My keynote lecture at SMACC-Chicago was on OODA loops and the supremacy of System I for resuscitation. The lecture was plagued by AV-wankers to the point that I thought the talk was a shambles. I am rerecording the lecture here for EMCrit and the SMACC site. I hope you enjoy–SDW.
The OODA Loop
OODA Loops and John Boyd
- I'm loathe to link to this, but this probably the most accessible description of OODA loops and Boyd Philosophy
Protocols May Cause Harm
Why I Hate ATLS
Guidelines are not for experts
#smaccUS Definition of physician: a healthcare worker authorised to work outside guidelines.-Peter Brindley Yes, observe, analyze, act!
— Manoj Singh (@Drmanoj_s) June 26, 2015
Articles
Croskerry's Loop
More to Read and Watch
- Physiology Inside the Loop
- More on OODA
- Klein Ted Talk
- Klein Strategies of Decision Making
- Croskerry Lecture Thinking Straight Lecture from SMACC
- System 1 vs. System 2
- All things John Boyd
The Book to Buy
Streetlights and Shadows: Searching for the Keys to Adaptive Decision Making
Update
Ugggggghhhh. I couldn't see my notes while rerecording and I said Boyd was a Navy Pilot, when of course he was air force. And it was the air force that has reportedly not embraced his work. Sorry Navy. Thanks, Jim!
The Slides
Audio Only Version
Updates:
ED Docs seem to perform as well as trauma teams
Now On to the Vodcast…
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Scott Weingart
Hey Scott,
Great post as always. I was wondering about your thoughts on using FOAM as an educational tool for illness scripts. I started First10 because I wanted to become an expert resuscitationist, but I didn’t want to just wait for experience – I wanted to simulate it. As a result, I stumbled on this concept of mental practice. The blog and mental practice seem to work really well in creating action scripts, and I do think they have a value in that role, but as you say, the action is often not the difficult part of this loop – its the orientation. I have been struggling with a way to integrate resuscitation diagnosis (observation, orientation, and hypothesis testing) into my posts for a while, but I have failed. Your examples in the podcast involve rounds and listening to experts think through cases as they are presented. Do you have any thoughts on how we might promote education around illness scripts using the FOAM format?
Cheers
Justin
Awesome! Learned about Boyd and Mig Alley during Urban Combatives training – the approach resonated with our experiences training against street attacks……Boyd’s approach also explains something I’ve seen during the research we are doing using anesthetic checklists. Inexperienced resuscitators under stress sometimes jump to using the pre induction checklist which can block their opportunity to use system 1 and recognize the illness patterns. So far Ive called it “checklist bias”. The checklist behaves like a emotional shelter for the fear they experience, but unfortunately the shelter also prevents them from being open to the rain of observations that is falling in the resuscitation room. A piece of paper with checkboxes can never replace the expertise of a trained and experienced doctor, however it can catch the inevitable rate of errors of omission and commission that occur in any human system.
[…] Weingart walks us through the OODA Loop (Observe, Orient, Decide, & Act). A simply framework for thinking. […]
Hey Scott! Or is it Maverick?
Great vodcast. I was fortunate to see this talk in Chicago and it was excellent however it seemed from the stage.
Great insight linking Crosskerry’s/Kahneman’s decision systems to the decision piece of Boyd’s loop.
John Boyd was an Air Force pilot not Navy. May be a small point but definitely important to some.
Cheers!
thanks Jim. Couldn’t see my notes–added a correction to the shownotes
[…] Weingart walks us through the OODA Loop (Observe, Orient, Decide, & Act). A simply framework for thinking. […]
Dr. Weingart, I am a 30 year medic, and I have spent the past eleven of those years as a tertiary-care center affiliated flight paramedic. I am also a career fire service battalion chief. When I have free time, I fly airplanes as an instrument rated private pilot. I routinely preach Klein’s concepts of recognition-primed decision-making, and utilize the Shewhart Cycle to frame process improvement discussions. I would like to point out what I feel is ATLS’s positive contribution to a trauma resuscitation. I have taught BTLS/ITLS/ PHTLS for years and have audited ATLS numerous times. The restrictive framework does provide a handrail for that inexperienced resuscitationist that is flirting with Mike Mallin’s Condition Gray. It also allows for the team to ‘Get Off The X’ in a coordinated, if not nimble manner. Most importantly, it allows the team leader to receive and process information in chronologically structured manner. This allows the leader to operate their System I cognitive processing effectively in the background. In the fire service we conduct a 360-degree walk-around and size-up of our structure fires. Young officers hate these! They want to charge in and put the fire out. So do I, but I don’t want… Read more »
Hey Scott, thanks for the shout out for the ETM Course. Have been reading up heavily on Croskerry et al’s work recently and we are about to update ETM to specifically to incorporate activities that focus on clinical decision making. Due to demand from more experienced clinicians we are also looking at putting together an advanced version of ETM where we can delve deeper into this, with sicker patients to draw out some of the more complex issues around decision making. ETM is still in it’s infancy, this year we’re running courses around Australia and in New Zealand, we are in discussions with a group in Toronto to get it happening in Canada and once we have our international systems in place we’ll bring it to the US! Cheers. Andy
JEFF WILLIAMS WRITES: Scott, Tried to post this under the comments for the OODA podcast but the internet ate my post, so I’ll try again in this format. I enjoyed that podcast and as always thought provoking. As a former airline pilot that has returned to medicine, I would like to throw in my $0.02 based on my observations and experiences in both fields. I’ll try to tie all of this together without War and Peace volume II. I’m sure most people realize that the airline industry is one of the most if not the most standardized, policies and procedures and checklisted institutions you will encounter. It is so standardized that as I flew in the cockpits of other airlines while begging rides to and from work, I began to realize that I could function in their environment with little to no additional training outside of learning a new aircraft. We all do this standard work all day every day and as I look back and after reading on the subject, this equates to making system to transition to system 1. In emergencies or non standard times, that’s important. Your podcasts on stress inoculation plays into this as well. In… Read more »
[…] Weingart walks us through the OODA Loop (Observe, Orient, Decide, & Act). A simply framework for thinking. […]
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Thanks for this great post. Just listened to a keylime podcast questioning the role of metacognition in medical education: http://www.royalcollege.ca/rcsite/documents/canmeds/keylime-ep109-jf-zwaan-et-al-e.pdf
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System 1 vs System 2 is a false dichotomy…
It all has to do with having mental models that gives a person the ability to use true understanding that gives the ability to use ‘active’ thinking very very fast…
In order to do this effectively the mental models needs to be designed from scratch, in the areas that matters.
Peter Fallenius
Peter,
the dichotomy is based on neurological anatomy, function and imaging. It is not a theoretical paradigm.
[…] chief information security officer (CISO) should be familiar with the concept of OODA loops[7]. In a cyber emergency, the people who act are their best […]
[…] For more about decision making in the resuscitation room, make sure to review Scott Weingart’s talk on OODA loops. […]
[…] Tankemodeller: skrivs ju en hel del om sådant fr.a på akutläkarbloggar, här dock från Farnam. Detta inlägg om ooda-loop är läsvärt, finns även ett avsnitt på emcrit om samma […]
[…] Weingart walks us through the OODA Loop (Observe, Orient, Decide, & Act). A simply framework for thinking. […]
[…] and then act” sounds like a modification of the OODA loop (observe, orient, decide, act) that Scott Weingart has made famous in emergency medicine. The central tenet to both of these systems is that we often fail to change our perspective when […]