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Reflecting on the "self" component of "the inevitable triad" around which this issue is built, the authors offer definitional considerations to consider the term's practical implications.

Study objective Clinical reasoning is considered a core competency of physicians. Yet there is a paucity of research on clinical reasoning specifically in emergency medicine, as highlighted in the literature. Methods We conducted a scoping review to examine the state of research on clinical reasoning in this specialty. Our team, composed of content and methodological experts, identified 3,763 articles in the literature, 95 of which were included. Results Most studies were published after 2000. Few studies focused on the cognitive processes involved in decisionmaking (ie, clinical reasoning). Of these, many confirmed findings from the general literature on clinical reasoning; specifically, the role of both intuitive and analytic processes. We categorized factors that influence decisionmaking into contextual, patient, and physician factors. Many studies focused on decisions in regard to investigations and admission. Test ordering is influenced by physicians’ experience, fear of litigation, and concerns about malpractice. Fear of litigation and malpractice also increases physicians’ propensity to admit patients. Context influences reasoning but findings pertaining to specific factors, such as patient flow and workload, were inconsistent. Conclusion Many studies used designs such as descriptive or correlational methods, limiting the strength of findings. Many gray areas persist, in which studies are either scarce or yield conflicting results. The findings of this scoping review should encourage us to intensify research in the field of emergency physicians’ clinical reasoning, particularly on the cognitive processes at play and the factors influencing them, using appropriate theoretical frameworks and more robust methods.

Contexte et objectif : L’apprentissage par problème (APP) représente l’une des innovations pédagogiques les plus marquantes en éducation des sciences de la santé au cours des cinq dernières décennies. Cette méthode a été adoptée à travers le monde par de nombreuses facultés de médecine et de médecine dentaire. À la Faculté de médecine dentaire de Casablanca nous avons introduit pour la première fois en 2010 l’APP dans la discipline d’odontologie pédiatrique. L’objectif de cette étude exploratoire est de documenter l’impact de cette méthode d’enseignement sur la performance académique, ainsi que la satisfaction des étudiants vis-à-vis de cette modalité. Méthodes : Les 85 étudiants de 4e année de la Faculté de médecine dentaire de Casablanca ont été divisés au cours de l’année universitaire 2011–2012 en deux groupes : un groupe ayant bénéficié de l’APP et un groupe contrôle exposé à un enseignement traditionnel. L’efficacité de l’APP a été mesurée en comparant le niveau de connaissances et la qualité du raisonnement des deux groupes. La satisfaction des étudiants a été mesurée à l’aide d’un questionnaire administré à la fin de la dernière séance d’APP. Résultats : La moyenne des scores était de 3,96/10 (écart type = 1,42) pour le groupe APP et de 3,23/10 (écart type = 1,38) pour le groupe contrôle (p Conclusion : Les résultats de cette étude plaident en faveur du développement de l’enseignement par APP en odontologie pédiatrique.

Objectif : La motivation en formation étant positivement corrélée à l’implication, à la persévérance et aux performances des apprenants, nous avons souhaité identifier le profil motivationnel des étudiants de la première promotion du diplôme d’études spécialisées (DES) en médecine d’urgence (MU), afin d’identifier des leviers motivationnels et d’actions pour les enseignants permettant d’améliorer la qualité de la formation. Matériel et méthodes : Nous avons mené une étude observationnelle descriptive multicentrique auprès des internes de première année de DES. Un questionnaire autoadministré en ligne a été envoyé à tous les internes. Cinq composantes de la motivation étaient explorées : la motivation intrinsèque (MI), la motivation extrinsèque (ME), la perception de valeur à la tâche (PVT), la perception de contrôlabilité (PCO) et le sentiment d’efficacité personnel (SEP). Résultats : Trois cent soixante-quinze internes de la promotion 2017–2018 ont répondu, soit un taux de participation de 81,5 %. La MI était nettement supérieure à laME (5,7 versus 3,8). Parmi les autres composantes de la motivation, la PVT était la plus élevée (5,9) devant la PCO (5,2) et le SEP (5,2). Il n’y avait pas de corrélation entre les différentes composantes de la motivation et le rang de classement à l’ECN (épreuves classantes nationales) ni selon le fait que la MU était ou non leur premier choix. Conclusion : La première promotion d’internes de MU obtient globalement des scores élevés de motivation. Deux leviers, sur lesquels les enseignants peuvent essayer d’agir prioritairement, ont été identifiés afin d’améliorer la motivation des internes.

