Cognitive Aids Research Articles

Does cognitive aid app design influence the speed of actions during a critical event?: A simulation study.

Does cognitive aid app design influence the speed of actions during a critical event?: A simulation study.

Like Shooting Phish in a Barrel: Cue Utilization and Cognitive Reflection Aid Performance in Controlled, but Not Naturalistic Phishing Tasks

The study tested the role of cue utilization and cognitive reflection tendencies in email users’ phishing decision capabilities in both controlled and naturalistic settings. 94 university students completed measures of their phishing cue utilization and cognitive reflection, a phishing decision task, and a naturalistic simulated phishing campaign, in which they were sent simulated phishing emails to their personal inboxes. For the phishing decision task, results revealed that participants with lower cognitive reflection tendencies were more likely to misclassify genuine emails as phishing, compared to participants with higher cognitive reflection. Further, participants with higher cognitive reflection and lower cue utilization took the most time to diagnose emails, but participants low in both cue utilization and cognitive reflection demonstrated the shortest response latencies. These findings suggest that greater cognitive reflection can offset lower levels of cue utilization. For the naturalistic simulation, neither cue utilization nor cognitive reflection predicted an increased propensity to interact with a suspicious email. This result highlights a potential gap between phishing investigations conducted in controlled and naturalistic settings. The implications extend to future research, emphasizing the need for studies that employ naturalistic methodologies to better understand and address phishing threats in real-world environments.

A review of cognitive aids and their application to emergency management in Australia

Decision-making in disasters and major crises faced by emergency services globally is a difficult combination of science and art to master. To assist decision-makers in these environments, a number of cognitive aids have been developed and subsequently adopted by individuals and organisations alike. However, these aids vary according to their intent and the context in which they are intended to be applied. This review explores the use of cognitive aids in the context of emergency management and explores how existing knowledge regarding the use of cognitive aids from other industries may be translated to emergency management. An iterative literature review of academic and industry material related to cognitive aids during incident and crisis response across a broad range of international emergency service and other industries within the last 20 years was completed. Ultimately, cognitive aids are not a silver bullet when it comes to decision-making in the emergency management context. The correct tool (that is correctly designed) must be correctly applied by trained and competent end users. The Australian emergency management sector may benefit from future research exploring how these existing tools adhere to the good practice principles identified in this study.

A comprehensive audit of difficult airway trolleys in selected Victorian hospitals.

This study aimed to assess the availability, design, and contents of difficult airway trolleys in hospitals in Victoria, Australia. A survey audit was conducted with a 92.3% reply rate, and the responses from 22 major Victorian hospitals were analysed. The results showed that difficult airway trolleys were available in 100% of operating theatres, emergency departments and intensive care units, and the rate of standardisation was high. Compliance with recommended design features and resources was on average 68.3%. There was no significant difference in the compliance rate of major tertiary centres compared with other hospitals. The carriage of non-essential items was reduced compared with earlier audits. However, there was heterogeneity in the brands of supraglottic airway devices, videolaryngoscopes and cognitive aids used. The study highlights the need for ongoing improvement to the organization and content of difficult airway trolleys, and for further discussion regarding the safety of equipment variation across institutions.

A Comparative Analysis of the Impact of Two Different Cognitive Aid Bundle Designs on Adherence to Best Clinical Practice in Simulated Perioperative Emergencies.

Background: Stress and human error during perioperative emergency situations can significantly impact patient morbidity and mortality. Previous research has shown that cognitive aid bundles (CABs) minimize critical misses by 75%. This study aimed to compare the effectiveness of two different CAB designs with the same content in reducing missed critical management steps for simulated perioperative emergencies. Methods: A multicenter randomized controlled simulation-based study was conducted including 27 teams, each consisting of three participants; each team performed four simulation scenarios. In the first scenario for each team (Scenario 1), no CAB was used. Scenarios 2 and 3 were randomly allocated to the groups, with either a branched, clustered design (CAB-1) or a linear, step-by-step design (CAB-2) of the cognitive aid. In Scenario 4, the groups used one of the previously mentioned CABs according to their own preference. The primary outcome was the difference in the percentage of missed critical management steps between the two different CABs. Secondary outcomes included user preference for one CAB design and the reduction in percentage of missed critical management steps using any CAB versus no CAB. Results: Twenty-seven teams simulated 108 perioperative emergency situations. The percentage of missed critical management steps was similar between CAB-1 and CAB-2 (27% [interquartile range (IQR) 20-29] versus 29% [IQR 20-35], p = 0.23). However, most participants favored the branched, clustered design CAB-1 (77.8%). Additionally, employing any CAB reduced the percentage of missed critical management steps by 36% (33% missed steps vs. 21% missed steps, p = 0.003). Conclusions: While the two CAB designs did not differ significantly in reducing missed critical management steps, the branched, clustered design was perceived as more user-friendly. Importantly, using any CAB significantly reduced the percentage of missed critical management steps compared to not using a cognitive aid, emphasizing the need for CAB use in the operating room.

