A quick guide to mental models
in Obstetrics
The first time we encounter a new situation
we attempt to process information from our environment
to understand what is happening.
Imagine you are the new senior house officer
on your first day on labour ward.
You are the first to respond to an emergency buzzer
and enter the delivery room.
On the CTG you notice a fetal bradycardia.
You have never encountered this situation before.
You do not have a mental model to draw from.
A novice has fewer and less rich mental models
and therefore has to spend more time and mental energy trying to comprehend and analyse
patterns of cues and information from their environment.
As we become more familiar with the situation,
its surroundings and the task to be undertaken
we create stored memories.
Imagine now you are the senior registrar
encountering the same scenario.
Because you have encountered this situation before multiple times
and have to developed the expertise to deal with the situation
your mental model is quickly activated.
You can initiate the typical actions that should occur in response to this scenario.
You are able to project what may occur in the future
if your plan of actions do not improve the situation.
As our expertise develops memories become stored mental models
that allow rapid pattern recognition from memory to facilitate situational awareness.
The resulting mental model produces expectations of a given situation
based on projections of our model
so we can understand what to typically expect and not expect.
An easy way to think of this is that
mental models provide a single step
between a recognised situation and the typical actions that occur in response to this.
Situations do not need to be an exact match
to a previous situation to be recognised.
There just needs to be enough similar features for a categorisation into a type to be made;
therefore if we are given inaccurate information
we can create or activate the wrong mental model.
If facts do not completely fit our mental model
we may bend them to make new fit a mental model which is wrong for the situation.
This is known as confirmation bias.
We therefore may wrongly reject, ignore or argue against any disconfirming cues
and this can lead to error.
Imagine you a called to a postpartum haemorrhage.
If you were incorrectly informed that the estimated blood loss was 500mls and ongoing
when in fact the estimated blood loss was 2000mls and ongoing;
this would activate the wrong mental model
as the series of typical actions and your
projection of the future in response to each situation differ significantly.
It is therefore important that to maintain situational awareness
we should regularly compare our mental model of the situation with the real world cues
that are occurring around us.
As healthcare professionals who work in teams
it is important we maintain situational awareness
by forming a shared mental model.
This ensures we all have the same understanding of the tasks in hand
and know who is responsible for each action.
On the labour ward this means
a multidisciplinary handover
so that we all receive the same information,
develop the same understanding,
the same plans and shared goals.
The labour ward board is
key in maintaining the shared mental model and situational awareness.
The board needs to be legible, up-to-date, accurate and concise.
A lack of shared mental model can contribute to adverse events.
By maintaining a shared mental model
we form expectations of who is responsible for each task
and in turn coordinate our actions
and adapt our behaviour to the demands of the task
and our other team members.
We therefore work together to form a shared goal
improving patient safety.