Cognitive Task Analysis to Evaluate Resident Physician Decision Making in the Intensive Care Unit

Area of Science:

• Medical Education
• Cognitive Psychology
• Clinical Decision Making

Background:

• Heuristics and clinical intuition are commonly used in medical decision-making under uncertainty.
• Trainees may struggle with appropriate heuristic selection and application due to limited experience.
• Understanding cognitive biases in trainees is crucial for improving clinical reasoning and reducing errors.

Purpose of the Study:

• To evaluate cognitive task analysis (CTA) as a method for studying trainee decision-making.
• To investigate how internal medicine residents make high-risk fluid resuscitation decisions in septic shock.

Main Methods:

• Utilized the critical decision method, a CTA technique, for semistructured interviews with residents.
• Focused on fluid resuscitation decisions for septic shock patients in a medical intensive care unit.
• Analyzed interview data using a template approach guided by the Recognition-Primed Decision model.

Main Results:

• Seven key domains influencing fluid resuscitation decisions were identified.
• Decisions were significantly affected by clinical intuition, non-physiological factors, and volume-based heuristics.
• Common cognitive biases observed included premature closure, confirmation bias, and status quo bias.

Conclusions:

• Cognitive task analysis is effective for examining trainee decision-making in complex clinical scenarios.
• Identifying trainees' specific heuristics and biases can guide the development of targeted educational interventions.
• Improved understanding of clinical reasoning can enhance patient safety and training effectiveness.