Clinical Issues - September 2024.

Selecting nonsterile sharps disposal containers Key words: sharps safety, Occupational Safety and Health Administration (OSHA), bloodborne pathogens, occupational exposure, disposal container. Life support certification requirements for perioperative RNs Key words: basic life support, advanced cardiac life support (ACLS), cardiopulmonary resuscitation, certification, training. Using crisis checklists in the perioperative environment Key words: emergency manuals, cognitive aids, clinical emergencies, crew resource management, crisis checklist. Walking patients to the OR Key words: fall prevention, fall risk, mobility assessment, safe patient handling and mobility (SPHM), ambulate.

A Prospective Observational Study of EHR-Based Versus Virtual Desktop-Based Access to Pediatric Anesthesia Emergency Algorithms.

When pediatric anesthesia emergencies occur, situations can deteriorate rapidly. At our hospital, the Society for Pediatric Anesthesia's (SPA) emergency algorithms are used as cognitive aids during crises, and nurses are tasked with accessing the algorithms. Operating room nurses' typical workflow includes continuous display of the of the electronic health record (EHR) intraoperative navigator, which can delay navigating to the virtual desktop window and the algorithms' icon. Thus, we implemented a button in the intraoperative navigator's toolbar to access the algorithms with one click. We conducted an observational study of the time required to access and display overhead an algorithm using the new button and old method. We surveyed participants on usability.

A Rapid Response Mobile Application Improves First-Year Resident Clinical Performance During Simulated Care Events: A Randomized Controlled Trial.

Rapid response teams (RRTs) are critical to the timely and appropriate management of acutely decompensating patients. In the academic setting, the vital role of RRT leader is often filled by a junior resident physician who may lack the necessary medical knowledge and experience. Cognitive aids help improve guideline adherence and may support resident performance as they transition into leadership roles. This study evaluated the impact of a rapid response mobile application on intern performance during simulated rapid response events. This randomized controlled trial compared the performance of interns in two simulated rapid response scenarios with and without access to the rapid response mobile application. The scenarios included anaphylaxis and supraventricular tachycardia (SVT). Simulations were video recorded and coded by trained raters. Interns in all specialties at our institution. Outcomes included (1) time to ordering critical medications (epinephrine and adenosine), (2) overall clinical performance using a checklist-based performance measure, and (3) usability of the mobile application. Enrollment and data collection occurred between November 2022 and February 2023. Forty-four interns from 12 specialties were randomized to the intervention group (N = 22) and the control group (N = 22). Time to order critical medications was significantly reduced in the intervention group compared to control for anaphylaxis (P < 0.005) and SVT (P < 0.005). The intervention group had significantly higher performance scores compared to the control group for the anaphylaxis portion (P < 0.006). Usability scores for the rapid response toolkit were good. Access to a rapid response mobile application improved the quality of care administered by interns during two simulated rapid response scenarios as determined by a decrease in time to ordering critical medications and improved performance scores. The intervention group found the mobile application to be usable. This work adds to existing literature supporting the use of technology-based cognitive aids to improve patient care.

