expertExpert physicians: These are the ones who effortlessly handle a busy Emergency Department while juggling patient load, learners and consultants.

  • How do they make decisions?
  • How do they get there?

This article 1 studied macrocognition differences between novices and experts in the Emergency Department.

Study method

Qualitative study using semistructured interviews with novices (first year residents) and experts (more than 5 years in practice). Questions probe specifically for critical decision making cues.

What were the results?

Between the 5 novices and 6 experts, their differences are summarized:

Experts Novice
Encompassing View Maintain overview of department Difficuly integrating data from various sources
Sense-making Skills Recognize patterns and maintain an open frame Seek confirmation to fit diagnosis and have difficulty in gray zones
Anticipation Anticipate and mitigate potential problems Adhere to diagnosis too early and tightly
System Know and work around the system Do not know policies well
Manage time Can judge how long things take Lose track of time, particular in procedures
Communication Have developed skilled communication May struggle with communication

How would I apply this in teaching?

Specifically for junior trainees, I might:
  • Set time frame for procedures
  • Explain hospital policies
  • Discuss potentially difficult interactions beforehand
  • Ensure learners feel safe to ask questions
Schubert C, Denmark T, Crandall B, Grome A, Pappas J. Characterizing novice-expert differences in macrocognition: an exploratory study of cognitive work in the emergency department. Ann Emerg Med. 2013;61(1):96-109. [PubMed]
Stella Yiu, MD

Stella Yiu, MD

ALiEM Blog Contributor
Assistant Professor, University of Ottawa Staff Physician, The Ottawa Hospital
Stella Yiu, MD


Emergency physician and clinician educator in Ottawa, Canada. Own opinions. Go #FOAMed!