Emergency physicians are likely to encounter certain cognitive errors everyday practice. We present a new approach to teaching metacognition and error avoidance in high fidelity simulation setting.
Methods:
12 emergency medicine residents (PGY3 n = 7, PGY2 n = 5) experienced a difficult simulator lab scenario designed to lead the residents into an error trap of giving succinylcholine to a hyperkalemic patient. Residents were debriefed for 5 minutes post lab on their individual performance. Part two of the debriefing consisted of a power point with audio format CDROM with information on the use of succinylcholine (15 min) and cognitive forcing strategies (30 min). After debriefing, residents were interviewed by an ethnographer and given a written survey.
Results:
Relative to other learning experiences, the residents ranked their simulation experience as tied for second place with grand rounds and other simulation labs. Only direct supervised patient care ranked higher. Residents reported little or no prior exposure to cognitive forcing strategies (mean response 1.57, SD0.79), with 1 = no exposure and 5 = extensive exposure. Interview data reveals differences between PGY3s and PGY2s, especially in their ability to explain the concept of cognitive forcing strategies or metacognition (5 PGY3s and 1 PGY2 were able). When asked what they learned, 6 PGY3s and 1 PGY2 commented on cognitive strategies or heuristic techniques. PGY2s focused on the knowledge gained about succinylcholine (3 of 5). Most residents agreed that experiencing an error was helpful (11 of 12) and all described the overall experience as positive.
Conclusion:
Preliminary data suggests that metacognitive strategies can be taught through simulation and debriefing, although it may best be taught at the senior resident level.