노인 치매인지교구 및 교수활동안 개발연구

Objectives Due to the super-aging population, the number of elderly people and the number of elderly people with dementia are increasing rapidly, emerging as an important problem in our society. Therefore, there is a need to develop teaching aids necessary for preventing and delaying dementia. Therefore, the purpose of this study is to study teaching activities that can develop and utilize dementia cognitive teaching aids. Methods To achieve this, first, we selected the type of cognitive aids. We identified the types of aids suitable for use in nursing homes or day care centers and selected the appropriate ones. Second, we determined the purpose of the aids. We analyzed the processes of dementia in the elderly and investigated the content of classes in institutions such as nursing homes or day care centers. Third, through literature review, we examined domestically produced cognitive aids, repackaged cognitive aids, and practical cognitive aids. Fourth, we designed the aids in five different areas. Fifth, we conducted a validation and modification process with an expert group, followed by testing the usability of the aids and further modifications. Results Through preliminary research and literature review, we established the development process. As a result, we derived the domains for cognitive aids for elderly dementia patients and outlined teaching activities accordingly. Conclusions First, teaching aids were developed in five areas: language ability, numerical and spatial ability, sensory ability, memory thinking ability, and social relations ability. Second, teaching activity plans for five teaching aids were developed. This was used as a teaching aid for cognitive education for the elderly with dementia in the field, and access to the use of occupational therapists, social workers, and nursing care workers was minimized through the activity plan.

Factors Associated with Increased Use of Cognitive Aids in Emergency Medical Services

Background: Cognitive aids are an essential aspect of patient care within emergency medical services (EMS). Despite their availability in EMS, these aids are underutilized. Understanding factors associated with increased use of cognitive aids can help guide the development of effective implementation strategies. This study examines the association between the frequency of cognitive aid use in EMS and three factors: the use of these aids into initial education programs, policies mandating their use, and clinicians’ perceptions of cognitive aid usefulness. Methods: This study used a cross-sectional survey examining the use, previous training, policy, and perceived usefulness of 15 selected cognitive aids. The survey was emailed to 136,093 EMS clinicians in six participating states (TX, ME, MI, LA, SC, and AR). Descriptive statistics were used to describe the examined factors. Bivariate analysis was used to examine the relationship between the use of each cognitive aid and previous training with the aid, requirements for use, and perceived usefulness. Results: A total of 2,251 respondents met inclusion criteria and were included in the study. The length-based tape was the most common aid used during initial education programs (n=1724, 77.0%) and to have policy requiring its use during patient care (n=1194, 53.0%). Aids associated with pediatric medication administration were perceived as most useful. Clinicians were more likely to use a specific aid if there was policy requiring its use, if they used the aid during their initial education programs, or if they perceived it to be useful. Conclusions: The results of this study suggest that integrating a cognitive aid into EMS initial education programs, having policy requiring its use, and the aid being perceived as useful are all associated with increased use the aid during patient care. These results may provide valuable insights for devising more effective implementation strategies for cognitive aids.

Assessing Practice Variation of Anesthetic Management for Endovascular Thrombectomy in Acute Ischemic Stroke: A Comprehensive Multicenter Survey.

This study explored the current global landscape of periprocedural care of acute ischemic stroke patients undergoing endovascular thrombectomy (EVT). An anonymous, 54-question electronic survey was sent to 354 recipients in hospitals worldwide. The responses were stratified by World Bank country income level into high-income (HICs) and low/middle-income (LMICs) countries. A total of 354 survey invitations were issued. Two hundred twenty-three respondents started the survey, and 87 fully completed surveys were obtained from centers in which anesthesiologists were routinely involved in EVT care (38 in HICs; 49 in LMICs). Respondents from 35 (92.1%) HICs and 14 (28.6%) LMICs reported that their centers performed >50 EVTs annually. Respondents from both HICs and LMICs reported low rates of anesthesiologist involvement in pre-EVT care, though a communication system was in place in 100% of HIC centers and 85.7% of LMIC centers to inform anesthesiologists about potential EVTs. Respondents from 71.1% of HIC centers and 51% of LMIC centers reported following a published guideline during EVT management, though the use of cognitive aids was low in both (28.9% and 24.5% in HICs and LMICs, respectively). Variability in multiple areas of practice, including choice of anesthetic techniques, monitoring and management of physiological variables during EVT, and monitoring during intrahospital transport, were reported. Quality metrics were rarely tracked or reported to the anesthesiology teams. This study demonstrated variability in anesthesiology involvement and in clinical care during and after EVT. Centers may consider routinely involving anesthesiologists in pre-EVT care, using evidence-based recommendations for EVT management, and tracking adherence to published guidelines and other quality metrics.