Objectif : La prise en charge de l’arrêt cardiaque repose sur des recommandations internationales définissant notamment un schéma précis d’administration d’adrénaline. Chez les médecins exerçant la médecine d’urgence préhospitalière, il existe pourtant d’importantes variabilités interindividuelles concernant l’usage de l’adrénaline. L’objectif de cette étude était d’identifier les facteurs à l’origine du nonrespect des recommandations. Matériel et méthodes : Nous avons mené une étude qualitative prospective et multicentrique fondée sur des entretiens individuels semi-structurés auprès de médecins urgentistes. Après retranscription, ils ont fait l’objet d’une analyse thématique par le premier auteur. Résultats : Treize entretiens ont été menés. Ils ont permis de conclure qu’un non-respect des recommandations concernant l’administration de l’adrénaline était retrouvé chez sept médecins. Les interviewés expliquaient essentiellement ces écarts par une volonté de majorer les chances de succès de la réanimation (ce qui les conduisait à augmenter la posologie), ou bien en fin de réanimation, à vider la seringue d’adrénaline afin d’administrer un bolus final considéré comme la « dernière chance » pour le patient. Le poids du patient, les comorbidités et l’âge pouvaient également conduire à ajuster la posologie, tout comme le souhait de mettre en oeuvre une « réanimation d’attente », le niveau de connaissance des dernières recommandations par les praticiens ou leurs habitudes personnelles. Conclusion : Il existe, chez les médecins urgentistes, une importante variabilité dans l’usage de l’adrénaline lors de la prise en charge préhospitalière de l’arrêt cardiaque. Ces écarts de pratique imposent la mise en oeuvre de mesures destinées à favoriser le respect des recommandations scientifiques.

BACKGROUND In the health care environment, teamwork is paramount, especially when referring to patient safety. We are interested in recent and innovative solutions such as escape games, which is a type of adventure game that may be highly useful as an educational tool, potentially combining good communication skills with successful gamification. They involve teams of 5 to 10 individuals who are “locked” in the same room and must collaborate to solve puzzles while under pressure from a timer. OBJECTIVE The purpose of this paper was to describe the steps involved in creating and implementing an educational escape game. This tool can then be put into service or further developed by trainers who wish to use it for learning interprofessional collaboration. Therefore, we started with an experience of creating an educational escape game for emergency medicine teams. METHODS We chose to develop an educational escape game by using 6 successive steps. First, we built a team. Second, we chose the pedagogical objectives. Third, we gamified (switched from objectives to scenario). Next, we found the human and material resources needed. Thereafter, we designed briefing and debriefing. Lastly, we tested the game. RESULTS By following these 6 steps, we created the first ambulant educational escape game that teaches people, or nurses, doctors, and paramedics, working in emergency medicine to work as a team. CONCLUSIONS From a pedagogic point of view, this game may be a good tool for helping people in multidisciplinary fields (medical and paramedical teams) to learn how to work collaboratively and to communicate as a group. Above all, it seems to be an innovative tool that complements medical simulation–based learning and thus consolidates traditional education.

