Recognize Cues – in life and in healthcare


Features with deeper meaning

The low fuel light in your car.

The half-open lid of your mailbox.

The sound of your front door opening.

These are all features of our environment that have meaning for us. They all signify something deeper than what you see or hear. We need to get gas, the mail arrived, our significant other is home.

Features that signify deeper meaning – called cues – are all around us. Knowing the meaning of cues is a key element of going about our daily lives. Cues are also key to making accurate decisions quickly in situations when making accurate decisions is important.

In chess, your opponent’s piece positions are cues that allow you to calculate your next move. In tennis, your opponent’s position on the court is a cue that changes where you serve the ball. In the fire service, a warning alarm is a cue that could indicate low levels of air in your cylinder. In health care, a patient with chest pain is exhibiting a cue that may indicate a heart attack.

Recognizing and attaching accurate meaning to cues in situations and environments is the critical first step to accomplish what’s needed in those circumstances.

In health care, especially pre-hospital and emergency health care, recognizing and attaching meaning – accurately and quickly – to diagnostic cues presented by patients and their environments can make a life-or-death difference.

Hone Virtual Education will soon be releasing a resource called Hone Cue Recognition that helps you achieve even greater mastery in making quick and accurate decisions based on cues presented by patients in multiple types of environments. More about that later but first, here’s a quick summary of the logic that’s driving the development of this virtual simulation training you can download to your augmented reality enabled smartphone or tablet.

The essential diagnostic skills: Identify cues and recognize patterns

In health care, accurate diagnosis is the basis of everything that comes later. However, diagnostic errors are one of the biggest problems of modern health care. Medical error is the third leading cause of death in North America, and the most frequent type of medical error is an error of diagnosis.[1]

Nobody wants medical diagnosis error and nobody intends it – probably especially not you! But still, medical diagnosis errors happen.

So what can be done? For one thing, we can identify the mechanisms that contribute to diagnostic excellence.

In studies that examined diagnostic expertise, one dominant characteristic distinguished the most expert diagnosticians from others: the ability to identify diagnostic cues and recognize patterns. For example, Loveday et alreported that, “It is evident that experts who have been identified on the basis of their diagnostic performance are more likely to use pattern recognition in comparison to their non-expert peers,” and “…experienced diagnosticians could be divided into competent and expert practitioners based on their capacity for pattern recognition or cue utilization.” [2]

Health care practitioners need to master the ability to identify diagnostic cues and recognize patterns, quickly and accurately. That is expecially true for practitioners on the front lines who work with patients in pre-hospital or emergency care.

So how do you get better and better at that?

What we know about learning that achieves mastery

In recent years, scientists and researchers have identified adult learning practices that help anyone in any profession move from novice to competent to expert to master. Here are some highlights.[3]

Bite size pieces. First, within each skill set, the requirements are separated into tiny detailed components – very specific actions performed in specific ways. That means in earlier stages of learning something new, you’re not distracted or overwhelmed by multiple stimuli, but can focus on one small component at a time.

Immediate feedback. Second, mastery learning requires immediate feedback. You know immediately when you’ve done something correctly and when you’ve made an error, so you can correct the errors and get better and better at doing things right.

Deliberate practice. Third, mastery learning requires deliberate practice (whether it’s to identify specific cues or to carry out a specific action). You keep practicing correctly to achieve the intended results until your proficiency is embedded in your brain and becomes automatic.

Gradually increasing difficulty and complexity. Within each subset of cues and actions, you gradually increase the difficulty and complexity of the practice tasks so you achieve continuously increasing mastery.

Increasing pattern recognition. On-going deliberate practice of increasing difficulty allows you to get better and better at recognizing patterns. That can increase accuracy and also shortcut the time required for assessment and decision.

Mastery learning for Healthcare Practitioners: 4 challenges

It’s useful to identify the kind of learning practices that lead to mastery. Making those mastery learning practices available to Healthcare Practitioners will optimize their ability to identify diagnostic cues and recognize patterns. There are some challenges, though, in applying mastery learning practices to health practitioner training.

Hone Virtual Education has been developing solutions to those challenges for a while now. Hone Cue Recognition augmented reality virtual simulation training modules are a start, as you’ll see later.

Four of the challenges (if you’re a health practitioner you’ve almost certainly experienced them) are…

Multiple Cues. Within each area of initial patient assessment, there are multiple cues related to Airway, Breathing, Circulation, Disabilities, and Exposure (A-B-C-D-E). In classroom, simulation or practicum experiences, or in professional practice, you could go months or years and not encounter some of the possible cues. To become a master of identifying diagnostic cues and recognizing patterns could take decades.

Multiple sub-actions. Within each skill set involved in assessment and diagnosis, there are many sub-actions. Even during training, you may have few opportunities to practice sub-sets of skills again and again, in order to become so proficient you can perform each action expertly and automatically, almost without thinking.

No opportunity to slow it down. During training, whether in classrooms, simulation settings or practicum placements, the entire Observe, Orient, Decide, Act process often unfolds quickly without the opportunity for you to slow it down and look at each cue and its potential meaning or each component of each skill within a larger process. In the real world of practice, of course, “slowing it down” is even less possible than during training.

Limited opportunity for immediate feedback. Though trainers, colleagues, and supervisors do provide feedback to students and practitioners, mastery learning requires immediate feedback about each aspect of your performance. That is simply not possible even during training, and certainly not once you are registered as a certified professional.

How Hone Cue Recognition simulation training modules help you achieve mastery

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

Founded by pre-hospital and emergency medical practitioners, Hone is combining the best of mastery learning psychology with augmented reality technology to create simulation training modules you can download to your augmented reality smartphone or tablet.

Hone Cue Recognition is a medically accurate cue recognition virtual simulation training platform that allows you to deliberately practice diagnostic cue recognition and receive immediate, expert feedback – on demand.

Different modules focus on sub-aspects of Airway, Breathing, Circulation, Disabilities, and Exposure. Each module allows you to practice specific observations and skills again and again, as often as you choose, with immediate feedback after each action, until the learning is anchored in your brain. 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.

The modules are intended to help you to…

  • Decrease your mental workload during the initial stages of patient contact, improve your situational awareness, and therefore improve patient safety;
  • Build a mental diagnostic cue “pattern recognition database” more quickly than is otherwise possible;
  • Assess your own performance accurately;
  • Reduce any performance anxiety and workplace stress by improving your confidence.

Find out more

The first Hone Cue Recognition simulation training modules will be released soon. In the meantime, you can…

  • 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] A 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. A brief summary of the study is at

[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] This summary is drawn from multiple adult learning and performance psychology sources, but much appears in Ericsson, K. A. (2016) Peak: Secrets from the new science of expertise. Eamon Dolan/Houghton Mifflin, Harcourt, CT, USA.

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.