title: Insights into emergency physicians' minds in the seconds before and into a patient encounter.
abstract: Clinical reasoning is a core competency in medical practice. No study has explored clinical reasoning occurring before a clinical encounter, when physicians obtain preliminary information about the patient, and during the first seconds of the observation phase. This paper aims to understand what happens in emergency physicians' minds when they acquire initial information about a patient, and when they first meet a patient. The authors carried out in-depth interviews based on the video recordings of emergency situations filmed in an "own-point-of-view-perspective". 15 expert emergency physicians were interviewed between 2011 and 2012. Researchers analysed data using an interpretive approach based on thematic analysis and constant comparison. Almost all participants used a few critical pieces of information to generate hypotheses even before they actually met the patient. Pre-encounter hypotheses played a key role in the ensuing encounter by directing initial data gathering. Initial data, collected within the first few seconds of the encounter, included the patient's position on the stretcher, the way they had been prepared, their facial expression, their breathing, and their skin colour. Physicians also rapidly appraised the seriousness of the patient's overall condition, which determined their initial goals, i.e. initiating emergency treatment or pursuing the diagnostic investigation. The study brings new insights on what happens at the very beginning of the encounter between emergency physicians and patients. The results obtained from an innovative methodological approach open avenues for the development of clinical reasoning in learners.
authors.affiliation: Faculty of Medicine, Centre for Training and Research in Health Sciences Education (CFR-PS), University of Strasbourg, 67000, Strasbourg, France. pelaccia@unistra.fr.|Prehospital Emergency Care Service (SAMU 67), Centre for Emergency Care Teaching (CESU 67), Strasbourg University Hospital, PO Box 426, 67200, Strasbourg, France. pelaccia@unistra.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Pelaccia
authors.affiliation: Department of Pedagogy, Faculty of Education, University of Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada. jacques.tardif@usherbrooke.ca.
authors.forename: Jacques
authors.initials: J
authors.lastname: Tardif
authors.affiliation: Faculty of Educational Sciences, University of Strasbourg, 67000, Strasbourg, France. triby@unistra.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Triby
authors.affiliation: Department of Emergency Medicine, Amiens University Hospital, 80054, Amiens, France. christine.ammirati@chu-amiens.fr.
authors.forename: Christine
authors.initials: C
authors.lastname: Ammirati
authors.affiliation: Prehospital Emergency Care Service (SAMU 94), Henri-Mondor Hospital, Public Hospitals of Paris, 94000, Créteil, France. catherine.bertrand2@aphp.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bertrand
authors.affiliation: Faculty of Medicine, Centre of Pedagogy Applied to Health Sciences (CPASS), University of Montreal, Montréal, QC, H3T 1J4, Canada. bernard.charlin@umontreal.ca.
authors.forename: Bernard
authors.initials: B
authors.lastname: Charlin
authors.affiliation: Undergraduate Medical Education and Centre for Medical Education, McGill University, Montreal, QC, H3A 1A3, Canada. valerie.dory@mcgill.ca.
authors.forename: Valérie
authors.initials: V
authors.lastname: Dory
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005602:France; D006801:Humans; D008875:Middle Aged; D019370:Observation / Q000379:methods; D010817:Physician-Patient Relations; D036301:Qualitative Research; D013850:Thinking
keywords: Clinical reasoning; Decision making; Dual-process theory; Emergency medicine; Hypotheses generation