Comms 5 (Clinical Reasoning)

Question 1

What is bounded rationality?

Answer 1

Concept that we work under constraints of limited information, that we have a limited intellectual capacity, and that we have a limited amount of time to make the decision.

Question 2

How do humans make decisions?

Answer 2

Small number of variables
Allocate value to those variables
In the time frame
= Decision

Question 3

What is satisficing?

Answer 3

Within the constraints discussed we decide on and pursue a course of action that will satisfy the minimum requirements necessary to achieve a particular goal

Question 4

What is characteristic of system 1 processing?

Answer 4

Pattern recognition
Based on experience
Illness Scripts
Cases
Short cuts
Mental maps
Heuristics
Rules of thumb

Question 5

What are the different types of bias?

Answer 5

Framing effect - decide on options based on whether the options are presented with positive or negative connotations
Anchoring bias – initial piece of information to make subsequent judgments
Confirmation bias – search for info supporting hypothesis
Search satisficing – found one thing, ignore others
Availability bias – easily recalled experience dominates evidence
Representativeness – several features typical but other explanation more likely
Bandwagon effect – we do it this way here
Sutton’s slip – going for the obvious
Gambler’s fallacy – I’ve seen 3 recently; this can’t be a fourth
Vertical line failure – routine repetitive tasks leading to thinking in silo
Visceral bias – emotional response/countertransference
Overconfidence
Blind spot bias – other people are susceptible to these biases but I am not

Question 6

What contextual factors can cause bias?

Answer 6

Affective state of clinician
Health of doctor
Tiredness/sleep deficit
Workload/Timing
Knowledge
Clinical Familiarity

Question 7

What is representation bias?

Answer 7

When you rely on representativeness to make judgments, they are likely to judge wrongly because the fact that something is more representative does not actually make it more likely.

Question 8

What is the law of small numbers?

Answer 8

People tend to fixate on small numbers with significant outcomes and over emphasises their significance.

Question 9

What is metacognition?

Answer 9

The process by which we reflect upon, and have the option of regulating, what we are thinking.
Remembering to stand back and regulate our thinking.

Question 10

What are the features of metacognition?

Answer 10

Awareness of the learning process and the cognitive demands of a particular situation
Recognition of the limitations of memory
Ability to appreciate the broader perspective
Capacity for self critique
Ability to select a particular strategy for improving the decision making, particularly when things don’t fit

Question 11

What are cognitive forcing strategies for improved performance?

Answer 11

Consider alternatives - routinely think: “if I am wrong what else might this be”
Seek incongruent data - don’t be afraid to try and prove you are wrong
Reframe when recording - mentally reconsider meaning and reassess the associations YOU have created
Reconsider dissonant facts - take a step back from the problem
Know and understand test accuracy - tests are only as good as the questions you ask of them
Use time as a diagnostic tool - careful, watchful, wait and see is NOT the same as inactivity
Heighten our metacognition - step back to reflect
Decrease reliance on memory- use cognitive aids (but use them wisely)
Be aware of own affective state - especially time pressures
Be aware of our decision mode
Establish accountability in a given situation
Be a giver and receiver of judgemental, constructive feedback