The COVID-19 pandemic has led to increased staffing needs in emergency departments. The question quickly arose as to whether it was appropriate to offer medical students the opportunity to assist this staff. The dilemma stems in part from the potential impact on their psychological well-being as well as their academic and clinical performances. We sought to determine the level of anxiety of medical students during the COVID-19 outbreak, and whether it was higher among the students who chose to return to the clinical setting, especially in first-line units (i.e., emergency departments and resuscitation units). In May 2020, 1180/1502 (78.5%) undergraduate medical students at Strasbourg Medical School (France) completed a questionnaire assessing their anxiety and clinical experience. A 2018 cohort of undergraduate medical students served as the baseline. The 2020 COVID cohort had higher rates of anxiety than the 2018 cohort. This difference was specifically observed in the students who chose not to return to the clinical setting during the crisis (N = 684, 59%). At linear regression, the main factors associated with anxiety were gender (p < 0.005) and perceived clinical activity personal conditions (p < 0.001). Employment site, including COVID first-line units, was not correlated with anxiety. Working in the clinical setting during the COVID-19 outbreak is not a risk factor for anxiety in medical students. Instead, it is an active coping strategy, suggesting that there are no barriers to allowing students to return to clinical settings during a pandemic, including first-line units, in terms of their psychological well-being.

Objectif : Determiner si les medecins exercant en services mobiles d'urgence et de reanimation (SMUR) ont des difficultes a remplir les certificats de deces et s'ils ressentent un besoin de formation.Materiels et methodes : Un questionnaire en ligne a ete envoye aux medecins des SMUR du Bas-Rhin. Il comprenait cinq situations cliniques courantes pour lesquelles il leur etait demande de rediger un certificat de deces.Resultats : Quarante et un des 67 medecins interroges ont repondu au questionnaire. Tous declaraient rediger couramment des certificats de deces en SMUR et eprouver des difficultes, la principale etant de notifier la cause du deces. Aucun medecin n'a su rediger sans erreur les cinq certificats. Respectivement 93 %, 64 %, 79 % et 71 % d'entre eux se trompaient au moins une fois lors du remplissage des cases « obstacle medico-legal », « obligation de mise en biere immediate », « obstacle au don du corps » et « prelevement en vue de rechercher la cause du deces ». 46 % enoncaient en outre « arret cardiorespiratoire » comme cause de deces. Pres d'un medecin sur deux rapportait ne jamais avoir beneficie de formation concernant la redaction des certificats de deces, dont le besoin moyen estime par echelle visuelle analogique etait de 5,6 sur 10.Conclusion : Les medecins exercant dans les SMUR du Bas-Rhin eprouvent d'importantes difficultes de redaction des certificats de deces, qui ne se traduisent pas toujours par un besoin de se former a cet acte, alors meme que les enjeux lies a celui-ci sont importants, en particulier sur le plan epidemiologique.

Objectif : Nous en savons tres peu sur la facon dont les medecins urgentistes raisonnent afin de prendre des decisions diagnostiques et therapeutiques. Les erreurs de raisonnement sont pourtant a l'origine de la majorite des erreurs diagnostiques survenant dans le cadre de la pratique clinique. Cet article presente a l'attention des praticiens et des enseignants de medecine d'urgence les principaux resultats d'une vaste etude qui a reuni entre 2010 et 2015 une equipe internationale de chercheurs issus de plusieurs disciplines, avec pour objectif de modeliser l'expertise en medecine d'urgence.Materiel et methodes : Nous avons mene une recherche observationnelle prospective multicentrique basee sur une approche qualitative. Des entretiens ont ete realises avec des medecins urgentistes experts jusqu'a saturation des donnees. Ils concernaient la prise en charge recente d'une situation d'urgence. Ils etaient sous-tendus par l'enregistrement video de la situation selon le propre point de vue des medecins.Resultats : Les medecins urgentistes interviewes utilisent essentiellement leur intuition, qui se forge tres rapidement, sur la base de deux a quatre informations cliniques et contextuelles. Ils trouvent souvent le bon diagnostic avant meme d'avoir rencontre le patient, mais attendent systematiquement les resultats des examens complementaires pour en etre certains. Ils sont loin d'etre « objectifs » dans la facon dont ils traitent les donnees de leur environnement et craignent toujours le pire.Conclusion : La modelisation de l'expertise en medecine d'urgence est susceptible d'aider les praticiens et les enseignants a mieux comprendre l'origine des erreurs de prise de decision dans le domaine de l'urgence.

