Context Matters in Expert Performance

Document Type

Article

Publication Date

2022

Abstract

Experts act in dynamic, open environments. In this paper, we combined quantitative and qualitativemethods to compare the behavior of resident (trainee, presumably less-expert) and attending (licensed,presumably expert) emergency physician behavior, observed in their natural work environment. Thoughconsistent with insights from both laboratory and observational studies, our analyses allow us toquantify the experts’ constrained adaptation to variability in the work setting. We examined the effectsof patient-, shift-, and system-level variation on expert behavior related to three different abstract taskbehaviors independent of medical complaint: establishing goals for patients, enacting goals for them,and reducing uncertainty. Our analyses indicate that attending physicians adapted their goalestablishment and uncertainty reduction behavior in response to contextual variation, whereas residentphysicians did not. In contrast, attending and resident physicians both adjusted their goal enactmentbehavior, but in response to different contextual features. The comparison of residents’ overall lack ofcontext sensitivity with expert behavior indicates that this skill develops subsequent to the formaltraining period of residency. Our findings underscore the need to account for constrained expertbehavioral adaptation across multiple instantiations of apparently similar problems in different contexts.

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