Purpose. Recent literature defines certain cognitive errors that emergency physicians will likely encounter. The authors have utilized simulation and debriefing to teach the concepts of metacognition and error avoidance.

Method. The authors conducted a qualitative study of an educational intervention at Lehigh Valley Hospital during academic year 2002–03. Fifteen emergency medicine residents—eight from postgraduate year three (PGY3) and seven from postgraduate year two (PGY2)—experienced a difficult simulator lab scenario designed to lead them into a cognitive error trap. The debriefing was a PowerPoint with audio format CD-ROM with a didactic on succinylcholine (15 minutes) and cognitive forcing strategies (30 minutes). After debriefing, residents were interviewed by an ethnographer with an 11-question (15-minute) interview and completed an eight-question written survey.

Results. The residents ranked this experience second only to direct patient care for educational effectiveness. Survey results (Likert scale, 1 = disagree completely to 5 = agree completely) included “Improved my ability to use succinylcholine” (mean = 4.73), “Improved my ability to diagnose and treat hyperkalemia” (mean = 4.6), and “Cognitive forcing strategies is a useful educational effort” (mean = 4.33). The major interview themes that evolved were that the simulation lab was a positive experience; succinylcholine knowledge was gained; mistakes caused reflection/motivation; the lab was stressful; attending feedback was desired; the lab was realistic; and cognitive forcing strategies were discussed. When asked what they learned, more of the PGY3s commented on cognitive strategies or heuristic techniques (six out of eight), whereas the PGY2s commented on knowledge gained about succinylcholine (five out of seven) and only one PGY2 mentioned cognitive strategies.

Conclusion. Pilot data suggest that metacognitive strategies can be taught to residents, though they may be better understood by upper-level residents.

Author Information

Dr. Bond is clinical assistant professor of emergency medicine, Department of Emergency Medicine; Dr. Deitrick is medical anthropologist/ethnographer, Department of Community Health and Health Studies; Mr. Arnold is research assistant, Department of Community Health and Health Studies; Ms. Kostenbader is manager, George. E. Moerkirk Emergency Medicine Institute, Department of Emergency Medicine; Dr. Barr is clinical assistant professor of emergency medicine, Department of Emergency Medicine; Dr. Kimmel is senior research and evaluation scientist, Department of Community Health and Health Studies; and Dr. Worrilow is clinical assistant professor of emergency medicine, Department of Emergency Medicine, Lehigh Valley Hospital, Allentown, PA. All are at Lehigh Valley Hospital, Allentown, Pennsylvania. Dr. Bond, Ms. Deitrick, Dr. Barr, Dr. Kimmel, and Dr. Worrilow also have faculty appointments at Pennsylvania State University College of Medicine, Hershey, Pennsylvania.

Correspondence and requests for reprints should be addressed to William F Bond, MD, Lehigh Valley Hospital-Muhlenberg, 2545 Schoenersville Road, Bethlehem, PA 18017; telephone: 484-884-2888; fax: 484-884-2885; e-mail: 〈〉.

© 2004 Association of American Medical Colleges