Question

compare and contrast the strengths and weaknesses of mixed methods reseaech for medical errors.

Answer 1

Ans) Role of cognition in diagnostic reasoning has been an area of interest in Emergency Medicine for over 15 years and is gaining attention in anesthesiology and critical care; however, examination of the use and validity of different decision pathways is in its infancy.

- Studies should be conducted to understand the cognitive processes used by skilled and seasoned physicians in critical care and to understand how stressors and other variables impact their performance. The latter will help overcome some of the questions raised from studies on students and early residents.

- Rather than regarding different strategies as either friend or foe, it may be more worthwhile starting with an open-ended approach to understand what differentiates high and low levels of performance. Exposure of a cohort of trainees to a standard of septic shock and development of a validated scoring tool revealed a wide range of technical and behavioral performances.imilar studies can be conducted with emphasis on evaluating what aspects of decision making underlie variations in performance.

- Creation of educational programs around the strategies associated with the best diagnostic performance will provide trainees with models of expertise and its nature at an earlier part of their training.

- The concentration of errors in critical care certainly mirrors the high burden of illness and number of interventions experienced by this population but also generates some questions of whether physician factors synergize with the patients’ states in a manner that amplifies risk and whether there are means by which this can be minimized. The face validity of the psychological concepts of judgment under uncertainty to critical care seems high; however, naturalistic studies to back up these assumptions are essential to any effort designed to improve patient safety in the ICU.