Accurate identification of individuals with subjective cognitive decline using 3D regional fractal dimensions on structural magnetic resonance imaging

Background and ObjectiveAccurate identification of individuals with subjective cognitive decline (SCD) is crucial for early intervention and prevention of neurodegenerative diseases. Fractal dimensionality (FD) has emerged as a robust and replicable measure, surpassing traditional geometric metrics, in characterizing the intricate fractal geometrical properties of brain structure. Nevertheless, the effectiveness of FD in identifying individuals with SCD remains largely unclear. A 3D regional FD method can be suggested to characterize and quantify the spatial complexity of the precise gray matter, providing insights into cognitive aging and aiding in the automated identification of individuals with SCD. MethodsThis study introduces a novel integer ratio based 3D box-counting fractal analysis (IRBCFA) to quantify regional fractal dimensions (FDs) in structural magnetic resonance imaging (MRI) data. The innovative method overcomes limitations of conventional box-counting techniques by accommodating arbitrary box sizes, thereby enhancing the precision of FD estimation in small, yet neurologically significant, brain regions. ResultsThe application of IRBCFA to two publicly available datasets, OASIS-3 and ADNI, consisting of 520 and 180 subjects, respectively. The method identified discriminative regions of interest (ROIs) predominantly within the limbic system, fronto-parietal region, occipito-temporal region, and basal ganglia-thalamus region. These ROIs exhibited significant correlations with cognitive functions, including executive functioning, memory, social cognition, and sensory perception, suggesting their potential as neuroimaging markers for SCD. The identification model trained on these ROIs demonstrated exceptional performance achieving over 93 % accuracy on the discovery dataset and exceeding 87 % on the independent testing dataset. Furthermore, an exchange experiment between datasets revealed a substantial overlap in discriminative ROIs, highlighting the robustness of our method across diverse populations. ConclusionOur findings indicate that IRBCFA can serve as a valuable tool for quantifying the spatial complexity of gray matter, providing insights into cognitive aging and aiding in the automated identification of individuals with SCD. The demonstrated generalizability and robustness of this method position it as a promising tool for neurodegenerative disease research and offer potential for clinical applications.

Cognitive aid and performance for simulated umbilical venous catheter placement: A randomized trial

IntroductionNeonatal resuscitation may require urgent umbilical venous catheter (UVC) placement. Complications can be observed with umbilical venous catheterization, especially in a stressful context. Inspired by the aeronautic environment, medical routine checklists, also called “cognitive aids,” secure the equipment and environment for the patients once they are admitted to the operating room. We hypothesized that reading a cognitive aid for UVC placement in the delivery room during neonatal resuscitation simulation scenarios can (a) improve the performance in reducing catheterization duration and (b) can limit complications. MethodsThis was a prospective single-center randomized study. A total of 23 dyads for a simulation scenario were included: 12 in the control group and 11 in the cognitive aid group. In the cognitive aid group, the cognitive aid was read by the same facilitator for every scenario. ResultsNo significant difference concerning the duration of the procedure was identified between the cognitive aid and control groups: 412 s [342; 420] vs. 374 s [338;402], respectively (p = 0.781). Nevertheless, there were significantly fewer deviations from hygiene guidelines and improved prevention of air embolism in the cognitive aid group compared with the control group. ConclusionThe UVC insertion time was similar between the control and cognitive aid groups. Moreover, cognitive aid can limit infectious complications or air embolism by allowing caregivers to follow UVC placement standards.

Identifying and Reducing Insulin Errors in the Simulated Military Critical Care Air Transport Environment: A Human Factors Approach.

