Anglia Ruskin School of Medicine, Anglia Ruskin University, Chelmsford, UK.
Department of Anaesthetics, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK.
Postgrad Med J. 2018 Apr;94(1110):216-219. doi: 10.1136/postgradmedj-2017-135411. Epub 2018 Jan 9.
The complexity of modern clinical practice has highlighted the fallibility of individual clinicians' decision-making, with effective teamwork emerging as a key to patient safety. Dual process theory is widely accepted as a framework for individual decision-making, with type 1 processes responsible for fast, intuitive and automatic decisions and type 2 processes for slow, analytical decisions. However, dual process theory does not explain cognition at the group level, when individuals act in teams. Team cognition resulting from dynamic interaction of individuals is said to be more resilient to decision-making error and greater than simply aggregated cognition.
Clinicians were paired as teams and asked to solve a cognitive puzzle constructed as a drug calculation. The frequency at which the teams made incorrect decisions was compared with that of individual clinicians answering the same question.
When clinicians acted in pairs, 63% answered the cognitive puzzle correctly, compared with 33% of clinicians as individuals, showing a statistically significant difference in performance (χ (1, n=116)=24.329, P<0.001). Based on the predicted performance of teams made up of the random pairing of individuals who had the same propensity to answer as previously, there was no statistical difference in the actual and predicted teams' performance.
Teams are less prone to making errors of decision-making than individuals. However, the improved performance is likely to be owing to the effect of aggregated cognition rather than any improved decision-making as a result of the interaction. There is no evidence of team cognition as an emergent and distinct entity.
现代临床实践的复杂性凸显了个体临床医生决策的易错性，有效的团队合作已成为患者安全的关键。双加工理论被广泛接受为个体决策的框架，其中 1 型加工负责快速、直观和自动的决策，2 型加工负责缓慢、分析性的决策。然而，双加工理论并不能解释个体在团队中进行决策时的群体认知。当个体在团队中进行动态互动时，所产生的团队认知据说对决策错误更具弹性，且优于简单的聚合认知。
将临床医生配对成团队，并要求他们解决一个由药物计算构成的认知难题。将团队做出错误决策的频率与单独回答相同问题的临床医生的频率进行比较。
当临床医生成对行动时，有 63%的团队正确回答了认知难题，而单独的临床医生回答正确的比例为 33%，这表明团队表现存在统计学上的显著差异（χ(1, n=116)=24.329, P<0.001）。根据由具有相同倾向的个体随机配对组成的团队的预测表现，团队的实际表现与预测表现之间没有统计学差异。
团队做出决策错误的可能性小于个体。然而，表现的提高可能归因于聚合认知的影响，而不是由于互动而导致的任何决策改进。没有证据表明团队认知是一种新兴的独特实体。
