REBEL Cast

REBEL Rundown
























Key Points






Attention is a finite resource. Emergency medicine heavily taxes directed attention through interruptions, task switching, threat monitoring, and constant high-stakes decisions.

Nature gives directed attention a chance to recover. Natural environments engage “soft fascination”. That’s referring to the effortless, bottom-up attention- which allows our effortful, goal-directed attention systems to rest and recharge. 

Nature helps downshift the stress response and may reduce stress physiology, support parasympathetic activity, improve mood, and potentially improve emotional regulation.

Exposure can be brief to reset: even a 40-second view of greenery was associated with improved sustained attention in one study. Windows, plants, nature imagery, and brief outdoor breaks can make a difference. We can even design nature into healthcare.

Nature is a tool but not a treatment for broken systems. Nature exposure shouldn’t become another individual “wellness” obligation or substitute for fixing understaffing, moral injury, or other structural problems. And it’s also okay to go outside simply because being outside feels good, without optimizing anything.







Click here for Direct Download of the Podcast.







Previously Covered and Related Content:






REBEL MIND: Rest is not Sleep: 7 Dimensions of True Recovery







Introduction






Welcome to Rebel MIND, the podcast where we explore concepts that help us understand our minds so that we can take better care of our patients and ourselves. MIND stands for Mastering Internal Negativity during Difficulty. In this episode, Dr. Kim Bambach talks with emergency physician and neuroscientist Dr. Adrienne Taren as well as emergency physician and wilderness medicine expert Dr. Linda Keyes about the Nature Reset: how exposure to nature can restore attention, downshift our stress response, and help our brains recover from the cognitive demands of medicine. 
Dr. Adrienne Taren is an emergency medicine physician, clinical neuroscience faculty at the Laureate Institute for Brain Research, and adjunct professor at Oklahoma State University in medical education. She completed her MD/PhD (Neuroscience) at the University of Pittsburgh-Carnegie Mellon University. Her current research focuses on the neural circuit function underlying occupational traumatic stress symptoms in frontline healthcare workers.
Dr. Linda Keyes is a board-certified emergency physician, an adjunct professor at University of Colorado, Vice President of the International Society of Mountain Medicine, and past-president of the Wilderness Medical Society.  Since she was a medical student at Yale University, she has travelled the globe in pursuit of science. Dr. Keyes has partnered with researchers and clinicians on five continents to understand the effects of high altitude on the human body. She has authored of scores of original research articles and international guidelines on high-altitude medicine with a focus on women’s health and understanding acute mountain sickness. The mountains are her happy place. She believes in wilderness as medicine and in conservation for the health of the planet.






Cognitive Question






How can nature help us recover during or after a difficult shift?






How does nature exposure affect our cognition?






Clinical medicine keeps our brains in a near-constant state of cognitive and physiologic activation. We sustain attention despite interruptions, track multiple patients simultaneously, make high-stakes decisions with incomplete information, and continuously scan for threats and changes in our environment. This heavily taxes directed attention, the effortful, top-down attentional system we use to deliberately focus on a task. Importantly, attention is a finite neurobiological resource that fatigues with sustained use. 
Nature provides a unique form of cognitive recovery. Rather than demanding directed attention, natural environments engage what researchers call soft fascination: our attention is gently captured by things like moving leaves, shifting light, clouds, or water without requiring deliberate effort. This allows our directed attention systems an opportunity to rest and recover. Through soft fascination, nature gives our directed attention a break and creates space for the default mode network (DMN) which allows our minds to wander, consolidate memories, reflect, and make connections between ideas. Nature exposure may also help downregulate the physiologic stress response, with evidence suggesting reductions in cortisol and increased parasympathetic activity.
Importantly, meaningful nature exposure doesn’t necessarily require a hike in the wilderness.
The 40-Second Reset: In one study, participants who took a 40-second microbreak viewing a green roof subsequently demonstrated better sustained attention than those viewing a concrete roof. This suggests that even very brief nature exposures may have cognitive benefits.
Nature Between Shifts: Longer exposures may allow more complete autonomic downregulation, while outdoor light exposure and low-intensity movement may also support circadian regulation which is particularly relevant for shift workers.
Biophilic Design: We can also bring elements of nature into the environments where we work. Windows, natural light, plants, nature imagery, green walls, and accessible outdoor spaces may offer opportunities to incorporate restorative nature exposure into healthcare design.