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Artificial intelligence (AI) is often presented as the future of medical practice. The concept of AI was developed in the 1950s and has been defined as “the use of a computer to model intelligent behaviour with minimal human intervention.” 1 It is an alternative to human intelligence, particularly as a replacement for the diagnostic skill of physicians. For several years, the scientific literature and lay media have commented that nonhuman intelligence could equal or even exceed human intelligence in diagnostic tasks.2 Human intelligence is evident in the concept of clinical reasoning, 3 which has been defined as “the internal mental processes that a physician uses when approaching clinical situations.”4 This central component of physicians’ competence, once honed, allows them to make diagnoses.3 In medicine, clinical reasoning is often understood from the perspective of cognitive psychology’s information process theory.4 Artificial intelligence may refer to several different methods. Most AI diagnostics are based on machine learning algorithms that are “intelligent” enough to handle difficult and complex problems; algorithms rely on human intelligence for their creation.5 Recently, substantial progress has been made in this field through the resurgence of neural networks — a family of methods of machine learning — and particularly deep neural networks.6 Herein, we focus mainly on machine learning (specifically deep neural networks). We analyze the differences in the ways humans and AI approach diagnostic reasoning to argue that human reasoning will not become obsolete in medical diagnosis.

Resume Le raisonnement clinique est au cœur de la competence des professionnels de sante. L’etape diagnostique est notamment consideree comme cruciale dans la pratique medicale. Pour les superviseurs, il est donc necessaire de pouvoir identifier la demarche diagnostique des etudiants en medecine et de les accompagner dans le developpement de leur raisonnement. La methode SNAPPS, acronyme anglais correspondant aux premieres lettres des six etapes structurant la presentation de cas clinique (Summarize, Narrow, Analyse, Probe, Plan, Select), est une approche centree sur l’apprenant, qui est destinee a structurer la presentation de cas de patients par les etudiants, a faciliter l’expression de leur demarche diagnostique et a les aider a exprimer leur incertitude diagnostique, en respectant les contraintes de temps inherentes a l’activite des cliniciens. L’efficacite de la methode quant a sa capacite a explorer le raisonnement des etudiants en medecine et leur incertitude, et a promouvoir l’apprentissage autodirige a ete demontree par plusieurs travaux. Cette methode s’applique a toutes les specialites, a la fois en milieu liberal et hospitalier. Nous l’avons experimentee avec des etudiants de cinquieme et sixieme annee de medecine, en stage a l’institut de medecine legale de Strasbourg. La methode a ete utilisee dans le cadre des activites de supervision des autopsies, des examens de victimes et des expertises judiciaires. Elle a ete jugee tres utile par les etudiants qui plebiscitent son utilisation dans d’autres stages cliniques.

Problematique : La motivation est un concept qui fascine les chercheurs depuis de nombreuses decennies. Le milieu de l’education des professionnels de la sante s’y est interesse plus recemment, en questionnant le postulat implicitement admis jusqu’alors, selon lequel les etudiants en medecine ou plus generalement en sante sont forcement motives, en raison de leur engagement dans une formation tres professionnalisante debouchant sur un metier bien specifique. En effet, la motivation est un determinant majeur de la qualite des apprentissages et de la reussite. Un defaut de motivation peut expliquer bien des situations de decouragement, de desinteret ou d’abandon, que les enseignants constatent parfois chez les etudiants en medecine ou en sante, avec un sentiment d’impuissance ou de resignation. Exegese: Apres avoir decrit l’importance de la motivation pour l’apprentissage lie a la formation en sante, ce guide definit le concept de motivation en l’ancrant dans une approche sociocognitive. Dans une deuxieme partie, nous formulons un certain nombre de recommandations basees sur le « modele de la dynamique motivationnelle », qui offre une multitude et une variete de leviers afin d’agir positivement sur la motivation des etudiants.

