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Published on: January 15, 2017
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Diagnostic reasoning and cognitive error in emergency medicine: Implications for teaching and learning
Thierry Pelaccia1,2, Jonathan Sherbino3,4, Peter Wyer5
1Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France.
Summary
Dual-process theory in emergency medicine (EM) explains diagnostic reasoning. Research suggests a harmonious relationship between fast (System 1) and slow (System 2) thinking, challenging current bias-correction training for EM residents.
Area of Science:
- Cognitive Science
- Medical Education
- Emergency Medicine
Background:
- Accurate diagnosis in emergency medicine (EM) is critical and complex.
- Dual-process theory, distinguishing fast (System 1) and slow (System 2) thinking, is a valid model in EM.
- System 1 uses experience for rapid hypotheses; System 2 uses analysis for diagnosis.
Purpose of the Study:
- To review literature on dual-process theory in cognitive science, medical education, and EM.
- To analyze interpretations of the relationship between System 1 and System 2 in diagnostic reasoning.
- To propose improved educational strategies for EM residents' diagnostic reasoning.
Main Methods:
- Literature review across cognitive science, medical education, and emergency medicine.
- Analysis of prominent interpretations of dual-process theory in diagnostic reasoning.
- Identification of implications for clinical learner training.
Main Results:
- Two interpretations of System 1 and System 2 interaction exist.
- One interpretation, common in EM, views System 1 errors as bias, corrected by System 2.
- Research does not support this 'check-and-balance' model; an alternative harmonious model is proposed.
Conclusions:
- Current EM training advising System 2 to correct System 1 biases lacks research support.
- An alternative interpretation suggests Systems 1 and 2 work harmoniously, driven by knowledge.
- New educational strategies based on this harmonious model are needed for EM residents.
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