ABSTRACT
Emergency Medicine is a specialty that deals with the diagnosis and management of the full spectrum of acute illness or injury. It involves decision making in an often chaotic and unpredictable environment; the stakes are high and the data on which to base decisions is often unavailable or unrefined. The UK Emergency Department is also the proving ground for the junior doctor, an environment rich with patients and their “real life problems” – and thus opportunities for learning. In this difficult, time pressured, and stressful arena, junior doctors have their first experience of making important decisions about patient care, and thus practicing as real doctors.
This chapter explores the nature of decision making in Emergency Medicine, drawing on cognitive and narrative perspectives and learning theory from the literature. Qualitative data from a series of interviews with trainers and trainees is presented, illustrating the interwoven nature of practice and learning in the Emergency Department. Reframing decision making in Emergency Medicine as socially situated, this chapter highlights the essential role of workplace based learning in developing the skills and experience required, whilst differing perspectives provide insight for those supporting learning in this context.