Pour des raisons ethiques, didactiques ou pedagogiques, la simulation est une methode pedagogique largement utilisee dans l’enseignement des sciences de la sante. L’evolution recente des technologies et l’implication des hautes instances en charge de l’evaluation de la qualite des soins et de la securite des patients ont favorise son essor dans les cursus de formation initiale et continue des professionnels de sante. Apres avoir discute des enjeux et des principes d’utilisation de la simulation en sante, nous presenterons successivement les outils et methodes utilises, leur impact et les implications pour la formation des enseignants en sciences de la sante.

Out-of-hospital cardiac arrest occurs most often at home and often in the presence of family members of the patient who witness the event. Cardiopulmonary resuscitation (CPR) training of the next of kin of at-risk patients is thus potentially beneficial. The aim of our study was to document the prevalence of appropriate training among cardiac patients' cohabitants, as well as the motivations or obstacles to seeking training. 153 cohabitants of 127 patients who were hospitalized 1 year prior for confirmed coronary disease in a cardiology department (Paris, France) were interviewed using a structured questionnaire between October 2013 and March 2014. 38 % of interrogated cohabitants had received CPR training, and in two-thirds of the cases, their training was undertaken prior to the onset of the patient's heart disease. The training received was often a single instruction session. Half took place more than 5 years prior to the interview. For two-thirds of interrogated families, the reasons they sought training were related to professional or military duties. Training undertaken solely due to cohabitation with a patient affected by coronary disease represented only 3.5 % of the trained respondents. A lack of information regarding existing training programs and a lack of concrete propositions were given as the main barriers to seeking training. The families of patients who are at-risk for cardiac arrests that were interrogated in our study are inadequately trained in CPR. The creation of dedicated training programs at cardiac rehabilitation services for patients' next of kin or the use of alternative methods such as self-instruction kits could potentially remedy this situation.

Study objective Decisionmaking is influenced by the environment in which it takes place. The objective of our study was to explore the influence of the specific features of the emergency department (ED) environment on decisionmaking. In this paper, we specifically report on the way emergency physicians use their knowledge of their collaborators to make their decisions. Methods We conducted a qualitative study on emergency physicians recruited in 3 French hospitals. Physicians were equipped with a microcamera to record their clinical activity from their "own-point-of-view perspective." Semistructured interviews, based on viewing the video, were held with each physician after an actual clinical encounter with a patient. They were then analyzed thematically, using constant comparison and matrices, to identify the central themes. Results Fifteen expert emergency physicians were interviewed. Almost all of them reported using their knowledge of other health care professionals to assess the seriousness of the patient's overall condition (sometimes even before his or her arrival in the ED) to optimize the patient's treatment and to anticipate future care. Conclusion Emergency physicians interact with many other health care workers during the different stages of the patient's management. The many ways in which experts use their knowledge of other health care professionals to make decisions puts traditional conceptions of expert knowledge into perspective and opens avenues for future research.

Motivation is a major learning determinant. Motivated learners are more likely to engage with, persevere, and succeed in learning tasks. A simulated environment presents numerous advantages to motivate participants. It is referred to as a high-potential motivational tool. It is, however, necessary that the instructors enhance this tool with specific strategies in order to preserve the motivational effect beyond the initial attraction of learners for the innovative and original character of simulation, compared to their usual learning environment. The objectives of this chapter are to assist lecturers in the identification and implementation of these strategies.

