RT Journal Article
SR Electronic
T1 Opening the Black Box: Cognitive Strategies in Family Practice
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 144
OP 150
DO 10.1370/afm.264
VO 3
IS 2
A1 Robert E. Christensen
A1 Michael D. Fetters
A1 Lee A. Green
YR 2005
UL http://www.annfammed.org/content/3/2/144.abstract
AB PURPOSE We wanted to describe the cognitive strategies used by family physicians when structuring the decision-making tasks of an outpatient visit. METHODS This qualitative study used cognitive task analysis, a structured interview method in which a trained interviewer works individually with expert decision makers to capture their stages and elements of information processing. RESULTS Eighteen family physicians of varying levels of experience participated. Three dominant themes emerged: time pressure, a high degree of variation in task structuring, and varying degrees of task automatization. Based on these data and previous research from the cognitive sciences, we developed a model of novice and expert approaches to decision making in primary care. The model illustrates differences in responses to unexpected opportunity in practice, particularly the expert’s use of attentional surplus (reserve capacity to handle problems) vs the novice’s choice between taking more time or displacing another task. CONCLUSIONS Family physicians have specific, highly individualized cognitive task-structuring approaches and show the decision behavior features typical of expert decision makers in other fields. This finding places constraints on and suggests useful approaches for improving practice.