Tay Shu Wen, Ryan Paul, Ryan C Anthony
Department of Neonatology, Cork University Maternity Hospital, Ireland; Department of Paediatrics and Child Health, University College Cork, Ireland.
Department of Neonatology, Cork University Maternity Hospital, Ireland; Department of Paediatrics and Child Health, University College Cork, Ireland; Teagasc, Moorepark, Fermoy, Co. Cork, Ireland.
Can Med Educ J. 2016 Oct 18;7(2):e97-e103. eCollection 2016 Oct.
Diagnostic decision-making is made through a combination of Systems 1 (intuition or pattern-recognition) and Systems 2 (analytic) thinking. The purpose of this study was to use the Cognitive Reflection Test (CRT) to evaluate and compare the level of Systems 1 and 2 thinking among medical students in pre-clinical and clinical programs.
The CRT is a three-question test designed to measure the ability of respondents to activate metacognitive processes and switch to System 2 (analytic) thinking where System 1 (intuitive) thinking would lead them astray. Each CRT question has a correct analytical (System 2) answer and an incorrect intuitive (System 1) answer. A group of medical students in Years 2 & 3 (pre-clinical) and Years 4 (in clinical practice) of a 5-year medical degree were studied.
Ten percent (13/128) of students had the intuitive answers to the three questions (suggesting they generally relied on System 1 thinking) while almost half (44%) answered all three correctly (indicating full analytical, System 2 thinking). Only 3-13% had incorrect answers (i.e. that were neither the analytical nor the intuitive responses). Non-native English speaking students (n = 11) had a lower mean number of correct answers compared to native English speakers (n = 117: 1.0 s 2.12 respectfully: p < 0.01). As students progressed through questions 1 to 3, the percentage of correct System 2 answers increased and the percentage of intuitive answers decreased in both the pre-clinical and clinical students.
Up to half of the medical students demonstrated full or partial reliance on System 1 (intuitive) thinking in response to these analytical questions. While their CRT performance has no claims to make as to their future expertise as clinicians, the test may be used in helping students to understand the importance of awareness and regulation of their thinking processes in clinical practice.
诊断决策是通过系统1（直觉或模式识别）和系统2（分析性）思维的结合来做出的。本研究的目的是使用认知反思测试（CRT）来评估和比较临床前和临床课程的医学生中系统1和系统2思维的水平。
CRT是一个三题测试，旨在衡量受访者激活元认知过程并在系统1（直觉）思维会使他们误入歧途时切换到系统2（分析性）思维的能力。每个CRT问题都有一个正确的分析性（系统2）答案和一个错误的直觉性（系统1）答案。对一所5年制医学学位的2年级和3年级（临床前）以及4年级（临床实习）的一组医学生进行了研究。
10%（13/128）的学生对这三个问题给出了直觉性答案（表明他们通常依赖系统1思维），而近一半（44%）的学生全部答对（表明完全是分析性的系统2思维）。只有3%-13%的学生给出了错误答案（即既不是分析性答案也不是直觉性答案）。非英语母语的学生（n = 11）的正确答案平均数量低于英语母语的学生（n = 117：分别为1.0对2.12；p < 0.01）。随着学生完成问题1到3，临床前和临床学生中正确的系统2答案的百分比增加，直觉性答案的百分比下降。
多达一半的医学生在回答这些分析性问题时表现出对系统1（直觉）思维的完全或部分依赖。虽然他们的CRT表现并不能说明他们未来作为临床医生的专业水平，但该测试可用于帮助学生理解在临床实践中意识到并调节其思维过程的重要性。
