Dual processing theory and experts' reasoning: exploring thinking on national multiple-choice questions.
Steven J Durning1, Ting Dong2, Anthony R Artino2
1Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, 20814, Bethesda, MD, USA. steven.durning@usuhs.edu.
Perspectives on Medical Education
|August 6, 2015
Summary
Non-analytical reasoning, or pattern recognition, was more effective for answering medical questions correctly. Analytic reasoning did not improve accuracy, suggesting a continuum of cognitive processes rather than distinct systems.
Area of Science:
- Cognitive Psychology
- Medical Education
- Medical Education Research
Background:
- A debate exists regarding the effectiveness of non-analytic (pattern recognition) versus analytic (comparing diagnostic options) reasoning in medical education.
- Faculty thought processes in clinical problem-solving using dual-process theory have not been extensively studied, especially concerning task difficulty and fatigue.
- The influence of personal factors like sleep deprivation on reasoning processes in medical assessments requires further investigation.
Purpose of the Study:
- To determine which reasoning processes (analytic, non-analytic, combination) faculty use when answering clinical multiple-choice questions (MCQs).
- To investigate if reasoning processes differ based on accuracy, reading/answering time, item difficulty, and self-reported sleep deprivation.
- To explore the relationship between cognitive processes and MCQ performance in medical education.
Main Methods:
- A think-aloud procedure was employed to capture faculty's cognitive processes while they answered MCQs.
- Think-aloud data were coded for reasoning type (analytic, non-analytic, guessing, combination), word count, concepts, reading time, answering time, and accuracy.
- Statistical analyses examined correlations between reasoning frequencies, item accuracy, item difficulty, and recent work hours.
Main Results:
- Non-analytical reasoning led to correct answers more frequently than incorrect answers, irrespective of item difficulty ('hard' or 'easy').
- Significant correlations were observed between recent work hours and think-aloud metrics (word count, concepts), but not item accuracy.
- The frequency of analytic, non-analytic, or combined reasoning processes explained 19% of the variance in correctness across all MCQs.
Conclusions:
- Item difficulty is a result of the interaction between the item and the individual, not solely an item characteristic.
- Analytic reasoning did not demonstrate a significant improvement in accuracy for answering MCQs.
- Individuals likely utilize a continuum of cognitive processes rather than exclusively System 1 or System 2 thinking.
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