Immediate Action Steps for Your Next Shift






**Step Outside**: Try to step outside on your next shift for even a few minutes. Even a brief dose of nature may help interrupt sustained directed attention.
**Look for Nature**: When getting outside isn’t possible, intentionally notice natural elements around you—a window view, trees, plants, daylight, or even nature imagery.
**Let Your Mind Wander**: Give yourself a few minutes with a cognitive task. Allow soft fascination to create space for reflection and the default mode network. 
**Write Yourself a Nature Rx**:What would be restorative to you? It might be a hike, a visit to your local botanical garden, or some time in a hammock just to enjoy yourself. 






Conclusion






Spending time in nature can provide a meaningful reset for attention and stress. Natural environments give directed attention a break while creating space for reflection and mind-wandering. Even brief, intentional doses of nature like stepping outside during a shift or taking a walk after work may help restore cognitive resources and reduce stress. Building small moments of nature into  your day can support your well-being and resilience. Nature isn’t a “fix-all” for system pressures and stressors like understaffing. We still need to advocate for better systems, but nature can be a cost-effective, beneficial, and relatively simple adjunct that can improve well-being. 






Clinical Bottom Line






Give yourself permission for a “nature reset” or “nature Rx”. An intentional dose of nature that can reduce stress, restore depleted attention, and replenish the cognitive resources we rely on to think and focus in challenging clinical environments. 






Post Peer Reviewed By: Mark Ramzy, DO (X/IG: @MRamzyDO)




















Further Reading






Lee et al.
40-second green roof views sustain attention: The role of micro-breaks in attention restoration. Journal of Environmental Psychology. 2015;42:182–9.

Ulrich, et al.
Stress Recovery During Exposure to Natural and Urban Environments. Journal of Environmental Psychology. 1991;11(3):201–30.

Kaplan, S. 
The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology. 1995;15(3):169–82.

Bergman, et al.
The cognitive benefits of interacting with nature. Psychological Science. 2008;19(12):1207–1212.
PMID: 19121124

Bratman, et al. 
Nature experience reduces rumination and subgenual prefrontal cortex activation. PNAS. 2015;112(28):8567–8572.
PMID: 26124129

White, et al. 
Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific Reports. 2019;9(1).
PMID: 31197192

The Wilderness Medical Society 

The International Society for Mountain Medicine 

The International Sisters High Altitude Research Expedition






Meet the Authors




























Kim Bambach, MD


Assistant Professor of Emergency Medicine, Assistant Residency Program Director


The Ohio State University Wexner Medical Center, Columbus, OH




















Adrienne Taren, MD, PhD


Emergency Medicine Physician, Associate Investigator at the Laureate Institute for Brain Research, Adjunct Professor, Oklahoma State University School of Medicine


Ascension St John’s, Tulsa, OK




















Linda Keyes, MD, FACEP


Adjunct Professor of Emergency Medicine, Past President of the Wilderness Medical Society, Vice President of the International Society of Mountain Medicine


University of Colorado Anschutz Medical Campus, Aurora, CO














Showing Slide 1 of 3






















































The post REBEL MIND – The Nature Reset appeared first on REBEL EM - Emergency Medicine Blog.

Key Points






Gamification in medical education can deeply engage learners and improve clinical skills.
Rapid Sequence alternates between game blocks, where learners act in clinical scenarios, and teaching blocks, where insights are shared.
True expertise is about developing effective cognitive strategies, not just accumulating knowledge.
Building mental models involves not just learning, but practicing decision-making in complex environments.
The learning environment should foster psychological safety and encourage growth through reflection and feedback.










REBEL Rundown






























Introduction






Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. 
In this episode, we introduce an innovative teaching tool called Rapid Sequence, aimed at revolutionizing how clinicians learn critical care through gamified experiences. With host Dr. Mark Ramzy, we invite Drs. Sarah Crager, and Ryan Ernst, to explore what it takes to become an expert and how gamification can transform learning in the medical field.






