• Adam Szulewski, Heather Braund, Rylan Egan, Andreas Gegenfurtner, Andrew K Hall, Daniel Howes, Damon Dagnone, and van Merrienboer Jeroen J G JJG School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands..
• Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada. Electronic address: aszulewski@qmed.ca.
• Ann Emerg Med. 2019 Nov 1; 74 (5): 647-659.

Study ObjectiveSimulation is commonly used to teach crisis resource management skills and assess them in emergency medicine residents. However, our understanding of the cognitive processes underlying crisis resource management skills is limited because these processes are difficult to assess and describe. The objective of this study is to uncover and characterize the cognitive processes underlying crisis resource management skills and to describe how these processes vary between residents according to performance in a simulation-based examination.MethodsTwenty-two of 24 eligible emergency medicine trainees from 1 tertiary academic center completed 1 or 2 resuscitation-based examinations in the simulation laboratory. Resident performance was assessed by a blinded expert using an entrustment-based scoring tool. Participants wore eye-tracking glasses that generated first-person video that was used to augment subsequent interviews led by an emergency medicine faculty member. Interviews were audio recorded and then transcribed. An emergent thematic analysis was completed with a codebook that was developed by 4 research assistants, with subsequent analyses conducted by the lead research assistant with input from emergency medicine faculty. Themes from high- and low-performing residents were subsequently qualitatively compared.ResultsHigher-performing residents were better able to anticipate, selectively attend to relevant information, and manage cognitive demands, and took a concurrent (as opposed to linear) approach to managing the simulated patient.ConclusionThe results provide new insights into residents' cognitive processes while managing simulated patients in an examination environment and how these processes vary with performance. More work is needed to determine how best to apply these findings to improve crisis resource management education.Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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