Exploring Implications of Context Specificity and Cognitive Load in Residents

Temple A Ratcliffe,Anthony R Artino,Jeroen J G Van Merrienboer,Katherine Picho,Lambert Schuwirth,Steven J Durning,Cees P M Van Der Vleuten,Jimmie Leppink,Elexis Mcbee

doi:10.15694/mep.2017.000048

Temple A Ratcliffe, Anthony R Artino + Show 7 more

Open Access

https://doi.org/10.15694/mep.2017.000048

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Abstract

This article was migrated. The article was not marked as recommended. Introduction: Context specificity (CS) refers to the variability in clinical reasoning across different presentations of the same diagnosis. Cognitive load (CL) refers to limitations in working memory that may impact clinicians' clinical reasoning. CL might be one of the factors that lead to CS. Although CL during clinical reasoning would be expected to be higher in internal medicine residents, CL's effect on CS in residents has not been studied. Methods: Internal medicine residents watched a series of three cases portrayed on videos. Following each case, participants filled out a post-encounter form and completed a validated measure of CL. Results: Fourteen residents completed all three cases. Across cases, self-reported CL was relatively high and there were small to moderate correlations between CL and performance in clinical reasoning (r's = .43, -.33, -.23). In terms of changing CL across cases, the correlations between change in CL and change in total performance were statistically significantly only in moving from case 1 to case 2 (r = -.54, p =.05). Discussion and Conclusion: Residents self-reported measurements of CL were relatively high across cases. However, higher CL was not consistently associated with poorer performance. We did observe the expected associations when looking at case-to-case change in CL. This relationship warrants further study.

Highlights

Context specificity (CS) refers to the variability in clinical reasoning across different presentations of the same diagnosis
Small to moderate, but inconsistent, correlations between Cognitive load (CL) and performance in clinical reasoning
The correlation was positive only for case 1 and there was no significant change in CL in going from case 1 to case 3 (Table 2) (p >.05)

Summary

Introduction

Context specificity (CS) refers to the variability in clinical reasoning across different presentations of the same diagnosis. Situated cognition posits that clinical reasoning does not exist solely in the physician’s mind, but rather is situated "in the specifics of the event" and is made up of interactions between a doctor, his or her patient and other encounter factors (Durning & Artino 2011). In this framework, context is essential, as changes in context may affect clinical reasoning performance. Context is essential, as changes in context may affect clinical reasoning performance Through this lens, contextual factors are dimensions of an individual case that may pertain to the doctor, patient, encounter and/or their interactions. Contextual factors are proposed to affect reasoning within the situated cognition framework and through these interactions they could contribute to CS (contextual factors, in addition to the clinical content of a case, might lead to case to case performance variability)

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