Cognitive Question






What does it truly mean to be an expert in emergency and critical care medicine?






What Is Rapid Sequence??






It’s a gamified clinical case simulation tool consisting of different “blocks” where you have individual learners that can work through cases in non-multiple choice format. 
You’re basically working on shifts, seeing multiple patients with your team.
There’s a cast of characters, interruptions, distractions, and you enter orders just like you would as if you were on shift, and then the cases advance to see the outcome of your decisions, good or bad
For more information check it out the Rapid Sequence website here. Use the following Promo Code: REBEL2026 at checkout page to receive a 20% off coupon

Figure 1: Screenshot from Rapid Sequence showing the initial dashboard






Learning Must Be An Active Not Passive Process






An important part of the process when acquiring new skills or information is making it an active process
It is not just passively listening, but actively participating, providing answers that aren’t multiple choice, and then responding to the outcome
This provides the engagement, and increases both the comprehension and retainability of new concepts
When you then apply those same concepts in future times of questioning (or in Rapid Sequence’s case “Blocks”) it helps expedite active recall through spaced repetition






How This Applies to the Emergency Department or ICU?






In high-stakes environments like the ED or ICU, clinicians must make fast, informed decisions often without complete data. Rapid Sequence provides a simulated space where clinicians can make mistakes without risk to real patients, receive feedback, and build the cognitive resilience needed for actual shifts, mirroring the chaotic nature of these departments.







Immediate Action Steps for Your Next Shift






**Embrace Gamified Learning**: Engage with or seek out platforms like Rapid Sequence that offer a practice ground for real-world medical scenarios.

**Develop Mental Models**: Start by breaking down complex cases into mental models that you can refer back to during your shift. 

**Prioritize Feedback and Reflection**: After each shift, allocate time to reflect on decisions and seek peer feedback to refine your cognitive strategies.

**Foster a Safe Learning Environment**: Encourage open discussions in your team where all members can express uncertainties and learn from one another.







Conclusion






Embracing innovative teaching methodologies such as gamification can lead to significant improvements in clinical education and practice. By integrating tools like Rapid Sequence in training, healthcare professionals can not only enhance their skills but also foster a culture of continuous learning and psychological safety.






Clinical Bottom Line






Effective medical education isn’t about rote memorization—it’s about developing the ability to think critically and adapt rapidly in ever-changing environments. Gamified tools offer an engaging path to achieve true expertise, ensuring clinicians are well-equipped to provide the best patient care possible.




















Meet the Authors




























Sara Crager, MD


Associate Professor, Critical Care and Emergency Medicine


UCLA, Los Angeles, CA









































Ryan Ernst, MD


Assistant Professor of Emergency Medicine, Section Chief of Global EM


University of Utah, Salt Lake City, UT














Showing Slide 1 of 2


























The post REBEL MIND – Teaching Towards Expertise with Gamification appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Rundown
























Key Points






Mastery Learning: A unique educational framework focusing on achieving high competence with minimal variability among learners.
Deliberate Practice: Involves learner-driven improvement, guided by expert feedback and breaking skills down into micro steps.
 Psychological Safety: Essential in mastery learning, allowing open feedback without fear or shame, enhancing growth. Embrace the productive struggle! 
Practice to Prevent Skill Decay and Improve Clinically: Application of mastery learning principles helps maintain high proficiency levels in both common and rare procedures.








Click here for Direct Download of the Podcast.







Previously Covered and Related Content:






REBEL MIND: The Dunning-Kruger Effect
REBEL MIND: Growth vs Fixed Mindset






Introduction






Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, host Dr. Kim Bambach chats with master educator Dr. Jennifer Yee about the science of performance through mastery learning and deliberate practice. 
Jennifer Yee, DO is an associate residency program director for OSU Emergency Medicine, the OSU EM director for assessment and evaluation, and an associate professor of emergency medicine.  She is from Akron, Ohio and earned her bachelor degree from Ohio University and her medical degree through the Ohio University College of Medicine. Her residency training was completed through Summa Akron City Hospital. After serving as chief resident, she completed a simulation medicine fellowship at Summa.
She completed Northwestern’s Designing and Implementing Simulation-Based Mastery-Learning Curricula, as well as Ohio State’s Master of Art’s program in Biomedical Education. She established a mastery-based procedural curriculum for OSU’s EM residency program before creation of an institution-wide mastery-based central venous catheter (CVC) curriculum for all housestaff expected to place CVCs during their clinical training.