International audience

Objectif : Le diplôme d’études spécialisées de médecine d’urgence a été créé en France à la rentrée universitaire 2017. En 2018, 21 postes ont été laissés vacants aux épreuves classantes nationales (ECN). Cette étude avait pour but d’identifier les raisons pour lesquelles les étudiants souhaitent ou non choisir la médecine d’urgence, ainsi que leur motivation pour cette spécialité. Matériel et méthodes : Nous avons mené une étude observationnelle prospective et monocentrique. Tous les étudiants du premier et du deuxième cycle de la faculté de médecine de Strasbourg ont été sollicités entre 2017 et en 2018. Des questionnaires ont été autoadministrés en présentiel ou en ligne afin de recueillir le type de spécialisation envisagé, le degré de motivation des répondants pour devenir médecin urgentiste et l’influence de différents facteurs motivationnels sur leur volonté ou non de choisir la médecine d’urgence aux ECN. Résultats : Sept pour cent des étudiants de première année de médecine souhaitent choisir la médecine d’urgence comme spécialité. Ils ne sont plus qu’un pour cent en sixième année. Le mode de vie est considéré de façon croissante entre le début et la fin des études prégraduées comme particulièrement dissuasif. La variété des pathologies rencontrées et le défi intellectuel sont des facteurs attractifs et stables. Conclusion : L’attractivité de la médecine d’urgence pourrait être renforcée en communiquant auprès des étudiants en médecine de deuxième cycle sur les facteurs sources de motivation et en poursuivant la réflexion visant à améliorer la qualité de vie des médecins urgentistes.

Clinical reasoning is a core skill for health professionals. It is developed via repeated exposure of students to diversified experiences and the opportunities provided to think about these experiences from the viewpoint of the reasoning processes involved and the knowledge used. In view of the numerous constraints inherent to clinical traineeships—theoretically a privileged clinical reasoning learning setting—using simulation as a tool for such learning meets educational needs and ethical obligations with regard to the patients. To achieve this, simulation instructors must consider the principles that favor the development of reasoning in a simulated environment. The objectives of this chapter are to assist instructors in the identification and implementation of these principles.

Objectives To determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician’s experience (≤10 vs >10 years). Methods Early thoracic CT Scan for Community-Acquired Pneumonia at the Emergency Department is an interventional study conducted from November 2011 to January 2013 in four French emergency departments, and included suspected patients with CAP. We analysed changes in emergency physician CAP diagnosis classification levels before and after CT scan; and their agreement with an adjudication committee. We performed univariate analysis to determine the factors associated with modifying the diagnosis classification level to be consistent with the radiologist’s CT scan interpretation. Results 319 suspected patients with CAP and 136 emergency physicians (75% less experienced with ≤10 years, 25% with >10 years of experience) were included. The percentage of patients whose classification was modified to become consistent with CT scan radiologist’s interpretation was higher among less-experienced than experienced emergency physicians (54.2% vs 40.2%; p=0.02). In univariate analysis, less emergency physician experience was the only factor associated with changing a classification to be consistent with the CT scan radiologist’s interpretation (OR 1.77, 95% CI 1.01 to 3.10, p=0.04). After CT scan, the agreement between emergency physicians and adjudication committee was moderate for less-experienced emergency physicians and slight for experienced emergency physicians (k=0.457 and k=0.196, respectively). After CT scan, less-experienced emergency physicians modified patient management significantly more than experienced emergency physicians (36.1% vs 21.7%, p=0.01). Conclusions In clinical practice, less-experienced emergency physicians were more likely to accurately modify their CAP diagnosis and patient management based on thoracic CT scan than more experienced emergency physicians. Trial registration number NCT01574066

The primary focus of research on the physician-patient relationship has been on patients' trust in their physicians. In this study, we explored physicians' trust in their patients. We held semi-structured interviews with expert emergency physicians concerning a patient they had just been managing. The physicians had been equipped with a head-mounted micro camera to film the encounter from an "own point of view perspective". The footage was used to stimulate recall during the interviews. Several participants made judgments on the reliability of their patients' accounts from the very beginning of the encounter. If accounts were not deemed reliable, participants implemented a variety of specific strategies in pursuing their history taking, i.e. checking for consistency by asking the same question at several points in the interview, cross-referencing information, questioning third-parties, examining the patient record, and systematically collecting data held to be objective. Our study raises the question of the influence of labeling patients as "reliable" or "unreliable" on their subsequent treatment in the emergency department. Further work is necessary to examine the accuracy of these judgments, the underlying cognitive processes (i.e. analytic versus intuitive) and their influence on decision-making.

