Department of Medicine, University of Toronto, Canada.
Adv Health Sci Educ Theory Pract. 2012 Aug;17(3):419-29. doi: 10.1007/s10459-011-9320-5. Epub 2011 Aug 28.
Clinicians are believed to use two predominant reasoning strategies: system 1 based pattern recognition, and system 2 based analytical reasoning. Balancing these cognitive reasoning strategies is widely believed to reduce diagnostic error. However, clinicians approach different problems with different reasoning strategies. This study explores whether clinicians have insight into their problem specific reasoning strategy, and whether this insight can be used to balance their reasoning and reduce diagnostic error. In Experiment 1, six medical residents interpreted eight ECGs and self-reported their predominant reasoning strategy using a four point scale (4S). Self-assessed reasoning strategy correlated with objective assessment by two clinical experts using a post hoc talk-aloud protocol (ρ = 0.69, p < 0.0001). Reporting an analytic strategy was also associated with 40% longer interpretation times (p = 0.01). In Experiment 2, twenty-four residents were asked to reinterpret eight ECGs with instructions customized to their 4S. Half of the ECGs were reinterpreted with instructions to use the opposite reasoning strategy to that reported, and half with instructions to use the same reasoning strategy. ECG reinterpretation scores did not differ with potentiating compared to balancing reasoning instructions (F(1,188) = 0.22, p = 0.64). However, analytic instructions were associated with improved scores (F(1,188) = 15, p < 0.0001). These data suggest that clinicians are able to recognize their reasoning strategies. However, attempting to balance reasoning strategies through customizable instructions did not result in a reduction in diagnostic errors. This suggests important limitations to the widespread belief in balancing reasoning strategies to reduce diagnostic error.
基于系统 1 的模式识别和基于系统 2 的分析推理。平衡这些认知推理策略被广泛认为可以减少诊断错误。然而，临床医生使用不同的推理策略来处理不同的问题。本研究探讨了临床医生是否对其特定问题的推理策略有洞察力，以及这种洞察力是否可以用于平衡他们的推理并减少诊断错误。在实验 1 中，六名住院医生解释了 8 份心电图，并使用四点量表（4S）自我报告他们的主要推理策略。自我评估的推理策略与两位临床专家使用事后大声说出协议的客观评估高度相关（ρ=0.69，p<0.0001）。报告分析策略也与解释时间延长 40%相关（p=0.01）。在实验 2 中，二十四名住院医生被要求根据他们的 4S 重新解释 8 份心电图。一半的心电图被重新解释，指示使用与报告相反的推理策略，另一半则指示使用相同的推理策略。与平衡推理指令相比，增强推理指令并未导致 ECG 重新解释得分的差异（F（1,188）=0.22，p=0.64）。然而，分析指令与提高的得分相关（F（1,188）=15，p<0.0001）。这些数据表明，临床医生能够识别他们的推理策略。然而，通过可定制的指令试图平衡推理策略并没有导致诊断错误的减少。这表明平衡推理策略以减少诊断错误的广泛信念存在重要限制。
