Clinical Decision Making by Emergency Room Physicians and Residents

IntroductIon Clinical decision-making is a complex process that is reliant on accurate and timely information. Clinicians are dependent (or should be dependent) on massive amounts of information and knowledge to make decisions that are in the best interest of the patient. Increasingly, information technology (IT) solutions are being used as a knowledge transfer mechanism to ensure that clinicians have access to appropriate knowledge sources to support and facilitate medical decision-making. One particular class of IT in which the medical community is showing increased interest is clinical decision support systems (CDSSs). CDSS is " any program designed to help health-care professionals make clinical decisions " (Musen, Shahar & Shortliffe, 2001). Decision models used in CDSS, especially those providing patient management and diagnostic advice, are normally based on expert knowledge, either discovered from past data or elicited from medical books or practice guidelines. The quality of any patient-specific CDSS is reliant on the quality of the underlying decision model(s). These models have to reflect clinical expertise, which implies that clini-cians using such systems have to provide values for the CDSS input variables that can be correctly elicited only with an appropriate level of expertise. That is, only experienced clinicians will be able to provide CDSS input variables in a reliable and comprehensive manner, while inexperienced clinicians will be forced to gather information and make assessments for activities that they may lack the clinical acumen to do accurately. This may diminish the usefulness of the CDSS and the validity of the advice generated by the system, and lead to the rejection of the system by novice clinicians as forcing them to evaluate a patient in a way in which they are not accustomed. CDSS users can be categorized using the classical taxonomy of novice or expert decision-makers. Differences between these two classes of decision-makers have been widely documented in the decision-making and medical literature. In complex domains such as medicine, it typically takes 10 years of training before one can be considered an expert (Prietula & Simon, 1989). Over time, experts develop a capability to systematize information and to form complex networks of knowledge that is stored in long-term memory (Arocha, Wang & Patel, 2005; Prietula & Simon, 1989). Novices lack these knowledge networks, and thus, when faced with new informational cues, they need to produce more hypotheses than experts (Kushniruk, 2001) and are unable to filter out irrelevant cues (Patel, Arocha & …