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Effect of expertise on diagnosis accuracy, non-technical skills and thought processes during simulated high-fidelity anaesthetist scenarios
  1. Allistair P McRobert1,
  2. Simon J Mercer2,
  3. David Raw2,
  4. Jeff Goulding2,
  5. A Mark Williams3
  1. 1Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, Merseyside, UK
  2. 2Centre for Simulation and Patient Safety, Aintree University Hospitals NHS Foundation Trust, Merseyside, UK
  3. 3Department of Health, Kinesiology, and Recreation, The University of Utah, Salt Lake City, Utah, USA
  1. Correspondence to Dr Allistair P McRobert, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool L3 3AF, UK; a.p.mcrobert{at}


Background The expert performance approach can be used to examine expertise during representative field-based tasks, while collecting process-tracing measures such as think-aloud verbal reports. Collecting think-aloud verbal reports provides an insight into the cognitive mechanisms that support performance during tasks.

Method We examined the thought processes and performance of anaesthetists during simulated environments. Verbal reports of thinking and the anaesthetists’ non-technical skills (ANTS) were recorded to examine cognitive processes, non-technical behaviours and diagnosis accuracy during fully immersive, high-fidelity medical scenarios. Skilled (n=6) and less skilled (n=9) anaesthetists were instructed to respond to medical scenarios experienced in theatre.

Results Skilled participants demonstrated higher diagnosis accuracy and ANTS scores compared to less skilled participants. Furthermore, skilled participants engaged in deeper thinking and verbalised more evaluation, prediction and deep planning statements.

Conclusions The ability to employ an effective cognitive processing strategy, more efficient non-technical behaviours and superior diagnosis is associated with superior performance in skilled participants.

  • Decision-making
  • Anaesthesia
  • Verbal reports
  • Medical simulation

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  • Correction notice This paper has been amended since it was published Online First. The last author two first names were transposed, and his correct name is A Mark Williams.

  • Twitter Follow Allistair McRobert @allistair1980

  • Contributors MAW, DR and APM were responsible for the conception and design of the current study. DR, SJM, JG and APM collected the data and engaged in many hours of subsequent analysis and interpretation of these data. ARM was responsible for the initial draft of the article, revisions and approval of the final version submitted. MAW, DR and SJM were responsible for critically revising drafts for intellectual content and quality of submission.

  • Competing interests None declared.

  • Ethics approval Liverpool John Moores University .

  • Provenance and peer review Not commissioned; externally peer reviewed.

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