title: From Context Comes Expertise: How Do Expert Emergency Physicians Use Their Know-Who to Make Decisions?
abstract: Decisionmaking is influenced by the environment in which it takes place. The objective of our study was to explore the influence of the specific features of the emergency department (ED) environment on decisionmaking. In this paper, we specifically report on the way emergency physicians use their knowledge of their collaborators to make their decisions.
  
  
  
  We conducted a qualitative study on emergency physicians recruited in 3 French hospitals. Physicians were equipped with a microcamera to record their clinical activity from their "own-point-of-view perspective." Semistructured interviews, based on viewing the video, were held with each physician after an actual clinical encounter with a patient. They were then analyzed thematically, using constant comparison and matrices, to identify the central themes.
  
  
  
  Fifteen expert emergency physicians were interviewed. Almost all of them reported using their knowledge of other health care professionals to assess the seriousness of the patient's overall condition (sometimes even before his or her arrival in the ED) to optimize the patient's treatment and to anticipate future care.
  
  
  
  Emergency physicians interact with many other health care workers during the different stages of the patient's management. The many ways in which experts use their knowledge of other health care professionals to make decisions puts traditional conceptions of expert knowledge into perspective and opens avenues for future research.
authors: Centre for Training and Research in Health Sciences Education, Faculty of Medicine, University of Strasbourg, Strasbourg, France; Prehospital Emergency Care Service-Centre for Emergency Care Teaching, Strasbourg University Hospital, Strasbourg, France. Electronic address: pelaccia@unistra.fr.
authors: Thierry
authors: T
authors: Pelaccia
authors: Department of Pedagogy, Faculty of Education, University of Sherbrooke, Sherbrooke, Québec, Canada.
authors: Jacques
authors: J
authors: Tardif
authors: Faculty of Educational Sciences, University of Strasbourg, Strasbourg, France.
authors: Emmanuel
authors: E
authors: Triby
authors: Department of Emergency Medicine, Amiens University Hospital, Amiens, France.
authors: Christine
authors: C
authors: Ammirati
authors: Prehospital Emergency Care Service, Henri-Mondor Hospital, Public Hospitals of Paris, Créteil, France.
authors: Catherine
authors: C
authors: Bertrand
authors: Undergraduate Medical Education and Centre for Medical Education, McGill University, Montreal, Québec, Canada.
authors: Valérie
authors: V
authors: Dory
authors: Centre of Pedagogy applied to Health Sciences, Faculty of Medicine, University of Montreal, Montréal, Québec, Canada.
authors: Bernard
authors: B
authors: Charlin
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D014741:Video Recording