Trailhead to Triage: A Backcountry Ski Workshop for Sharpening Clinical Decision Making in Emergency Medicine Residents

Introduction Decision making in emergency medicine is influenced by cognitive bias, time pressure, uncertainty, and incomplete or unreliable feedback. Outdoor experiential learning may provide an environment in which these decision-making processes can be experienced and discussed in a practical context. Objective This study evaluated a novel outdoor experiential learning workshop designed to assess changes in emergency medicine residents’ self-reported awareness and understanding of decision-making science. Methods We conducted a prospective single-cohort study of emergency medicine residents participating in an outdoor experiential learning workshop. Residents completed a 15-min asynchronous video lecture during the 2 wk preceding the field day, followed by guided backcountry activities incorporating structured discussions of decision-making science and clinical parallels. Participants completed surveys before and after the workshop and a 3-mo follow-up survey. Descriptive statistics and independent-samples t tests were used to evaluate changes in self-reported decision-making awareness and understanding. Results Thirty residents completed the pre-intervention survey, 21 (70%) completed the post-intervention survey, and 22 (73%) completed the 3-mo follow-up. All measures demonstrated overall improvements from before to after the survey. The largest improvement was in understanding the importance of feedback in decision making (3.53±1.17 vs 4.38±0.74; P =0.001). This improvement maintained statistical significance at the longitudinal follow-up (3.53±1.17 vs 4.09±1.11; P =0.043), reflecting continued appreciation for the value of feedback in decision making. Conclusions Participants reported increased awareness and understanding of decision-making science following the workshop, with several measures remaining elevated at the 3-mo follow-up. Participants also reported high levels of enjoyment and perceived educational value.