CLINICAL DECISION-MAKING OF ANESTHESIOLOGY RESIDENTS IN EMERGENCY MEDICAL CARE
Background. The purpose of current work is to clarify characteristics of anesthesiologists’ use of heuristics in emergency medical care. Two separate studies were carried out to evaluate the characteristics of anesthesiologists’ use of heuristics: (a) according to gained experience; (b) and under stressful conditions.
Methods. First (longitudinal design) study was comprised of two phases 10-11 months apart. In both phases, participants solved three vignettes that required the provision of emergency medical care. In the second study, participants solved three medical vignettes under stressful conditions (i.e. under the influence of the cold pressor test). Physiological data – participants’ heart rate – was registered using finger plethysmograph before and after the cold pressor test. The adequacy of decisions were evaluated independently by two experts in anesthesiology.
Results and conclusions. Results of quantitative content analysis of the first longitudinal design study showed a decrease in the use of availability and an increase in anchoring and adjustment of heuristic as anesthesiology residents become more experienced. Results of both studies indicate that 32-38% of all anesthesiology residents’ thoughts are heuristic in nature and 3-11% of all thoughts are cognitive errors.
Buckingham, C. D., Adams, A. (2000). Classifying clinical decision making: interpreting nursing intuition, heuristics and medical diagnosis. Journal of Advanced Nursing, 32(4), 990-998.
Charlin, B., Boshuizen, H. P. A., Custers, E. J., Feltovich, P. J (2007). Scripts and clinical reasoning. Medical Education, 41, 1178-1184.
Chuang, C. Y., Han, W. R., Young, S. T. (2009). Heart rate variability response to stressful event in healthy subjects. IFMBE Proceedings, 23, 378-380.
Croskerry, P. (2002). Achieving quality in clinical decision making: Cognitive strategies and detection of bias. Academic Emergency Medicine, 9(11), 1184-1204.
Croskerry, P. (2003). Cognitive forcing strategies in clinical decision making. Annals of Emergency Medicine, 41(1), 110-120.
Croskerry, P. (2009a). A universal model of diagnostic reasoning. Academic medicine, 84(8), 1022-1028.
Croskerry, P. (2009b). Clinical cognition and diagnostic error: Applications of a Dual Process model of reasoning. Advances in Health Sciences Education: Theory and Practice, 14, 27-35.
Croskerry, P., Nimmo, G. R. (2011). Better clinical decision making and reducing diagnostic error. Journal of the Royal College of Physicians of Edinburgh, 41, 155-162.
Deuter, C. E., Kuehl, L. K., Blumenthal, T. D., Schulz, A., Oitzl, M. S, Schachinger, H. (2012) Effects of cold pressor stress on the human startle response. PLoS ONE, 7(11), 1-7.
Ericsson, K. A., Simon, H. A. (1993). Protocol Analysis: Verbal Reports as Data (2nd ed.). Cambridge, MA: The MIT Press.
Ericsson, K. A., Simon, H. A. (1980). Verbal reports as data. Psychological Review, 87(3), 215-251. Eva, K. W. (2009). Diagnostic error in medical education: where wrongs can make rights. Advances in Health Sciences Education: Theory and Practice, 14, 71-81.
Evans, J. St. B. T. (1984). Heuristic and analytic processes in reasoning. British Journal of Psychology, 75, 451-468.
Evans, J. St. B. T. (2008). Dual-Processing accounts of reasoning, judgment, and social cognition. Annual Review of Psychology, 59, 255-278.
Evans, J. St. B. T., Stanovich, K. E. (2013). Dual-Process theories of higher cognition: Advancing the debate. Perspectives on Psychological Science, 8(3), 223-241.
Giardino, N. D., Lehrer, P. M., Edelberg, R. (2002). Comparison of finger plethysmograph to ECG in the measurement of heart rate variability. Psychophysiology, 39(2), 246-253.
Hershberger, P. J., Markert, R. J., Part, H. M., Cohen, S. M., Finger, W. W. (1997). Understanding and Addressing Cognitive Bias in medical Education. Advances in Health Sciences Education: Theory and Practice, 1, 221-226.