Cognitive Question






How can use the principles of mastery learning as better benchmark for learning, performance, and patient safety? How can we practice deliberately?






What is Mastery Learning?






Unlike traditional clinical training, which is time-bound (e.g., “you are competent after a 3-year residency” or “after 10 chest tubes”), Mastery Learning is outcome-bound. The goal is to get every single learner from their unique baseline to an identical, objectively high level of performance with minimal variation. In this framework, learners start with a pre-brief, followed by baseline assessment, targeted debrief, deliberate practice, and a final evaluation using a checklist with a strict minimum passing standard (often set via methods like the Mastery Angoff). The mastery learning framework has been shown to improve patient safety.
The Northwestern Central Line Study: Research demonstrated that requiring residents to achieve a set benchmark on a simulator prior to clinical performance led to fewer needle passes, a decrease in mechanical complications (such as accidental arterial punctures), and a subsequent reduction in catheter-associated infection rates in the intensive care unit.
High-Acuity, Low-Occurrence (HALO) Procedures: Studies have demonstrated that for rare, critical procedures like emergency cricothyrotomies or transvenous pacing, baseline testing shows that very few trainees can meet a standard passing score initially. However, following targeted simulation training and deliberate practice, 100% of participants successfully achieved the minimum standard required to perform the procedure competently.







The Anatomy of Deliberate Practice






We often assume experience or confidence equals competence, but humans are notoriously poor self-assessors (plug for our Dunning-Kruger episode!). True deliberate practice isn’t just repeating a task for 10,000 hours; it is purposeful, learner-driven micro-skill improvement guided by an expert coach.
High-Quality Feedback: Avoid vague phrases like “good job” or “read more.” Effective coaching relies on strictly objective, real-time observations (e.g., “I am watching your needle angle. If you enter the skin more steeply, you will hit the vessel faster”).

Embrace a Growth Mindset: Stripping away your ego to be silently watched and critiqued  is inherently awkward. Normalize deliberate practice to create psychological safety. Overcoming this requires building an environment centered on patient safety, where baselines are treated as data points rather than judgments. True growth happens with the “productive struggle”.

Adaptive Expertise: True mastery means moving past a rigid checklist. It requires learners to understand the reasoning behind their actions and anticipate next steps, complications, and plot twists in real time.







Immediate Action Steps for Your Next Shift






**Reflect on Personal Goals**: Identify specific clinical skills you wish to improve and set objectives.  
**Seek Expert Feedback**: Find a mentor or coach for guided practice and objective feedback on your skills.  
**Cultivate Psychological Safety**: Foster an environment where discussing mistakes and receiving feedback is viewed as growth rather than criticism.  
**Practice Adaptively**: Introduce scenarios with atypical anatomy,  complications, plot twists to better prepare for real-world complexity. 






Conclusion






By focusing on specific skill improvement and welcoming constructive feedback, clinicians can build competence and confidence, ultimately improving performance and patient safety. Effective mastery learning hinges on creating psychologically safe learning environments, engaging in focused deliberate practice, and leveraging expert feedback. This approach can be applied to clinical procedural excellence as well as many other skills, including communication and team dynamics.






Clinical Bottom Line






Mastery learning is an outcome-bound framework to reach a high standard of performance and deliberate practice is the tool that can help you achieve that high performance through expert feedback.




















