Kushniruk A, Patel V, Fleiszer D
Cognitive Studies in Medicine: Centre for Medical Education, McGill University, Montreal, Quebec, Canada.
Proc Annu Symp Comput Appl Med Care. 1995:193-7.
The improved support of complex medical decision making will require a greater understanding of the cognitive processes of physicians. Decision making in medicine often involves the careful weighing of uncertain and ill-structured information from various sources. In this paper a cognitive approach to analyzing complex intensive care decision making is outlined. The study described involved the presentation of case descriptions of systematically varied complexity, to two levels of physicians: intensive care residents (intermediates) and intensive care specialists (experts). Subjects were asked to "think aloud" in providing treatment and management decisions for the cases. The audiotaped protocols were then analyzed for the use of decision strategies and for key aspects of decision making. It was found that expert subjects tended to focus on developing a more refined situational analysis of the decision problem. The study results are being used in the design of a system for aiding physicians in making complex decisions in intensive care medicine.
要更好地支持复杂的医疗决策，就需要更深入地了解医生的认知过程。医学决策通常需要仔细权衡来自各种来源的不确定且结构不良的信息。本文概述了一种分析复杂重症监护决策的认知方法。所描述的研究涉及向两个层次的医生呈现系统变化复杂性的病例描述：重症监护住院医生（中级）和重症监护专家（专家）。要求受试者在为病例提供治疗和管理决策时“边想边说”。然后对录音协议进行分析，以了解决策策略的使用情况和决策的关键方面。研究发现，专家受试者倾向于专注于对决策问题进行更精细的情境分析。研究结果正被用于设计一个辅助医生进行重症监护医学复杂决策的系统。
