Healthcare Practitioners and Cue Recognition

By Bonnie Hutchinson

What separates expert Healthcare Practitioners from novices?

Experience, of course. But experience is not the same as expertise.

One specific ability stands out as the difference between expert and non-expert Healthcare Practitioners: cue recognition.

That ability is present, not only among expert Healthcare Practitioners but among experts in many fields. Pick a field, any field – aviation, sports, social work, finance, musical performance, any of the trades. Those who have the greatest expertise have mastered cue recognition in their particular field. They notice details and nuances that others miss, and they recognize the meaning of what they notice.

A few examples

A few quick (okay, simplistic!) examples of cues and cue recognition, and then we’ll get to what’s been observed among expert Healthcare Practitioners.

Cues: sights, sounds, touches, tastes and smells that have meaning.

Cue recognition: noticing the cues and grasping what they mean.

  • Cue: The sight of a blinking light on the truck dash;
    Cue recognition: time to check the oil level.
  • Cue: The sound of the back door opening;
    Cue recognition: your partner is home.
  • Cue: Uncomfortably cool temperature in a room;
    Cue recognition: time to check the thermostat.
  • Cue: The taste of a burger seems “off.”
    Cue recognition: The ground meat may be past its “best before” date.
  • Cue: The smell of coffee.
    Cue recognition: A favourite person is bringing you your morning coffee.

Pattern recognition: noticing that when certain cues cluster together, there’s a larger meaning. For example…


  • Sights: darker clouds overhead; trees beginning to sway.
  • Sounds: wind beginning to make noise; clatter of objects being blown around.
  • Touch: air is cooler than it was; feeling pelted with dust particles.
  • Smell: a damp smell in the air.

Pattern recognition: the cluster of cues suggests a rainstorm is about to begin.

The relevance to Healthcare Practitioners is…

The examples above are simplistic. Health practices are not simplistic. The relevance is that no matter what your particular health profession, cue recognition and pattern recognition are at the centre of expert practice.

Every health practitioner’s practice begins with assessment and diagnosis. The essence of assessment and diagnosis is the ability to notice what cues are apparent in the patient and the environment, and what those cues mean. From there, the practitioner connects to a larger body of knowledge, decides what’s needed and implements a course of action.

Diagnosis is at the centre of every health practice, but here’s a sobering fact. A Johns Hopkins study[1] reported that the third leading cause of death in North America (after heart disease and cancer) is medical error. Every year about 250,000 people die because of medical error. That’s shocking.

The most frequent type of medical error? Error of diagnosis. Incorrect diagnosis leads to incorrect interventions. Patients suffer and even die. That’s not why anyone chose to become a health practitioner.

The key difference between experts at diagnosis and those who are not

Loveday et al[2] and other researchers have shown that the key difference between practitioners who are expert at diagnosis and those who are not is the experts’ ability to recognize cues in the patient and the environment, see the patterns, and understand what the patterns mean.

In a study comparing expert and novice nurses’ cue collection during clinical decision making, [3] the results showed that expert nurses collected more cues and acquired a greater understanding of patient status and greater ability to anticipate potential problems.

Expert nurses collected a wider range of cues than novice nurses, almost twice as many different cues. The expert nurses also clustered more cues together to identify patient status when making decisions. Expert nurses were more proactive in collecting relevant cues and anticipating problems that may help identify patient problems.[4]

In the early stages of clinical assessment, expert nurses collected a wider range of cues and were able to form a larger picture of the patient as a whole. On the other hand, in a simulation exercise where the task was to identify cues related to a specific problem, the expert nurses selected only those cues that were relevant to the identified problem.

In other words, in the midst of multiple cues, expert nurses had greater ability to assess which were the most relevant cues.[5]

Cue recognition:  a cause and effect of becoming an expert

Cue recognition is a characteristic of experts. However, honing your cue recognition abilities also helps in the early learning stage. As an example from the field of aviation, two studies by Wiggins et al[6] identified that when students were learning how to take-off and land, the better they were at cue recognition, the quicker and better they learned the skills. The researchers concluded:

In both studies, a relationship was established between cue utilization and task-related performance, whereby relatively higher levels of cue utilization were associated with both a greater rate of skill acquisition and a greater proportion of successful trials in learning…

Given that cue utilization also differentiates greater from lesser performance among experienced operators, the results suggest that the acquisition and subsequent utilization of cues may play a significant role in facilitating the rate and the achievement of expertise. [7]

The researchers also concluded:

In combination, the results suggest that the capacity for the acquisition and the subsequent utilization of cues is an important predictor of skill acquisition, particularly during the initial stages of the process. [8]

In summary, getting better and better at diagnostic cue recognition during your early learning stage helps you become expert more quickly. Continuing to hone your diagnostic cue recognition abilities helps you move from expertise to mastery as a practitioner.

Hone simulation training modules focus on cue recognition

Hone Virtual Education’s mission is “to help practitioners perform at peak levels, capable of rapidly and correctly identifying diagnostic cues, enabling correct clinical decisions.” The over-arching mission is to save lives.

Hone combines mastery learning psychology with augmented reality technology to create simulation training modules you can download to your augmented reality smartphone or tablet.

The initial Hone training modules are focussed on diagnostic cue recognition in the first few minutes of patient contact. Each module allows you to practice specific observations and skills again and again. Once your accuracy is assured, the modules increase the speed with which cues are presented, so you learn to make assessments and decisions more quickly. That’s especially relevant in the high pressure environments in which most Healthcare Practitioners practice.

Find out more

The first Hone Cue Recognition modules will soon be released. In the meantime, check out

  • Learn more about Hone Cue Recognition simulation training;
  • Be notified of updates and launch dates;
  • Apply to be a beta tester as new modules are developed for Healthcare Practitioners in high-stress environments.



Bonnie Hutchinson is a writer and lifelong learner with degrees in Education and Whole Systems Design as well as extensive training and experience in adult learning and teaching. She’s author of bestselling Transitions: Pathways to the Life and World Your Soul Desires.

[1] The Johns Hopkins study, led by Dr. Martin Makary of the Johns Hopkins School of Medicine, was released in 2016. A follow-up about whether anything had changed was reported by Ray Sipherd, special to  Published 9:31 AM ET Thu, 22 Feb 2018 and updated 9:39 AM ET Wed, 28 Feb 2018.

[2] T. Loveday, M. Wiggins, M. Fest, D. Scheel, D. Twigg (2013), “Pattern Recognition as an Indicator of Diagnostic Expertise” in Latorre Carmona P., Sanchez J., Fred A. (eds) in Pattern Recognition – Application and Methods, Advances in Intelligent Systems and Computing, Vol 204. Springer, Berlin, Heidelberg.

[3] A K Hoffman, L. Aitken and C. Duffield (2009). A comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbal protocol analysis. International Journal of Nursing Studies. 46. 1335-44. 10.1016/j.ijnurstu.2009.04.001.’_cue_collection_during_clinical_decision-making_Verbal_protocol_analysis

[4] Hoffman et al (2009), op. cit.

[5] Hoffman et al 2(009), op. cit.

[6] M. W Wiggins, S. Brouwers, J. Davies and T. Loveday (2014), Trait-based cue utilization and initial skill acquisition: implications for models of the progression to expertise. Frontier Psychology,  5:541. doi: 10.3389/fpsyg.2014.00541.

[7] Wiggins et al (2014), op. cit.

[8] Wiggins et al (2014), op. cit.

Hone CUE Recognition on the App Store

The Hone CUE Recognition App will soon be available on the App Store for early adopters. When it is available - you will be able to download it via the link below.