Clinical reasoning is a core competency in medical practice. No study has explored clinical reasoning occurring before a clinical encounter, when physicians obtain preliminary information about the patient, and during the first seconds of the observation phase. This paper aims to understand what happens in emergency physicians' minds when they acquire initial information about a patient, and when they first meet a patient. The authors carried out in-depth interviews based on the video recordings of emergency situations filmed in an "own-point-of-view-perspective". 15 expert emergency physicians were interviewed between 2011 and 2012. Researchers analysed data using an interpretive approach based on thematic analysis and constant comparison. Almost all participants used a few critical pieces of information to generate hypotheses even before they actually met the patient. Pre-encounter hypotheses played a key role in the ensuing encounter by directing initial data gathering. Initial data, collected within the first few seconds of the encounter, included the patient's position on the stretcher, the way they had been prepared, their facial expression, their breathing, and their skin colour. Physicians also rapidly appraised the seriousness of the patient's overall condition, which determined their initial goals, i.e. initiating emergency treatment or pursuing the diagnostic investigation. The study brings new insights on what happens at the very beginning of the encounter between emergency physicians and patients. The results obtained from an innovative methodological approach open avenues for the development of clinical reasoning in learners.

Background Making diagnostic and therapeutic decisions is a critical activity among physicians. It relies on the ability of physicians to use cognitive processes and specific knowledge in the context of a clinical reasoning. This ability is a core competency in physicians, especially in the field of emergency medicine where the rate of diagnostic errors is high. Studies that explore medical decision-making in an authentic setting are increasing significantly. They are based on the use of qualitative methods which are applied at two separate times: 1) a video recording of the subject's actual activity in an authentic setting and 2) an interview with the subject, supported by the video recording. Traditionally, activity is recorded from an “external perspective”, i.e. a camera is positioned in the room in which the consultation takes place. This approach has many limits, both technical and with respect to the validity of the data collected. Objectives The article aims at 1) describing how decision-making is currently being studied, especially from a qualitative standpoint, and the reasons why new methods are needed, and 2) reporting how we used an original, innovative approach to study decision-making in the field of emergency medicine and findings from these studies to guide further the use of this method. The method consists in recording the subject's activity from his own-point-of-view, by fixing a microcamera on his temple or the branch of his glasses. An interview is then held on the basis of this recording, so that the subject being interviewed can relive the situation, in order to facilitate the explanation of his reasoning with respect to his decisions and actions. Results and conclusions We describe how this method has been used successfully in investigating medical decision-making in emergency medicine. We provide details on how to use it optimally, taking into account the constraints associated with the practice of emergency medicine, and the benefits in the study of clinical reasoning. The ‘own-point-of-view’ video technique is a promising method to study clinical decision-making in emergency medicine. It is a powerful tool to stimulate recall and help physicians make their reasoning explicit, thanks to a greater psychological immersion. This article is protected by copyright. All rights reserved.

Study objective The ability to make a diagnosis is a crucial skill in emergency medicine. Little is known about the way emergency physicians reach a diagnosis. This study aims to identify how and when, during the initial patient examination, emergency physicians generate and evaluate diagnostic hypotheses. Methods We carried out a qualitative research project based on semistructured interviews with emergency physicians. The interviews concerned management of an emergency situation during routine medical practice. They were associated with viewing the video recording of emergency situations filmed in an "own-point-of-view" perspective. Results The emergency physicians generated an average of 5 diagnostic hypotheses. Most of these hypotheses were generated before meeting the patient or within the first 5 minutes of the meeting. The hypotheses were then rank ordered within the context of a verification procedure based on identifying key information. These tasks were usually accomplished without conscious effort. No hypothesis was completely confirmed or refuted until the results of investigations were available. Conclusion The generation and rank ordering of diagnostic hypotheses is based on the activation of cognitive processes, enabling expert emergency physicians to process environmental information and link it to past experiences. The physicians seemed to strive to avoid the risk of error by remaining aware of the possibility of alternative hypotheses as long as they did not have the results of investigations. Understanding the diagnostic process used by emergency physicians provides interesting ideas for training residents in a specialty in which the prevalence of reasoning errors leading to incorrect diagnoses is high.