Preparing novice physicians for an unknown clinical future in healthcare is challenging. This is especially true for emergency departments (EDs) where the framework of adaptive expertise has gained traction. When medical graduates start residency in the ED, they must be supported in becoming adaptive experts. However, little is known about how residents can be supported in developing this adaptive expertise. This was a cognitive ethnographic study conducted at two Danish EDs. The data comprised 80 h of observations of 27 residents treating 32 geriatric patients. The purpose of this cognitive ethnographic study was to describe contextual factors that mediate how residents engage in adaptive practices when treating geriatric patients in the ED. Results showed that all residents fluidly engaged in both adaptive and routine practices, but they were challenged when engaging in adaptive practices in the face of uncertainty. Uncertainty was often observed when residents' workflows were disrupted. Furthermore, results highlighted how residents construed professional identity and how this affected their ability to shift between routine and adaptive practices. Residents reported that they thought that they were expected to perform on par with their more experienced physician colleagues. This negatively impacted their ability to tolerate uncertainty and hindered the performance of adaptive practices. Thus, aligning clinical uncertainty with the premises of clinical work, is imperative for residents to develop adaptive expertise.

中文翻译：

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探索住院医师的适应性专业知识：不确定性的（错过的）机会。

让新手医生为医疗保健领域未知的临床未来做好准备是一项挑战。对于急诊科 (ED) 来说尤其如此，适应性专业知识框架已获得广泛关注。当医学毕业生开始在急诊室实习时，必须支持他们成为适应性专家。然而，人们对如何支持居民发展这种适应性专业知识知之甚少。这是在两个丹麦急诊室进行的认知人种学研究。该数据包括 27 名居民治疗 32 名老年患者 80 小时的观察结果。这项认知人种学研究的目的是描述介导居民在急诊室治疗老年患者时如何进行适应性实践的背景因素。结果显示，所有居民都能流畅地进行适应性实践和常规实践，但在面对不确定性的情况下进行适应性实践时，他们遇到了挑战。当居民的工作流程被打乱时，经常会出现不确定性。此外，结果强调了居民如何解释职业身份，以及这如何影响他们在常规实践和适应性实践之间转换的能力。住院医师报告说，他们认为自己的表现应该与更有经验的医生同事相当。这对他们容忍不确定性的能力产生了负面影响，并阻碍了适应性实践的表现。因此，将临床不确定性与临床工作的前提相结合，对于住院医师发展适应性专业知识至关重要。