Further Reading






Barsuk JH, et al.
Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ Quality & Safety. Sep 2014.
PMID: 24632995

Klein MR, et al.
Developing simulation-based mastery learning curricula for emergency medicine skills training. AEM Education and Training. Jun 2025.
PMID: 40521339






Meet the Authors

















Kim Bambach, MD


Assistant Professor of Emergency Medicine


The Ohio State University Wexner Medical Center, Columbus, OH




















Jennifer Yee, DO


Associate Professor of Emergency Medicine, Associate Program Director


The Ohio State University Wexner Medical Center, Columbus, OH














Showing Slide 1 of 2





































The post REBEL MIND – Mastery Learning and Deliberate Practice appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Rundown

























Click here for Direct Download of the Podcast.







What Is Nitrous Oxide?






Nitrous Oxide (N2O) is a colorless, odorless inhaled anesthetic that has been used for centuries, particularly in the surgical world. Mechanistically, it can induce euphoria, anxiolysis, and intoxication via NMDA receptor antagonism.
During the late twentieth century, nitrous oxide was increasingly used recreationally due its accessibility and perceived benign nature.
The modern day slang term for nitrous oxide is “whippets” – which tends to refer to the canisters that contain this agent and are frequently used as whipped cream foaming agents.
Despite the legal nature and benign perception of nitrous, frequent use can lead to lasting and permanent neurologic effects.






How Nitrous Oxide Causes Toxicity






Nitrous oxide toxicity results from its ability to oxidize the cobalt moiety in Vitamin-B12, thus leading to a functional B12 deficiency, despite adequate consumption and absorption.1
Functioning B12 is needed as a cofactor for methionine synthase.2 This enzyme has two critical roles:
The conversion of 5-methyl tetrahydrofolate to tetrahydrofolate; tetrahydrofolate is essential for the synthesis of our DNA.
And the conversion of homocysteine to methionine; methionine is needed to maintain the integrity of the myelin sheath of our axons.
As a result, nitrous toxicity leads to: a megaloblastic anemia and demyelination of both the dorsal columns and the lateral corticospinal tracts (also known as subacute combined degeneration).






Clinical Manifestations of Nitrous Oxide Toxicity






These patients will have a combination of both upper and lower motor neuron symptoms due to demyelination of the dorsal columns, lateral corticospinal tracts, and peripheral nerves. As a result, the following may manifest:
Dorsal Columns: diminished sense of proprioception, vibration, and fine touch.
Lateral Corticospinal Tracts: upgoing plantars, hyperreflexia, weakness of voluntary distal muscle control
Peripheral Nerves: numbness/tingling and weakness in a glove and stocking pattern (symptoms that start initially in the feet and hands that progressively spread proximally to the ankles and wrists)
Taking all of this into account, patients may present with difficulty ambulating, positive Romberg sign, dysmetria (difficulty with finger to nose or heel to shin), upgoing Babinski reflex, and decreased strength and sensation in a glove and stocking pattern.






How to Diagnose Nitrous Oxide Neurotoxicity






History is key! As with a lot of pathologies in toxicology, identifying the exposure will expedite management.
A thorough neurologic exam will narrow the differential – with a particular focus to fine, peripheral motor and sensory deficits, dysmetria, proprioception, and ability to ambulate.
Magnetic resonance imaging of the spine may identify enhancement and/or edema of the dorsal columns, specifically on T2 weight axial imaging – sometimes referred to as the “inverted V” or “inverted rabbit ears appearance.”3
Serum B12 concentrations may be normal as the issue is with a functional deficiency as opposed to a vitamin absence. However, patients have elevated concentrations of both homocysteine and methylmalonic acid, both of which are metabolized in the presence of functional B12.






Management of Nitrous Oxide Toxicity






First and foremost, cessation of nitrous oxide abuse is crucial to limit/prevent toxicity.
While there is no universally agreed upon treatment regimen, supplementation with intramuscular B12 is recommended.
Approaches vary from daily or every other day injections until symptoms improve at which point injections can be spaced out to weekly and then monthly.
Physical and occupational therapy may be needed depending on the degree of functional debility.
It is important to note, that depending of the severity and chronicity of toxicity, some proportion of patients may not fully return to their baseline.






