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Bringing team science to the ambulatory diagnostic process: how do patients and clinicians develop shared mental models?

  • Aubrey Samost-Williams ORCID logo EMAIL logo , Eric J. Thomas , Olivia Lounsbury , Scott I. Tannenbaum , Eduardo Salas and Sigall K. Bell
Published/Copyright: October 21, 2024
Diagnosis
From the journal Diagnosis Volume 12 Issue 1

Abstract

The ambulatory diagnostic process is potentially complex, resulting in faulty communication, lost information, and a lack of team coordination. Patients and families have a unique position in the ambulatory diagnostic team, holding privileged information about their clinical conditions and serving as the connecting thread across multiple healthcare encounters. While experts advocate for engaging patients as diagnostic team members, operationalizing patient engagement has been challenging. The team science literature links improved team performance with shared mental models, a concept reflecting the team’s commonly held knowledge about the tasks to be done and the expertise of each team member. Despite their proven potential to improve team performance and outcomes in other settings, shared mental models remain underexplored in healthcare. In this manuscript, we review the literature on shared mental models, applying that knowledge to the ambulatory diagnostic process. We consider the role of patients in the diagnostic team and adapt the five-factor model of shared mental models to develop a framework for patient-clinician diagnostic shared mental models. We conclude with research priorities. Development, maintenance, and use of shared mental models of the diagnostic process amongst patients, families, and clinicians may increase patient/family engagement, improve diagnostic team performance, and promote diagnostic safety.

Keywords: shared mental models; ambulatory diagnostic safety; teamwork; patient engagement
Corresponding Author: Aubrey Samost-Williams, MD, MS, Assistant Professor, Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 5.020, Houston, TX, 77030, USA, E-mail:

Funding source: National Institute of General Medical Sciences

Award Identifier / Grant number: 5T32GM135118-02

Funding source: Agency for Healthcare Research and Quality

Award Identifier / Grant number: 5R18HS029362-02

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: Aubrey Samost-Williams was funded by the National Institutes of Health grant #5T32GM135118-02. Eric Thomas and Sigall Bell were funded by the Agency for Health Care Research and Quality grant #5R18HS029362-02.

  7. Data availability: Not applicable.

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Received: 2024-07-03
Accepted: 2024-09-23
Published Online: 2024-10-21

© 2024 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Systematic review and meta-analysis of observational studies evaluating glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCHL1) as blood biomarkers of mild acute traumatic brain injury (mTBI) or sport-related concussion (SRC) in adult subjects
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  6. Bringing team science to the ambulatory diagnostic process: how do patients and clinicians develop shared mental models?
  7. Vitamin D assay and supplementation: still debatable issues
  8. Original Articles
  9. Developing a framework for understanding diagnostic reconciliation based on evidence review, stakeholder engagement, and practice evaluation
  10. Validity and reliability of Brier scoring for assessment of probabilistic diagnostic reasoning
  11. Impact of disclosing a working diagnosis during simulated patient handoff presentation in the emergency department: correctness matters
  12. Implementation of a bundle to improve diagnosis in hospitalized patients: lessons learned
  13. Time pressure in diagnosing written clinical cases: an experimental study on time constraints and perceived time pressure
  14. A decision support system to increase the compliance of diagnostic imaging examinations with imaging guidelines: focused on cerebrovascular diseases
  15. Bridging the divide: addressing discrepancies between clinical guidelines, policy guidelines, and biomarker utilization
  16. Unnecessary repetitions of C-reactive protein and leukocyte count at the emergency department observation unit contribute to higher hospital admission rates
  17. Quality control of ultrasonography markers for Down’s syndrome screening: a retrospective study by the laboratory
  18. Short Communications
  19. Unclassified green dots on nucleated red blood cells (nRBC) plot in DxH900 from a patient with hyperviscosity syndrome
  20. Bayesian intelligence for medical diagnosis: a pilot study on patient disposition for emergency medicine chest pain
  21. Case Report – Lessons in Clinical Reasoning
  22. A delayed diagnosis of hyperthyroidism in a patient with persistent vomiting in the presence of Chiari type 1 malformation
  23. Letters to the Editor
  24. Mpox (monkeypox) diagnostic kits – September 2024
  25. Barriers to diagnostic error reduction in Japan
  26. Superwarfarin poisoning: a challenging diagnosis
  27. Reviewer Acknowledgment
  28. Reviewer Acknowledgment
DOI:  doi.org/10.1515/dx-2024-0115
Keywords for this article
shared mental models; ambulatory diagnostic safety; teamwork; patient engagement

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Systematic review and meta-analysis of observational studies evaluating glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCHL1) as blood biomarkers of mild acute traumatic brain injury (mTBI) or sport-related concussion (SRC) in adult subjects
  4. Opinion Papers
  5. From stable teamwork to dynamic teaming in the ambulatory care diagnostic process
  6. Bringing team science to the ambulatory diagnostic process: how do patients and clinicians develop shared mental models?
  7. Vitamin D assay and supplementation: still debatable issues
  8. Original Articles
  9. Developing a framework for understanding diagnostic reconciliation based on evidence review, stakeholder engagement, and practice evaluation
  10. Validity and reliability of Brier scoring for assessment of probabilistic diagnostic reasoning
  11. Impact of disclosing a working diagnosis during simulated patient handoff presentation in the emergency department: correctness matters
  12. Implementation of a bundle to improve diagnosis in hospitalized patients: lessons learned
  13. Time pressure in diagnosing written clinical cases: an experimental study on time constraints and perceived time pressure
  14. A decision support system to increase the compliance of diagnostic imaging examinations with imaging guidelines: focused on cerebrovascular diseases
  15. Bridging the divide: addressing discrepancies between clinical guidelines, policy guidelines, and biomarker utilization
  16. Unnecessary repetitions of C-reactive protein and leukocyte count at the emergency department observation unit contribute to higher hospital admission rates
  17. Quality control of ultrasonography markers for Down’s syndrome screening: a retrospective study by the laboratory
  18. Short Communications
  19. Unclassified green dots on nucleated red blood cells (nRBC) plot in DxH900 from a patient with hyperviscosity syndrome
  20. Bayesian intelligence for medical diagnosis: a pilot study on patient disposition for emergency medicine chest pain
  21. Case Report – Lessons in Clinical Reasoning
  22. A delayed diagnosis of hyperthyroidism in a patient with persistent vomiting in the presence of Chiari type 1 malformation
  23. Letters to the Editor
  24. Mpox (monkeypox) diagnostic kits – September 2024
  25. Barriers to diagnostic error reduction in Japan
  26. Superwarfarin poisoning: a challenging diagnosis
  27. Reviewer Acknowledgment
  28. Reviewer Acknowledgment
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