The goal of the present study was to examine the effects of domain-relevant expertise on running memory and the ability to process handoffs of information. In addition, the role of active or passive processing was examined.
Background:
Currently, there is little research that addresses how individuals with different levels of expertise process information in running memory when the information is needed to perform a real-world task.
Method:
Three groups of participants differing in their level of clinical expertise (novice, intermediate, and expert) performed an abstract running memory span task and two tasks resembling real-world activities, a clinical handoff task and an air traffic control (ATC) handoff task. For all tasks, list length and the amount of information to be recalled were manipulated.
Results:
Regarding processing strategy, all participants used passive processing for the running memory span and ATC tasks. The novices also used passive processing for the clinical task. The experts, however, appeared to use more active processing, and the intermediates fell in between.
Conclusion:
Overall, the results indicated that individuals with clinical expertise and a developed mental model rely more on active processing of incoming information for the clinical task while individuals with little or no knowledge rely on passive processing.
Application:
The results have implications about how training should be developed to aid less experienced personnel identify what information should be included in a handoff and what should not.
Anderson-MontoyaB.HubbardT.RamirezD.ScerboM. (2014). Handoff performance across varying levels of expertise (Board# 105-Research Abstract; Submission# 9561). Simulation in Healthcare, 9, 398. doi:10.1097/01.SIH.0000459275.38879.b0
3.
AroraV.JohnsonJ. (2006). A model for building a standardized hand-off protocol. The Joint Commission Journal on Quality and Patient Safety, 32, 646–655.
4.
AroraV.JohnsonJ. (2008). Handoffs. In McKeanS. C.BennettA. L.HalasyamaniL. K. (Eds.), Hospital medicine: Just the facts (pp. 62–67). New York, NY: McGraw-Hill.
5.
BhabraG.MackeithS.MonteiroP.PothierD. D. (2007). An experimental comparison of handover methods. Annals of The Royal College of Surgeons of England, 89, 298–300. doi:10.1308/003588407X168352
6.
BrittR. C.RamirezD.Anderson-MontoyaB. L.ScerboM. W. (2015). Resident handoff training: Initial evaluation of a novel method. Journal for Healthcare Quality, 37, 75–80. doi:10.1097/01.JHQ.0000460124.98684.19
7.
BroadwayJ. M.EngleR. W. (2010). Validating running memory span: Measurement of working memory capacity and links with fluid intelligence. Behavior Research Methods, 42, 563–570.
8.
BuntingM.CowanN.SaultsJ. S. (2006). How does running memory span work?Quarterly Journal of Experimental Psychology, 59, 1691–1700. doi:10.1080/17470210600848402
9.
ChabnerD. E. (2001). The language of medicine (6th ed.). Philadelphia, PA: W. B. Saunders Company.
10.
ChuE. S.ReidM.BurdenM.ManciniD.SchulzT.KenistonA.. . . AlbertR. K. (2010). Effectiveness of a course designed to teach handoffs to medical students. Journal of Hospital Medicine, 5, 344–348. doi:10.1002/jhm.633
11.
ClairL. L.TrussellP. M. (1969). The change of shift report: Study shows weaknesses, how it can be improved. Hospitals, 43, 91–95.
12.
CohenM. D.HilligossB.AmaralA. C. K. B. (2012). A handoff is not a telegram: An understanding of the patient is co-constructed. Critical Care, 16, 303.
13.
CollinsR. D. (2008). Differential diagnosis in primary care (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
14.
DunnS. A. (1998). Mosby’s primary care consultant. St. Louis, MO: Mosby, Inc.
15.
ElosúaM. R.RuizR. M. (2008). Absence of hardly pursued updating in a running memory task. Psychological Research, 72, 451–460. doi:10.1007/s00426-007-0124-4
FlemingD.HübnerU. (2013). How to improve change of shift handovers and collaborative grounding and what role does the electronic patient record system play? Results of a systematic literature review. International Journal of Medical Informatics, 82, 580–592. doi:10.1016/j.ijmedinf.2013.03.004
18.
HatanoG.InagakiK. (1986). Two courses of expertise. In StevensonH. W.AzumaH.HakutaK. (Eds.), Child development and education in Japan (pp. 262–272). New York, NY: WH Freeman/Times Books/Henry Holt & Co.
19.
HockeyR. (1973). Rate of presentation in running memory and direct manipulation of input-processing strategies. Quarterly Journal of Experimental Psychology, 25, 104–111. doi:10.1080/14640747308400328
20.
JarvisC. (2000). Physical examination and health assessment (3rd ed.). Philadelphia, PA: W. B. Saunders Company.
21.
KalkmanC. J. (2010). Handover in the perioperative care process. Current Opinion in Anesthesiology, 23, 749–753. doi:10.1097/ACO.0b013e3283405ac8
22.
KimballD. R.HolyoakK. J. (2000). Transfer and expertise. In TulvingE.CraikF. I. M. (Eds.) The Oxford handbook of memory (pp. 109–122). New York, NY: Oxford University Press.
23.
