Context Matters in Expert Performance

Experts act in dynamic, open environments. In this paper, we combined quantitative and qualitative methods to compare the behavior of resident (trainee, presumably less-expert) and attending (licensed, presumably expert) emergency physician behavior, observed in their natural work environment. Though
consistent with insights from both laboratory and observational studies, our analyses allow us to quantify the experts’ constrained adaptation to variability in the work setting. We examined the effects of patient-, shift-, and system-level variation on expert behavior related to three different abstract task behaviors independent of medical complaint: establishing goals for patients, enacting goals for them,
and reducing uncertainty. Our analyses indicate that attending physicians adapted their goal establishment and uncertainty reduction behavior in response to contextual variation, whereas resident physicians did not. In contrast, attending and resident physicians both adjusted their goal enactment behavior, but in response to different contextual features. The comparison of residents’ overall lack of context sensitivity with expert behavior indicates that this skill develops subsequent to the formal
training period of residency. Our findings underscore the need to account for constrained expert behavioral adaptation across multiple instantiations of apparently similar problems in different contexts.