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  1. Allistair Paul McRobert1,
  2. Joe Causer1,
  3. John Vassiliadis2,
  4. Leonie Watterson2,
  5. James Kwan3,
  6. Mark A Williams4
  1. 1Department of Sport and Exercise Science, Liverpool John Moores University, Liverpool, Merseyside, UK
  2. 2Simulation Division, Clinical Skills and Simulation Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
  3. 3Discipline of Emergency Medicine, Sydney Medical School, Sydney, New South Wales, Australia
  4. 4Department of Sport Sciences, Brunel University, London, UK
  1. Correspondence to Allistair Paul McRobert, Department of Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, Merseyside L3 3AF, UK; a.p.mcrobert{at}


Background It is well documented that adaptations in cognitive processes with increasing skill levels support decision making in multiple domains. We examined skill-based differences in cognitive processes in emergency medicine physicians, and whether performance was significantly influenced by the removal of contextual information related to a patient's medical history.

Method Skilled (n=9) and less skilled (n=9) emergency medicine physicians responded to high-fidelity simulated scenarios under high- and low-context information conditions.

Results Skilled physicians demonstrated higher diagnostic accuracy irrespective of condition, and were less affected by the removal of context-specific information compared with less skilled physicians. The skilled physicians generated more options, and selected better quality options during diagnostic reasoning compared with less skilled counterparts. These cognitive processes were active irrespective of the level of context-specific information presented, although high-context information enhanced understanding of the patients’ symptoms resulting in higher diagnostic accuracy.

Conclusions Our findings have implications for scenario design and the manipulation of contextual information during simulation training.

  • Decision making
  • Emergency department
  • Simulation
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