During high-fidelity simulations in the Critical Care Air Transport (CCAT) Advanced course, we identified a high frequency of insulin medication errors and sought strategies to reduce them using a human factors approach. Of 169 eligible CCAT simulations, 22 were randomly selected for retrospective audio-video review to establish a baseline frequency of insulin medication errors. Using the Human Factors Analysis Classification System, dosing errors, defined as a physician ordering an inappropriate dose, were categorized as decision-based; administration errors, defined as a clinician preparing and administering a dose different than ordered, were categorized as skill-based. Next, 3 a priori interventions were developed to decrease the frequency of insulin medication errors, and these were grouped into 2 study arms. Arm 1 included a didactic session reviewing a sliding-scale insulin (SSI) dosing protocol and a hands-on exercise requiring all CCAT teams to practice preparing 10 units of insulin including a 2-person check. Arm 2 contained arm 1 interventions and added an SSI cognitive aid available to students during simulation. Frequency and type of insulin medication errors were collected for both arms with 93 simulations for arm 1 (January-August 2021) and 139 for arm 2 (August 2021-July 2022). The frequency of decision-based and skill-based errors was compared across control and intervention arms. Baseline insulin medication error rates were as follows: decision-based error occurred in 6/22 (27.3%) simulations and skill-based error occurred in 6/22 (27.3%). Five of the 6 skill-based errors resulted in administration of a 10-fold higher dose than ordered. The post-intervention decision-based error rates were 9/93 (9.7%) and 23/139 (2.2%), respectively, for arms 1 and 2. Compared to baseline error rates, both arm 1 (P = .04) and arm 2 (P < .001) had a significantly lower rate of decision-based errors. Additionally, arm 2 had a significantly lower decision-based error rate compared to arm 1 (P = .015). For skill-based preparation errors, 1/93 (1.1%) occurred in arm 1 and 4/139 (2.9%) occurred in arm 2. Compared to baseline, this represents a significant decrease in skill-based error in both arm 1 (P < .001) and arm 2 (P < .001). There were no significant differences in skill-based error between arms 1 and 2. This study demonstrates the value of descriptive error analysis during high-fidelity simulation using audio-video review and effective risk mitigation using training and cognitive aids to reduce medication errors in CCAT. As demonstrated by post-intervention observations, a human factors approach successfully reduced decision-based error by using didactic training and cognitive aids and reduced skill-based error using hands-on training. We recommend the development of a Clinical Practice Guideline including an SSI protocol, guidelines for a 2-person check, and a cognitive aid for implementation with deployed CCAT teams. Furthermore, hands-on training for insulin preparation and administration should be incorporated into home station sustainment training to reduced medication errors in the operational environment.

TraumaFlow-development of a workflow-based clinical decision support system for the management of severe trauma cases.

The treatment of severely injured patients in the resuscitation room of an emergency department requires numerous critical decisions, often under immense time pressure, which places very high demands on the facility and the interdisciplinary team. Computer-based cognitive aids are a valuable tool, especially in education and training of medical professionals. For the management of polytrauma cases, TraumaFlow, a workflow management-based clinical decision support system, was developed. The system supports the registration and coordination of activities in the resuscitation room and actively recommends diagnosis and treatment actions. Based on medical guidelines, a resuscitation room algorithm was developed according to the cABCDE scheme. The algorithm was then modeled using the process description language BPMN 2.0 and implemented in a workflow management system. In addition, a web-based user interface that provides assistance functions was developed. An evaluation study was conducted with 11 final-year medical students and three residents to assess the applicability of TraumaFlow in a case-based training scenario. TraumaFlow significantly improved guideline-based decision-making, provided more complete therapy, and reduced treatment errors. The system was shown to be beneficial not only for the education of low- and medium-experienced users but also for the training of highly experienced physicians. 92% of the participants felt more confident with computer-aided decision support and considered TraumaFlow useful for the training of polytrauma treatment. In addition, 62% acknowledged a higher training effect. TraumaFlow enables real-time decision support for the treatment of polytrauma patients. It improves guideline-based decision-making in complex and critical situations and reduces treatment errors. Supporting functions, such as the automatic treatment documentation and the calculation of medical scores, enable the trauma team to focus on the primary task. TraumaFlow was developed to support the training of medical students and experienced professionals. Each training session is documented and can be objectively and qualitatively evaluated.

Clinical Issues - June 2024.

Addressing pediatric perioperative anxiety Key words: pediatric patient, anxiety, parental presence, stress-diversion activities, anxiolytic medications. Using acupressure to reduce perioperative anxiety in children Key words: acupressure, anxiety, pediatric patient, complementary care interventions, acupressure wristband. Screening for obstructive sleep apnea in pediatric surgical patients Key words: obstructive sleep apnea (OSA), pediatric patient, adenotonsillectomy, screening tool, polysomnography. Assessing fire risk Key words: fire risk assessment, fire prevention, algorithm, cognitive aid, fire triangle.