Kahneman, D. A. (2003). Perspective on judgment and choice, mapping bounded rationality. American Psychologist, 58(9), 697-720.
Kain, Z. N., Chan, K. M., Katz, J. D., Nigam, A., Fleisher, L., Dolev, J., Rosenfeld, L. E. (2002). Anesthesiologists and acute perioperative stress: A Cohort Study. Anesthesia & Analgesia, 95, 177-183.
Kim, J. J., Diamond, D. M. (2002). The stressed hippocampus, synaptic plasticity and lost memories. Nature Reviews Neuroscience, 3, 453-462.
Lieberman, M. D. (2000). Intuition: a social cognitive neuroscience approach. Psychological Bulletin, 126(1), 109-137. 32
Lieberman, M. D. (2007). The X- and C-systems: The neural basis of reflexive and reflective social cognition. In E. Harmon-Jones, P. Winkelman (eds.), Fundamentals of Social Neuroscience. New York: Guilford. pp. 290-315.
Mamede, S., van Gog, T., van den Berge, K., Rikers, R. M. J. P., van Saase, J. L. C. M., van Guldener, C., Schmidt, H. G. (2010). Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. The Journal of the American Medical Association, 304(11), 1198-1203.
Marewski, J. N., Gigerenzer, G. (2012). Heuristic decision making in medicine. Dialogues in Clinical Neuroscience, 14(1), 77-89.
McLaughlin, K., Eva, K. W., Norman, G. R. (2014). Reexamining our bias against heuristics. Advances in Health Sciences Education: Theory and Practice, 19, 457-464.
Pruessner, J. C., Dedovic, K., Pruessner, M., Lord, C., Buss, C., Collins, L., Lupien, S. J. (2010). Stress regulation in the central nervous system: Evidence from structural and functional neuroimaging studies in human populations – 2008 Curt Richter award winner. Psychoneuroendocrinology, 35, 179-191.
Reyna, V. F., Brainerd, C. J. (1995). Fuzzy-trace theory: An interim synthesis. Learning and Individual Differences, 7(1), 1-75.
Rieger, A., Stoll, R., Kreuzfeld, S., Behrens, K., Weippert, M. (2014). Heart rate and heart rate variability as indirect markers of surgeons’ intraoperative stress. International Archives of Occupational and Environmental Health, 87, 165-174.
Rumelhart, D. E., Ortony, A. (1977). The representation of knowledge in memory. In R. C. And- erson, R. J. Spiro, W. E. Montague (Eds.), Schooling and the acquisition of knowledge. Hillsdale, NJ: Erlbaum. pp. 99-135.
Schafer, A., Vagedes, J. (2013). How accurate is pulse rate variability as an estimate of heart rate variability? A review on studies comparing photoplethysmographic technology with an electrocardiogram. International Journal of Cardiology, 166(1), 15-29.
Schank, R. C., Abelson, R. P. (1977). Scripts, Plans, Goals and Understanding: An Inquiry Into Human Knowledge Structures. Hillsdale, New Jersey: Lawrence Erlbaum Associates. Schank, R. C. (1982). Dynamic Memory: A theory of reminding and learning in computers and people. New York: Cambridge University Press.
Schmidt, H. G., Boshuizen, P. A. (1993). On acquiring expertise in medicine. Educational Psychology Review, 5(3), 205-221.
Schmidt, H. G., Norman, G. R., Boshuizen, P. A. (1990). A cognitive perspective on medical expertise: Theory and implications. Academic medicine, 65(10), 611-621.
Sloman, S. A. (1996). The empirical case for two systems of reasoning. Psychological Bulletin, 119(1), 3-22.
Starcke, K., Brand, M. (2012). Decision making under stress: A selective review. Neuroscience and Biobehavioral Reviews, 36, 1228-1248.
Stiegler, M. P., Neelankavil, J. P., Dhillon, A. (2012). Cognitive errors detected in anesthesiology: A Literature Review and Pilot Study. British Journal of Anaesthesia, 108(2), 229-235.
Stiegler, M. P., Tung, A. (2014). Cognitive processes in anesthesiology decision making. Anesthesiology, 120, 204-217.
Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: Heuristics and biases. Science, 185(4157), 1124-1131.
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