Mental Processes in Emergency Medicine

  • Jimmie LeppinkEmail author
  • José Hanham


In Chap.   2 of this book, we discuss that cognitive schemas determine what are the information elements that must be processed with more or less effort. Chapter   3 builds forth on that notion: the more developed and automated our cognitive schemas about a particular type of problem, the easier we can recognise problem states and possible solutions. This allows us to process routine information such as fixed procedures with less effort so that we have more working memory capacity available for what needs to be processed with more effort. This chapter applies these principles to emergency medicine. Emergency medicine involves people working in teams to assist those in need of immediate medical attention. Those who work in an emergency medicine department have to make rapid decisions under time pressure, stress and uncertainty as well as manage teamwork and organisational processes. This chapter focuses on the mental processes employed by emergency medicine practitioners when doing their work.


  1. Burke, C. S., Salas, E., Wilson-Donnelly, K., & Priest, H. (2004). How to turn a team of experts into an expert medical team: Guidance from the aviation and military communities. BMJ Quality & Safety, 13, 96–104. CrossRefGoogle Scholar
  2. Charlin, B., Lubarsky, S., Millette, B., Crevier, F., Audetat, M. C., Charbonneau, A., et al. (2012). Clinical reasoning processes: Unravelling complexity through graphical representation. Medical Education, 46, 454–463. CrossRefGoogle Scholar
  3. Croskerry, P. (2009). A universal model of diagnostic reasoning. Academic Medicine, 84, 1022. CrossRefGoogle Scholar
  4. Fraser, K., Huffman, J., Ma, I., Sobczak, M., McIlwrick, J., Wright, B., et al. (2014). The emotional and cognitive impact of unexpected simulated patient death: A randomized controlled trial. Chest, 145, 958–963. CrossRefGoogle Scholar
  5. Fraser, K., Ma, I., Teteris, E., Baxter, H., Wright, B., & McLaughlin, K. (2012). Emotion, cognitive load and learning outcomes during simulation training. Medical Education, 46, 1055–1062. CrossRefGoogle Scholar
  6. Gawande, A. (2009). The checklist manifesto: How to get things right. New York: Metropolitan Books.Google Scholar
  7. Lafleur, A., Côté, L., & Leppink, J. (2015). Influences of OSCE design on students’ diagnostic reasoning. Medical Education, 49, 203–214. CrossRefGoogle Scholar
  8. Leppink, J., & Van den Heuvel, J. (2015). The evolution of cognitive load theory and its application to medical education. Perspectives on Medical Education, 4, 119–127. CrossRefGoogle Scholar
  9. Leppink, J., Van Gog, T., Paas, F., & Sweller, J. (2015). Cognitive load theory: Researching and planning teaching to maximise learning. In J. Cleland & S. J. Durning (Eds.), Researching medical education (Chapter 18, pp. 207–218). Chichester, UK: Wiley & Blackwell.CrossRefGoogle Scholar
  10. Moulton, C., Regehr, G., Mylopoulos, M., & MacRae, H. (2007). Slowing down when you should: A new model of expert judgment. Academic Medicine, 82, S109–S116. CrossRefGoogle Scholar
  11. Moxley, J. H., Ericsson, K. A., Charness, N., & Krampe, R. T. (2012). The role of intuition and deliberative thinking in experts’ superior tactical decision-making. Cognition, 124, 72–78. CrossRefGoogle Scholar
  12. Nance, J. J. (2008). Why hospitals should fly: The ultimate flight plan to patient safety and quality care. Bozeman, MT: Second River Healthcare Press.Google Scholar
  13. Parush, A., Kramer, C., Foster-Hunt, T., Momtahan, K., Hunter, A., & Sohmer, B. (2011). Communication and team situation awareness in the OR: Implications for augmentative information display. Journal of Biomedical Informatics, 44, 477–485. CrossRefGoogle Scholar
  14. Pines, J. M. (2017). What cognitive psychology tells us about emergency department physician decision-making and how to improve it. Academic Emergency Medicine, 24, 117–119. CrossRefGoogle Scholar
  15. Sibbald, M., & De Bruin, A. B. H. (2012). Feasibility of self-reflection as a tool to balance clinical reasoning strategies. Advances in Health Sciences Education, 17, 419–429. CrossRefGoogle Scholar
  16. Sibbald, M., De Bruin, A. B. H., & Van Merriënboer, J. J. G. (2013). Do checklists improve experts’ diagnostic decisions? Medical Education, 47, 301–308. CrossRefGoogle Scholar
  17. Sibbald, M., De Bruin, A. B. H., & Van Merriënboer, J. J. G. (2014). Twelve tips on engaging learners in checking health care decisions. Medical Teacher, 36, 111–115. CrossRefGoogle Scholar
  18. Skaugset, L. M., Farrell, S., Carney, M., Wolff, M., Santen, S. A., Perry, M., et al. (2016). Can you multitask? Evidence and limitations of task switching and multitasking in emergency medicine. Annals of Emergency Medicine, 68, 189–195. CrossRefGoogle Scholar
  19. Tremblay, M. L., Lafleur, A., Leppink, J., & Dolmans, D. H. J. M. (2017). The simulated clinical environment: Cognitive and emotional impact among undergraduates. Medical Teacher, 39, 181–187. CrossRefGoogle Scholar
  20. Van Merriënboer, J. J. G., & Sweller, J. (2010). Cognitive load theory in health professions education: Design principles and strategies. Medical Education, 44, 85–93. CrossRefGoogle Scholar
  21. Weller, J. (2012). Shedding new light on tribalism in health care. Medical Education, 46, 134–136. CrossRefGoogle Scholar
  22. Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes and patient safety: Overcoming barriers to effective teamwork in healthcare. BMJ Postgraduate Medical Journal, 90, 149–154. CrossRefGoogle Scholar
  23. Westbrook, J. I., Raban, M., Walter, S. R., & Douglas, H. (2018). Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: A prospective, direct observation study. BMJ Quality & Safety, 27, 1–9. CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Maastricht UniversityMaastrichtThe Netherlands
  2. 2.Western Sydney UniversityPenrithAustralia

Personalised recommendations