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:

Encompassing ViewMaintain overview of departmentDifficuly integrating data from various sources
Sense-making SkillsRecognize patterns and maintain an open frameSeek confirmation to fit diagnosis and have difficulty in gray zones
AnticipationAnticipate and mitigate potential problemsAdhere to diagnosis too early and tightly
SystemKnow and work around the systemDo not know policies well
Manage timeCan judge how long things takeLose track of time, particular in procedures
CommunicationHave developed skilled communicationMay 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!