Take-Home Points






Though legal and seemingly benign, nitrous oxide abuse can lead to permanent neurologic dysfunction.
Nitrous oxide toxicity can affect the dorsal columns, lateral corticospinal tracts, and peripheral nerves.
Thus leading to a constellation of both upper and lower motor neuron deficits, particular in a glove and stocking pattern: deficits in proprioception and fine motor skills, positive Romberg, upgoing Babinski, peripheral numbness, tingling, and weakness.
Magnetic resonance imaging may identify symmetric high signal intensity in the dorsal columns.
Treatment includes B12 supplementation and physical/occupational therapy as needed.




















References






Long H. Chapter 81. Inhalants. In: Nelson LS, et al. Goldfrank’s Toxicologic Emergencies. 11th ed. New York: McGraw-Hill; 2019
Shah K, Murphy C. Nitrous Oxide Toxicity: Case Files of the Carolinas Medical Center Medical Toxicology Fellowship. J Med Toxicol. 2019 Oct;15(4):299-303. doi: 10.1007/s13181-019-00726-x. Epub 2019 Aug 6. PMID: 31388940; PMCID: PMC6825085.
Schmitz ZP, Hoffman RS. Magnetic resonance imaging in a patient with nitrous oxide-induced subacute combined degeneration of the spinal cord. Clin Toxicol (Phila). 2023 Nov;61(11):1006-1008. doi: 10.1080/15563650.2023.2286205. Epub 2023 Dec 19. PMID: 38060330.






Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)






Associate Editor
















Anand Swaminathan
MD, MPH

All Things REBEL EM
















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The post REBEL Core Cast—Nitrous Oxide Toxicity: Whippets and Neurologic Injury appeared first on REBEL EM - Emergency Medicine Blog.

REBEL Rundown
























Key Points






Human Factors: The unseen behaviors, distractions and considerations critical in emergency medicine and the ICU, influencing patient care beyond just medical knowledge.

System Design: Effective system design directly impacts team performance by creating environments that facilitate optimal decision-making.

Real-world Application: The application of human factors in healthcare leads to better team dynamics, reduced stress, and improved patient outcomes.

It’s Everyone’s Job: Building a culture of adaptability and openness to change can lead to better healthcare delivery, communication and interprofessional relationships

Practical Solutions: Start the conversation in departments for actionable and pragmatic changes to current healthcare environments to enhance practitioner efficiency and patient care quality.







Click here for Direct Download of the Podcast.







Previously Covered and Related Content:






REBEL EM: Titles Don’t Make Leaders
REBEL MIND: Moving from Junior to Senior Leadership in Emergency Care
REBEL MIND: The Dunning-Kruger Effect
REBEL MIND: Growth vs Fixed Mindset







Introduction






Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, host Dr. Mark Ramzy chats with special guests and master educators about the concept of human factors.
Dr. Chris Hicks is an emergency physician and trauma team leader at St. Michael’s Hospital in Toronto, Assistant Professor in the Department of Medicine at the University of Toronto, and co-founder of Advanced Performance Healthcare Design, a physician-led simulation and design group. Dr. Andrew Petrosoniak is an emergency physician and trauma team leader at St. Michael’s Hospital, and Medical Director of the Unity Health Toronto Simulation Program. He’s an Assistant Professor at the University of Toronto where his research focuses on simulation for systems and design improvement and optimizing the care of the bleeding patient. Along with Dr. Hicks, he’s also President of Advanced Performance Healthcare Design, a consulting firm that works with high-performance teams and uses simulation to enhance and design better healthcare spaces






Cognitive Question






How can the integration of human factors improve decision-making and performance in emergency medicine and critical care environments?






What are Human Factors?






In the context of healthcare, human factors encompass the interplay between humans, the systems they work within, and the effectiveness of their interactions. It includes elements like communication, system design, environmental conditions, and behavioral patterns affecting individual and team decision-making processes. It’s the collective impact of individual behaviors, team dynamics, and the physical environment on performance and outcomes. The aim is to eliminate issues arising from human error by creating systems and environments that naturally guide and support optimal performance.






How This Applies to the Emergency Department or ICU?






