When I was a first-year resident, I spent Christmas Eve on the critical care service at the hospital. I’d been a doctor for only six months. While the one upper-level resident on service  managed the Medical Intensive Care Unit (MICU), I managed seven admissions to the Critical Intensive Care Unit (CICU). It was an intense night, and I had no opportunity to review any of the cases with the resident. It was physically impossible for me to get all the needed information for each of the seven critically ill patients before acting. So I did as all smart interns did. I relied heavily on the amazing critical care nurses and we all made it to the morning on the road to improvement.
One of the common occurrences during medical school, residency, and even as a physician is experiencing a period of time in which you receive more information than you can process, and yet are expected to make decisions based upon that information. In the medical sciences, the amount of information you receive is staggering and your ability to make decisions within that tide of information affects your performance. When you are a student on clinical rotations, that staggering amount of medical science knowledge is further complicated by contextual information that pertains to the specific patient you are encountering, and again you are required to make decisions that affect your own performance and begin to affect patient care. By the time you reach residency and certainly in practice, the complexity of decision-making increases and the actions you take and do not take will affect the health and wellbeing of other people.
Being able to manage information, prioritize, delegate, considering diverse options, understand your resources, and create short and long-term strategies—these are all critical to functioning as a medical student, resident, and physician. Yet these skills are rarely explicitly taught and assessed in medical school. One of the challenges in teaching and assessing these higher cognitive skills during medical school is that these “process of thinking” skills, when needed in the context of patient care, require a substantial amount of medical knowledge that is not present in students early in medical school. On that Christmas Eve in the ICU, what I decided to prioritize and delegate was based on my content knowledge of the specific patient presentations. That being said, when we delay training in the “process of thinking” skills until medical students have become residents, we miss four years of opportunity to teach and assess these critical skills.
AUC is excited to begin an educational program directed at teaching and learning these cognitive skills. We are working with Streufert, LLC to deliver this assessment and training through the use of a well-validated software program called Strategic Management Simulations. This program has been used extensively to train higher cognitive functions in people in professional and leadership positions. We believe that this specialized training will be beneficial to medical students as well.
Imagine for a moment that while in medical school, you could experience similar situations to my memorable Christmas Eve in which you receive more information than is possible to process, and have to manage information, prioritize, delegate, consider diverse options, understand your resources, and develop short and long-term strategies. Imagine that you received feedback on what you did well and where you could improve, and were able to complete training exercises that bolstered your processes of thinking. It is possible. As a school with a single mission, medical education, we are happy to lead the way.

Dr. Heidi Chumley

Posted February 28, 2014 04:32 PM

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