title: How and when do expert emergency physicians generate and evaluate diagnostic hypotheses? A qualitative study using head-mounted video cued-recall interviews.
abstract: OBJECTIVE
  The ability to make a diagnosis is a crucial skill in emergency medicine. Little is known about the way emergency physicians reach a diagnosis. This study aims to identify how and when, during the initial patient examination, emergency physicians generate and evaluate diagnostic hypotheses.
  
  
  METHODS
  We carried out a qualitative research project based on semistructured interviews with emergency physicians. The interviews concerned management of an emergency situation during routine medical practice. They were associated with viewing the video recording of emergency situations filmed in an "own-point-of-view" perspective.
  
  
  RESULTS
  The emergency physicians generated an average of 5 diagnostic hypotheses. Most of these hypotheses were generated before meeting the patient or within the first 5 minutes of the meeting. The hypotheses were then rank ordered within the context of a verification procedure based on identifying key information. These tasks were usually accomplished without conscious effort. No hypothesis was completely confirmed or refuted until the results of investigations were available.
  
  
  CONCLUSIONS
  The generation and rank ordering of diagnostic hypotheses is based on the activation of cognitive processes, enabling expert emergency physicians to process environmental information and link it to past experiences. The physicians seemed to strive to avoid the risk of error by remaining aware of the possibility of alternative hypotheses as long as they did not have the results of investigations. Understanding the diagnostic process used by emergency physicians provides interesting ideas for training residents in a specialty in which the prevalence of reasoning errors leading to incorrect diagnoses is high.
authors.affiliation: Centre for Training and Research in Health Sciences Education (CFR-PS), Department of Medical Education, Faculty of Medicine, University of Strasbourg, Strasbourg, France; Prehospital Emergency Care Service (SAMU 67)-Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, Strasbourg, France. Electronic address: pelaccia@unistra.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Pelaccia
authors.affiliation: Department of Pedagogy, Faculty of Education, University of Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Tardif
authors.affiliation: Faculty of Educational Sciences, University of Strasbourg, Strasbourg, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Triby
authors.affiliation: Department of Emergency Medicine, Amiens University Hospital, Amiens, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Ammirati
authors.affiliation: Prehospital Emergency Care Service (SAMU 94), Henri-Mondor Hospital, Public Hospitals of Paris, Créteil, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bertrand
authors.affiliation: Institute of Health and Society (IRSS), Catholic University of Louvain, Brussels, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Dory
authors.affiliation: Centre of Pedagogy applied to Health Sciences (CPASS), Faculty of Medicine, University of Montreal, Montréal QC H3T 1J4, Québec, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Charlin
mesh_terms: D003937:Diagnosis, Differential; D004635:Emergency Medicine / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D036301:Qualitative Research; D014741:Video Recording