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. […]

[…] Weingart walks us through the OODA Loop (Observe, Orient, Decide, & Act). A simply framework for thinking. […]

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

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

[…] Weingart walks us through the OODA Loop (Observe, Orient, Decide, & Act). A simply framework for thinking. […]

[…] Scott Weingart’s lecture at SMACC-Chicago was on OODA loops and the supremacy of System I for resuscitation. Check more here […]

[…] EmCrit podcast in question, Episode 171, is an audiovisual presentation by Scott D. Weingart, MD (host of the EmCrit Podcast) in which he […]

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

[…] talk (minus the technical gremlins that plagued his SMACC keynote) on thinking about thinking: OODA Loops. […]

[…] Podcast 171 – OODA Loops […]

[…] ED intensivist podcaster covers this really nicely in this blog post which is well worth a listen http://emcrit.org/podcasts/ooda-loops/ […]

[…] Published June 14, 2015. 2. Weingart S. OODA Loops. EMCRIT. http://emcrit.org/podcasts/ooda-loops/. Published April 2, […]

[…] 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. […]