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Little has been published on the methodology that emergency physician learners use to make clinical decisions. In this study, 37 first-year emergency medicine learners (registrars) from six hospitals in the U.K. were asked to recall a recent challenging case and a straightforward case and to describe their decision making. Responses were obtained through semi-structured interviews and focus groups and analyzed using standard qualitative research analytical methods.
The researchers identified three distinct and sequential clinical decision-making steps: (1) case framing (e.g., using initial case clues to determine patient acuity); (2) evolving reasoning (e.g., using hypothetico-deduction and heuristics to identify pattern recognition or red f…