Dispatch information affects diagnosis in paramedics: An experimental study of applied dual-process theory

2021 ◽  
Author(s):  
Toby Keene ◽  
Kristen Pammer ◽  
Bill Lord ◽  
Carol Shipp
Keyword(s):  
Experimental Study ◽  
Acute Coronary Syndrome ◽  
Secondary Task ◽  
Time Pressure ◽  
Diagnostic Error ◽  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Coronary Syndrome ◽  
Self Reports

Introduction. Previous research has shown that paramedics form intuitive impressions based on limited ‘pre-arrival’ dispatch information and this subsequently affects their diagnosis. However, this observation has never been experimentally studied. Method. This was an experimental study of 83 Australian undergraduate paramedics and 65 Australian paramedics with median 14 years’ experience (Range: 1 – 32 years). Participants responded to written vignettes in two parts that aimed to induce an intuitive impression by placing participants under time pressure and with a secondary task, followed by a diagnosis made without distraction or time pressure. The vignettes varied the likelihood of Acute Coronary Syndrome (ACS), and measured self-reports of typicality and confidence. Answer fluency, which is the ease with which the answer comes to mind, was also measured.Results. There was a difference in the proportion of participants diagnosing ACS according to what pre-arrival information was seen (.85 [95%CI: .78, .90] vs .74 [95%CI: .66, .81]; p = .03). Paramedics with greater than 14 years’ experience, were more likely to be affected by pre-arrival information in their diagnosis (.94 [78, .99] vs .67 [95%CI .48, .81]; p = .01). Answer fluency and confidence predicted impression, while the impression and confidence predicted final diagnosis.Conclusion. We have experimentally shown that pre-arrival information can affect subsequent diagnosis, increasing the chance of diagnostic error. The most experienced paramedics were most likely to be affected.

scholarly journals The psychology of diagnostic error

2015 ◽  
Vol 8 (3) ◽  
pp. 91-98
Author(s):  
L. Zwaan
Keyword(s):  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Diagnostic Process ◽  
Cognitive Errors ◽  
System 2 ◽  
System 1 ◽  
Analytic Reasoning

Diagnostic errors in medicine occur frequently and the consequences for the patient can be severe. Cognitive errors as well as system related errors contribute to the occurrence of diagnostic error, but it is generally accepted that cognitive errors are the main contributor. The diagnostic reasoning process in medicine, is an understudied area of research. One reason is because of the complexity of the diagnostic process and therefore the difficulty to measure diagnostic errors and the causes of diagnostic error. In this paper, I discuss some of the complexities of the diagnostic process. I describe the dual-process theory, which defines two reasoning modes, 1. a fast, automatic and unconscious reasoning mode called system 1, and a slow and analytic reasoning mode called system 2. Furthermore, the main cognitive causes of diagnostic error are described.

scholarly journals Fluency and confidence predict paramedic diagnostic intuition: An experimental study of applied dual-process theory

2021 ◽  
Author(s):  
Toby Keene ◽  
Kristen Pammer ◽  
Bill Lord ◽  
Carol Shipp
Keyword(s):  
Time Pressure ◽  
Experimental Methods ◽  
Dual Process ◽  
Dual Process Theory ◽  
Limited Information ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
Clinical Vignettes ◽  
Comparable Accuracy ◽  
And Performance

Introduction. Paramedics care for the sick and injured in a variety of settings and have been observed to form an impression of their patient prior to meeting them based on limited information. We report an experiment using Australian paramedics (n=64) and Australian paramedicine undergraduates (n=44), which considered the processes underlying the formation of an intuitive diagnostic impression. Previous research has signalled roles for objective likelihood of the disease, subjective typicality of the disease, and the ease with which the impression comes to mind (answer fluency) as important in impression formation.Method. Participants completed four brief written clinical vignettes under time pressure and with a concurrent navigation task to simulate conditions faced by paramedics prior to meeting a patient. The vignettes varied the objective likelihood of a diagnosis of Acute Coronary Syndrome (ACS), a condition often encountered by paramedics characterised by ambiguity and a need for accuracy. Diagnostic impression, confidence and subjective typicality of the vignette were self-reported while answer fluency was measured. Results. Likelihood, answer fluency, self-reported typicality and confidence predicted the impression but there was no effect of experience. Students and experienced paramedics had comparable accuracy and performance. Conclusion. The results support a role for answer fluency and confidence in forming that impression. We have shown it is possible to experimentally manipulate various factors associated with paramedic diagnostic impressions. These experimental methods can form the basis for additional studies into paramedic decision making.

Reflective Knowledge

2018 ◽  
Author(s):  
Chienkuo Mi ◽  
Shane Ryan
Keyword(s):  
Extended Cognition ◽  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Reflective Knowledge ◽  
Epistemological Disjunctivism ◽  
Recent Account

In this paper, we defend the claim that reflective knowledge is necessary for extended knowledge. We begin by examining a recent account of extended knowledge provided by Palermos and Pritchard (2013). We note a weakness with that account and a challenge facing theorists of extended knowledge. The challenge that we identify is to articulate the extended cognition condition necessary for extended knowledge in such a way as to avoid counterexample from the revamped Careless Math Student and Truetemp cases. We consider but reject Pritchard’s (2012b) epistemological disjunctivism as providing a model for doing so. Instead, we set out an account of reflection informed by Confucianism and dual-process theory. We make the case that reflective knowledge offers a way of overcoming the challenge identified. We show why such knowledge is necessary for extended knowledge, while building on Sosa’s (2012) account of meta-competence.

scholarly journals Dual Process Theory and Intermediate Effect: Are Faculty and Residents' Performance on Multiple-Choice, Licensing Exam Questions Different?

2015 ◽  
Vol 180 (suppl_4) ◽  
pp. 92-96 ◽  
Author(s):  
Ting Dong ◽  
Steven J. Durning ◽  
Anthony R. Artino ◽  
Cees van der Vleuten ◽  
Eric Holmboe ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Reading Time ◽  
Multiple Choice ◽  
Small Sample ◽  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Unexpected Finding ◽  
Licensing Examination ◽  
Intermediate Effect

ABSTRACT Background: Clinical reasoning is essential for the practice of medicine. Dual process theory conceptualizes reasoning as falling into two general categories: nonanalytic reasoning (pattern recognition) and analytic reasoning (active comparing and contrasting of alternatives). The debate continues regarding how expert performance develops and how individuals make the best use of analytic and nonanalytic processes. Several investigators have identified the unexpected finding that intermediates tend to perform better on licensing examination items than experts, which has been termed the “intermediate effect.” Purpose: We explored differences between faculty and residents on multiple-choice questions (MCQs) using dual process measures (both reading and answering times) to inform this ongoing debate. Method: Faculty (board-certified internists; experts) and residents (internal medicine interns; intermediates) answered live licensing examination MCQs (U.S. Medical Licensing Examination Step 2 Clinical Knowledge and American Board of Internal Medicine Certifying Examination) while being timed. We conducted repeated analysis of variance to compare the 2 groups on average reading time, answering time, and accuracy on various types of items. Results: Faculty and residents did not differ significantly in reading time [F (1, 35) = 0.01, p = 0.93], answering time [F (1, 35) = 0.60, p = 0.44], or accuracy [F (1, 35) = 0.24, p = 0.63] regardless of easy or hard items. Discussion: Dual process theory was not evidenced in this study. However, this lack of difference between faculty and residents may have been affected by the small sample size of participants and MCQs may not reflect how physicians made decisions in actual practice setting.

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