Lane-FallM. B.SpeckR. M.IbrahimS. A.SheaJ. A.McCunnM.BoskC. L. (2014). Are attendings different? Intensivists explain their handoff ideals, perceptions, and practices. Annals of the American Thoracic Society, 11, 360–366. doi:10.1513/AnnalsATS.201306-151OC
24.
LiJ. Z.KohrtH. E.CaugheyA. B. (2007). Blueprints clinical cases (2nd ed.). Baltimore, MD: Lippincott Williams and Wilkins.
25.
Lužar-StifflerV.StifflerC. (2002). Equivalence testing the easy way. Journal of Computing and Information Technology, 3, 233–239.
26.
ManserT.FosterS.GisinS.JaeckelD.UmmenhoferW. (2010). Assessing the quality of patient handoffs at care transitions. Quality and Safety in Healthcare, 19, 1–5. doi:10.1136/qshc.2009.038430
27.
MillerG. A. (1956). The magical number seven, plus or minus two: Some limits on our capacity for processing information. Psychological Review, 63, 81–97. doi:10.1037/h0043158
28.
MuzzinL. J.NormanG. R.FeightnerJ. W.TugwellP.GuyattG. (1983). Expertise in recall of clinical protocols in two specialty areas. Proceedings of the Annual Conference on Research in Medical Education, 22, 122–127.
29.
NolanM. S. (2011). Fundamentals of air traffic control (5th ed.). Clifton Park, NY: Delmar.
30.
NormanG. (2005). Research in clinical reasoning: Past history and current trends. Medical Education, 39, 418–427. doi:10.1111/j.1365-2929.2005.02127.x
31.
NormanG. R.BrooksL. R.AllenS. W. (1989). Recall by expert medical practitioners and novices as a record of processing attention. Journal of Experimental Psychology: Learning, Memory, and Cognition, 15, 1166–1174. doi:10.1037/0278-7393.15.6.1166
32.
NormanG. R.JacobyL. L.FeightnerJ. W.CampbellE. J. M. (1979). Clinical experience and the structure of memory. Proceedings of the Annual Conference on Research in Medical Education, 18, 214–218.
33.
O’ByrneK.ClarkR. E.MalakutiR. (1997). Expert and novice performance: Implications for clinical training. Educational Psychology Review, 9, 321–332.
34.
ParkhurstD. F. (2001). Statistical significance tests: Equivalence and reverse tests should reduce misinterpretation. BioScience, 51, 1051–1057.
35.
PatelV. L.GroenG. J.FrederiksenC. H. (1986). Differences between medical students and doctors in memory for clinical cases. Medical Education, 20, 3–9. doi:10.1111/j.1365-2923.1986.tb01033.x
36.
PattersonE. S.RothE. M.RenderM. L. (2005). Handoffs during nursing shift changes in acute care. In Proceedings of the Human Factors and Ergonomics Society 49th Annual Meeting (pp. 1057–1061). Santa Monica, CA: Human Factors and Ergonomics Society.
37.
PattersonE. S.RothE. M.WoodsD. D.ChowR.GomesJ. O. (2004). Handoff strategies in settings with high consequences for failure: Lessons for health care operations. International Journal for Quality in Health Care, 16, 125–132. doi:10.1093/intqhc/mzh026
38.
PattersonE. S.WearsR. L. (2010). Patient handoffs: Standardized and reliable measurement tools remain elusive. The Joint Commission Journal on Quality and Patient Safety, 36, 52–61.
39.
PetersonS. M.GursesA. P.ReganL. (2014). Resident to resident handoffs in the emergency department: An observational study. The Journal of Emergency Medicine, 47, 573–579. doi:10.1016/j.jemermed.2014.06.027
40.
PollackI.JohnsonL. B.KnaffP. R. (1959). Running memory span. Journal of Experimental Psychology, 57, 137–146. doi:10.1037/h0046137
41.
PothierD.MonteiroP.MooktiarM.ShawA. (2005). Pilot study to show the loss of important data in nursing handover. British Journal of Nursing, 14, 1034–1036. doi:10.12968/bjon.2005.14.20.20053
42.
PouloseB. K.RayW. A.ArbogastP. G.NeedlemanJ.BuerhausP. I.GriffinM. R.. . . HolzmanM. D. (2005). Resident work hour limits and patient safety. Annals of Surgery, 241, 847–860. doi:10.1097/01.sla.0000164075.18748.38
43.
Raduma-TomàsM. A.FlinR.YuleS.WilliamsD. (2011). Doctors’ handovers in hospitals: A literature review. BMJ Quality and Safety, 20, 128–133. doi:10.1136/bmjqs.2009.034389
44.
Rapid differential diagnosis. (2002). Philadelphia, PA: Lippincott Williams & Wilkins.
45.
RiesenbergL. A.LeitzschJ.MassucciJ. L.JaegerJ.RosenfeldJ. C.PatowC.. . . KarpovichK. P. (2009). Residents’ and attending physicians’ handoffs: A systematic review of the literature. Academic Medicine, 84, 1775–1787. doi:10.1097/ACM.0b013e3181bf51a6
46.