Post-diagnostic support for persons with young-onset dementia – a retrospective analysis based on data from the Swedish dementia registry SveDem

BackgroundApproximately 3.9 million persons worldwide have young-onset dementia. Symptoms related to young-onset dementia present distinct challenges related to finances, employment, and family. To provide tailored support, it is important to gain knowledge about the formal support available for persons with young-onset dementia. Therefore, this paper aims to describe formal support for persons with young-onset dementia in Sweden and the factors influencing this support.MethodsThis retrospective study used data on persons under 65 years of age (n = 284) from The Swedish Registry for Cognitive/Dementia Disorders (SveDem) between 2021 and 2022. SveDem was established to monitor the quality of dementia care in Sweden. Characteristics of participants were obtained, including age, sex, dementia diagnosis, MMSE, medications, accommodation, and care setting. Descriptive statistics and logistic regression were used to test for associations between participant characteristics and post-diagnostic support.ResultsInformation and educational support were usually offered to the person with young-onset dementia (90.1%) and their family (78.9%). Approximately half of the sample were offered contact with a dementia nurse (49.3%), counsellor (51.4%), or needs assessor (47.9%). A minority (28.5%) were offered cognitive aids. Six regression models were conducted based on participant characteristics to predict the likelihood that persons were offered support. Support was not predicted by age, sex, children at home, accommodation, or medications. Lower MMSE scores (p < .05) and home help (p < .05) were significantly associated with offer of a needs assessor. Living together was a significant predictor (p < .01) for information and educational support offered to the family. Care setting significantly predicted (p < .01) an offer of information and educational support for the person and family members, as well as contact with a counsellor.ConclusionThis study indicates potential formal support shortages for persons with young-onset dementia in some areas of dementia care. Despite equal support across most characteristics, disparities based on care setting highlight the importance of specialised dementia care. Pre-diagnostic support is minimal, indicating challenges for persons with young-onset dementia to access these services before diagnosis. While our study has identified areas in need of improvement, we recommend further research to understand the changing support needs of those with young-onset dementia.

Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies.

Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL),Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regardingthe actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.

ChatGPT as a Tool for Medical Education and Clinical Decision-Making on the Wards: Case Study.

Large language models (LLMs) are computational artificial intelligence systems with advanced natural language processing capabilities that have recently been popularized among health care students and educators due to their ability to provide real-time access to a vast amount of medical knowledge. The adoption of LLM technology into medical education and training has varied, and little empirical evidence exists to support its use in clinical teaching environments. The aim of the study is to identify and qualitatively evaluate potential use cases and limitations of LLM technology for real-time ward-based educational contexts. A brief, single-site exploratory evaluation of the publicly available ChatGPT-3.5 (OpenAI) was conducted by implementing the tool into the daily attending rounds of a general internal medicine inpatient service at a large urban academic medical center. ChatGPT was integrated into rounds via both structured and organic use, using the web-based "chatbot" style interface to interact with the LLM through conversational free-text and discrete queries. A qualitative approach using phenomenological inquiry was used to identify key insights related to the use of ChatGPT through analysis of ChatGPT conversation logs and associated shorthand notes from the clinical sessions. Identified use cases for ChatGPT integration included addressing medical knowledge gaps through discrete medical knowledge inquiries, building differential diagnoses and engaging dual-process thinking, challenging medical axioms, using cognitive aids to support acute care decision-making, and improving complex care management by facilitating conversations with subspecialties. Potential additional uses included engaging in difficult conversations with patients, exploring ethical challenges and general medical ethics teaching, personal continuing medical education resources, developing ward-based teaching tools, supporting and automating clinical documentation, and supporting productivity and task management. LLM biases, misinformation, ethics, and health equity were identified as areas of concern and potential limitations to clinical and training use. A code of conduct on ethical and appropriate use was also developed to guide team usage on the wards. Overall, ChatGPT offers a novel tool to enhance ward-based learning through rapid information querying, second-order content exploration, and engaged team discussion regarding generated responses. More research is needed to fully understand contexts for educational use, particularly regarding the risks and limitations of the tool in clinical settings and its impacts on trainee development.

6299887 Epidural management in labour: cognitive aids for novice anaesthetists

6299887 Epidural management in labour: cognitive aids for novice anaesthetists