Proactive versus reactive: the effect of experience on performance in a critical care simulator

Background We sought to study the cognitive performance of residents in a critical care patient simulator. Methods Residents in general surgery and emergency medicine were recruited to participate in the study. Subjects were read a morning report and presented with written data for 4 critical care patients. The subjects were evaluated on completing essential clinical tasks, cognitive errors, and directionality of reasoning. Results Nine residents completed the study. Months of clinical residency training did not significantly affect performance. Residents with more than 10 weeks of intensive care unit (ICU) experience (EXP) made significantly fewer cognitive errors than those with less than 10 weeks of ICU experience (N-I) (EXP: .75 ± .96 vs N-I: 7 ± 5.6 errors per subject, P < .05). An unexpected finding was that EXP performed far more proactive actions than N-I (EXP: 21.8 ± 9.9/subject vs N-I: 5.7 ± .6/subjects, P < .01). Conclusions A unique finding was that residents with more than 10 weeks of ICU experience initiated a large number of proactive actions immediately following presentation of patient information, while N-I rarely performed these actions. In addition, residents with this degree of experience committed significantly fewer cognitive errors. These differences might play a role in efficiency, cost, and overall outcome in the care of ICU patients.