Emergency on-call duties have been highlighted as a key stress factor in newly qualified physiotherapists whose job performance may be affected. The concept of stress relating to on-call work, the general lack of interest or confidence in the respiratory on-call field, and subsequent difficulties with recruitment and retention, pose a difficult problem for managers of services responsible for the maintenance of a competent workforce and a high standard of service provision. Differences in novice and expert physiotherapists’ patient management and clinical reasoning strategies have been previously examined in orthopaedic, neurology, domiciliary and cardiorespiratory fields. However, no such investigations have been undertaken in the field of emergency on-call. The purpose of this study was to determine if differences existed between novice and expert physiotherapists who had by definition differing levels of context-related experience within the emergency on-call environment. This study also aimed to consider what factors may influence their physiotherapy intervention for an acute cardiorespiratory patient. A purpose-designed vignette-based postal questionnaire was administered to 26 emergency on-call providers in New Zealand. The questionnaire sought demographic data, investigated participants’ attitudes towards emergency on-call service provision and presented a vignette-based clinical scenario which asked questions throughout an evolving clinical case scenario. Analysis was performed using the computer software package for social sciences, SPSS for Windows (version 14), results were analysed using descriptive statistics, and significance testing was performed using non-parametric methods. A good response rate was achieved (78.8%; n = 56). Statistically significant differences between novices and experts were determined in scores for confidence, stress, and support required, also in the factors affecting stress levels. Novices are less confident (p = < .0001), more stressed (p = < .001) and require more support than experts (p = < .001). Factors which influenced both novice, and to a lesser extent, expert stress levels when working as emergency on-call physiotherapists, were established. A relationship was determined between confidence and level of support required (r = -.65; p = < .001); confidence and amount of stress felt (r = -.58; p = < .001); and support required and stress felt (r = .47; p = < .001). Some differences were demonstrated between novice and expert physiotherapists in their answers to a clinical case scenario. Although these were not statistically significant, a trend was noted which may reflect the different clinical reasoning strategies of these physiotherapists. There is a need for novices to gain the type of experience which includes independent problem solving and guided reflection; the use of vignette-based case studies may be one method which could be further exploited. The profession is responsible for the provision of better ways to meet the needs of our future emergency on-call workforce. If this is not achieved, other professional groups will be required to fill the gaps and physiotherapy; particularly cardiorespiratory physiotherapy will lose out.

Emergency on-call duties have been highlighted as a key stress factor in newly qualified physiotherapists whose job performance may be affected. The concept of stress relating to on-call work, the general lack of interest or confidence in the respiratory on-call field, and subsequent difficulties with recruitment and retention, pose a difficult problem for managers of services responsible for the maintenance of a competent workforce and a high standard of service provision. Differences in novice and expert physiotherapists’ patient management and clinical reasoning strategies have been previously examined in orthopaedic, neurology, domiciliary and cardiorespiratory fields. However, no such investigations have been undertaken in the field of emergency on-call. The purpose of this study was to determine if differences existed between novice and expert physiotherapists who had by definition differing levels of context-related experience within the emergency on-call environment. This study also aimed to consider what factors may influence their physiotherapy intervention for an acute cardiorespiratory patient. A purpose-designed vignette-based postal questionnaire was administered to 26 emergency on-call providers in New Zealand. The questionnaire sought demographic data, investigated participants’ attitudes towards emergency on-call service provision and presented a vignette-based clinical scenario which asked questions throughout an evolving clinical case scenario. Analysis was performed using the computer software package for social sciences, SPSS for Windows (version 14), results were analysed using descriptive statistics, and significance testing was performed using non-parametric methods. A good response rate was achieved (78.8%; n = 56). Statistically significant differences between novices and experts were determined in scores for confidence, stress, and support required, also in the factors affecting stress levels. Novices are less confident (p = < .0001), more stressed (p = < .001) and require more support than experts (p = < .001). Factors which influenced both novice, and to a lesser extent, expert stress levels when working as emergency on-call physiotherapists, were established. A relationship was determined between confidence and level of support required (r = -.65; p = < .001); confidence and amount of stress felt (r = -.58; p = < .001); and support required and stress felt (r = .47; p = < .001). Some differences were demonstrated between novice and expert physiotherapists in their answers to a clinical case scenario. Although these were not statistically significant, a trend was noted which may reflect the different clinical reasoning strategies of these physiotherapists. There is a need for novices to gain the type of experience which includes independent problem solving and guided reflection; the use of vignette-based case studies may be one method which could be further exploited. The profession is responsible for the provision of better ways to meet the needs of our future emergency on-call workforce. If this is not achieved, other professional groups will be required to fill the gaps and physiotherapy; particularly cardiorespiratory physiotherapy will lose out.

La régulation médicale est une sous-discipline de la Médecine d'Urgence. La tâche du médecin régulateur s'apparente à la gestion d'un environnement dynamique à risque. SimulPhone© est un nouveau type d'outil permettant de simuler un appel. L'objet de ce travail est de construire un outil d'apprentissage par simulation à partir des données de l’ingénierie cognitive. A partir de scénarios de simulation, nous avons conduit cinq expériences. La première expérience permet d'étudier la faisabilité et de déterminer les axes d'analyse. La deuxième étude teste la validité et la fidélité du simulateur. Nous avons ensuite établi un score de performance cognitive. La troisième expérience détermine un sous-groupe d'experts grâce au score précédent. Leur comportement est analysé pour chaque scénario afin d'établir un guide pédagogique. La quatrième expérience étudie l'impact de la dominance sur le raisonnement et la décision. La dernière expérience analyse les apprentissages au cours d'une journée de simulation. Les résultats des expériences retrouvent (1) un réalisme important du simulateur. Nous avons démontré (2) la validité, la fidélité intra et inter-observateur du simulateur. Ces résultats ne sont pas modifiés par la profession du participant. Dans la troisième expérience, la sous-population d'experts nous permet de construire un guide pédagogique. Dans l'arrêt cardiorespiratoire, nous avons observé une limitation de la charge cognitive de l'appelant pour lui faire réaliser un massage cardiaque par téléphone. Nous avons démontré (4) l'impact des informations paraverbales sur la décision des régulateurs. Enfin, au cours d'une journée de formation (5), nous avons observé une réactivation des connaissances antérieures. / Emergency Medical Call Center is a part of Emergency Medicine. Emergency Medical Dispatching Physician (EMDP) deals with a critical dynamic environment. SimulPhone© is a novel simulator for call center. The aim of this work is to build a training simulation tool from the cognitive engineering. With simulation scenarios, we conducted five experiments. For the first one, we tested the feasibility and determined the fields of analysis. The second study tested the validity and reliability of the simulator. We then established a cognitive performance score. The third experiment determined a subgroup with experts with the previous score. Their behaviors were analyzed for each scenario in order to establish an educational guide. The fourth experiment studied the impact of dominance on the reasoning and decision. The last one analysed the learning experience during a simulation day. Our results found (1) a significant realism of the simulator. We have demonstrated (2) the validity, reliability, intra and inter-observer simulator. These results are not affected by the profession of the participants. In the third experiment, the subgroup of experts allowed us to build an educational guide. In cardiac arrest, we observed a cognitive underload from subject to the caller in order to realise a telephone cardiopulmonary resuscitation. We have demonstrated (4) the impact of paraverbal informations on the decision of EMDP. At least, during a training session (5), we observed previous knowledge awakening.