RusticusS. A.LovatoC. Y. (2011). Applying tests of equivalence for multiple group comparisons: Demonstration of the confidence interval approach. Practical Assessment, Research and Evaluation, 16, 1–6. Retrieved from http://www.pareonline.net/getvn.asp?v=16&n=7
47.
SchmidtH. G.BoshuizenP. A. (1993). On acquiring expertise in medicine. Educational Psychology Review, 5, 205–221. doi:10.1007/BF01323044
48.
SchmidtH. G.NormanG. R.BoshuizenP. A. (1990). A cognitive perspective on medical expertise: Theory and implications. Academic Medicine, 65, 611–621.
49.
SchumacherR. M.CzerwinskiM. P. (1992). Mental models and the acquisition of expert knowledge. In HoffmanR. R. (Ed.), The psychology of expertise: Cognitive research and empirical AI (pp. 61–92). Mahwah, NJ: Lawrence Erlbaum Associates.
50.
SinhaM.ShrikiJ.SalnessR.BlackburnP. A. (2007). Need for standardized sign-out in the emergency department: A survey of emergency medicine residency and pediatric emergency medicine fellowship program directors. Academic Emergency Medicine, 14, 192–196. doi:10.1197/j.aem.2006.09.048
51.
SnowM. P.ReisingJ. M.BarryT. P.HartstockD. C. (1999). Comparing new designs with baselines. Ergonomics in Design: The Quarterly of Human Factors Applications, 7, 28–33.
52.
StaggersN.ClarkL.BlazJ. W.KapsandoyS. (2011). Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: Insights from interviews and observations. Health Informatics Journal, 17, 209–223. doi:10.1177/1460458211405809.
53.
StaggersN.JenningsB. M. (2009). The content and context of change of shift report in medical and surgical units. Journal of Nursing Administration, 9, 393–398. doi:10.1097/NNA.0b013e3181b3b63a
54.
SteinE. S.GarlandD. J.MullerJ. K. (1999). Air-traffic controller memory: Capabilities, limitations and volatility. In WiseJ. A.HopkinV. D.GarlandD. J. (Eds.), Handbook of aviation human factors (pp. 21.1–21.39). Boca Raton, FL: CRC Press.
55.
StrachanM. W. J.SharmaS. K.HunterJ. A. A. (Eds.). (2012). Davidson’s 100 clinical cases. London: Churchill Livingstone Elsevier.
56.
TryonW. W. (2001). Evaluating statistical difference, equivalence, and indeterminacy using inferential confidence intervals: An integrated alternative method of conducting null hypotheses statistical tests. Psychological Methods, 6, 371–386. doi.org/10.1037/1082-989X.6.4.371
57.
VenturinoM. (1997). Interference and information organization in keeping track of continually changing information. Human Factors, 39, 532–539. doi:10.1518/001872097778667942
58.
VenturinoM.RomanoN. J.MillerS. L.MurphyM.CoffeyT. M. (1994). Dynamic memory: Keeping track of continually changing information. In Proceedings of the Human Factors and Ergonomics Society 38th Annual Meeting (pp. 1317–1321). Santa Monica, CA: Human Factors and Ergonomics Society.
59.
VidyarthiA. R.AroraV.SchnipperJ. L.WallS. D.WachterR. M. (2006). Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign-out. Medicine, 1, 257–266. doi:10.1002/jhm.103
60.
VidyarthiA. R.CoffeyM. (2015). Paperless handover: Are we ready?BMJ Quality and Safety, 25, 299–301. doi:10.1136/bmjqs-2015-005027
61.
WeingerM. B.SlagleJ. M.KuntzA. H.SchildcroutJ. S.BanerjeeA.MercaldoN. D.. . . FranceD. J. (2015). A multimodal intervention improves postanesthesia care unit handovers. Anesthesia and Analgesia, 121, 957–71. doi:10.1213/ANE.0000000000000670
62.
WellekS. (2010). Testing statistical hypotheses of equivalence and noninferiority (2nd ed.). Boca Raton, FL: Chapman & Hall/CRC Press.
63.
WittemanC. L. M.van den BerckenJ. H. L. (2007). Intermediate effects in psychodiagnostic classification. European Journal of Psychological Assessment, 23, 56–61. doi:10.1027/1015-5759.23.1.56.
64.
YangX. J.WickensC. D.ParkT.FongL.SiahK. T. H. (2015). Effects of information cost and accountability on medical residents’ information retrieval strategy and performance during prehandover preparation: Evidence from interview and simulation study. Human Factors, 57, 1459–1471. doi:10.1177/0018720815598889
65.
YntemaD. B. (1963). Keeping track of several things at once. Human Factors, 5, 7–17. doi:10.1177/001872086300500102
66.
YntemaD. B.MueserG. E. (1960). Remembering the present states of a number of variables. Journal of Experimental Psychology, 60, 18–22. doi:10.1037/h0040055
67.
YntemaD. B.MueserG. E. (1962). Keeping track of variables that have few or many states. Journal of Experimental Psychology, 63, 391–395. doi:10.1037/h0045706