Efficient integration of human factors in high-pressure settings like the Emergency Department (ED) or Intensive Care Unit (ICU) helps mitigate the risks associated with stressful and chaotic environments.
By focusing on system designs that account for human behavior, healthcare professionals can reduce errors, enhance team coordination, and ultimately improve patient care.
This is crucial as teams are often required to make rapid, life-saving decisions in these environments
The design of clinical spaces can either hinder or help efficient care. Poorly arranged equipment or cluttered workspaces increase stress and impede decision-making.
Implementing structured design principles, such as dedicated equipment zones and clear visual cues, can streamline workflows and enhance team coordination
It actually helps pave the way for more efficiency because you end up “working smarter instead of harder”.It speaks directly to the Daniel Kahneman’s theory of Type 2 Thinking – which is a slow, analytical cognitive process requiring deliberate thought
We’ll likely create a whole dedicated episode to this but if you want to read more ahead of time on it, check out his book Thinking, Fast and Slow







Immediate Action Steps for Your Next Shift






**Assess Your Environment**: Take note of any clutter, noise, or layout issues in your workspace that could hinder optimal performance. Identify problem areas that could be optimized.

**Recognizable Hard-Stop** – Implement a “Stop-Point” Check for areas or issues that involve more than just patient safety (ie. workflow inefficiencies, sign-out, throughput, etc). Use predefined benchmarks during procedures to ensure clarity and efficiency.

**Foster Open Communication** – Encourage an environment where every team member feels comfortable discussing their thoughts and decisions without fear of judgment.

**Prototype Solutions** – Work with colleagues to identify problems and brainstorm quick, cost-effective solutions that could be tested in your department.

**Role Clarity and Preparation** – Ensure roles are clearly defined and team members are prepared with necessary resources readily available during high-stakes scenarios.

**Test and Refine** – Conduct quick pilot tests of new setups or processes during quieter times and gather feedback from your team.






Conclusion






Human factors play a critical role in shaping healthcare outcomes. Through structured system designs and attention to team dynamics, it is possible to reduce inefficiencies and enhance both patient care and provider well-being.
It requires a shift in perspective from seeing design and systems as separate from human behaviors, to seeing them as intricately linked. By incorporating these principles, healthcare professionals can create environments that inherently support better, safer, and more effective patient care.






Clinical Bottom Line






Incorporating human factors into healthcare isn’t just about preventing errors—it’s about creating an ecosystem where the healthcare team is empowered to perform at their best, even under the most challenging conditions. Implementing small, iterative changes can create a meaningful impact, paving the way for improved systems and processes.
This starts by redesigning systems and environments with human factors in mind, which can significantly improve both the efficiency of care delivery and the safety of the healthcare environment.




















Further Reading






Petrosoniak A, Hicks C.
M&M rounds 2.0: the future of performance improvement. CJEM. Feb 2025
PMID: 39979684
Petrosoniak A, Hicks C
Design, build, train, excel: Using simulation to create elite trauma systems. International Anesthesiology Clinics. Publish Ahead of Print.
Request the Article here
Petrosoniak A, Hicks C, et al.
Design Thinking-Informed Simulation: An Innovative Framework to Test, Evaluate, and Modify New Clinical Infrastructure. Simul Healthc. 2020 Jun 2020.
PMID: 32039946
Bleetman A, et al.
Human factors and error prevention in emergency medicine. Emerg Med J. May 2012
PMID: 21565880
Hayden EM, et al.
Human Factors and Simulation in Emergency Medicine. Acad Emerg Med. 2018 Feb 2018
PMID: 28925571






Meet the Authors

















Mark Ramzy, DO


Co-Editor-in-Chief


Cardiothoracic Intensivist and EM Attending
RWJBH / Rutgers Health, Newark, NJ









































Chris Hicks, MD, Med


Co-Founder of Advanced Performance


Assistant Professor of Emergency Medicine, University of Toronto, Canada



























Andrew Petrosoniak, MD, MSc


Co-Founder and President of Advanced Performance


Medical Director of Unity Health Toronto Simulation Program














Showing Slide 1 of 3





































The post REBEL MIND – Human Factors: The Hidden Architecture of Emergency & Critical Care Medicine appeared first on REBEL EM - Emergency Medicine Blog.