Critical thinking, the capacity to be deliberate about thinking, is increasingly the focus of undergraduate medical education, but is not commonly addressed in graduate medical education. Without critical thinking, physicians, and particularly residents, are prone to cognitive errors, which can lead to diagnostic errors, especially in a high-stakes environment such as the intensive care unit. Although challenging, critical thinking skills can be taught. At this time, there is a paucity of data to support an educational gold standard for teaching critical thinking, but we believe that five strategies, routed in cognitive theory and our personal teaching experiences, provide an effective framework to teach critical thinking in the intensive care unit. The five strategies are: make the thinking process explicit by helping learners understand that the brain uses two cognitive processes: type 1, an intuitive pattern-recognizing process, and type 2, an analytic process; discuss cognitive biases, such as premature closure, and teach residents to minimize biases by expressing uncertainty and keeping differentials broad; model and teach inductive reasoning by utilizing concept and mechanism maps and explicitly teach how this reasoning differs from the more commonly used hypothetico-deductive reasoning; use questions to stimulate critical thinking: "how" or "why" questions can be used to coach trainees and to uncover their thought processes; and assess and provide feedback on learner's critical thinking. We believe these five strategies provide practical approaches for teaching critical thinking in the intensive care unit.
We theoretically investigate the effects of strong couplings in resonant Auger processes under the combination of strong resonant x-ray and nearly resonant optical pulses. The x-ray field couples the ground state with a core-excited state, while the optical field couples the core-excited state with another core-excited state of opposite parity. The Auger electron spectrum changes its shape as the intensities of the x-ray and/or optical fields increase, and at sufficiently high intensities we observe that the splitting, which is induced by the optical field, is superposed on the asymmetric splitting induced by the x-ray field in the Auger electron spectra. The asymmetric splitting itself, which is induced by the strong x-ray pulse, is persistent but modified due to the presence of the strong optical field. Moreover, through the systematic study by including or excluding the individual photoionization processes from the core-excited states and the direct photoionizaton process from the ground state, we clarify the contribution of the respective processes to the total electron yield and the Auger electron spectra. These results show that we can manipulate the resonant Auger processes through the introduction of the second core-excited state and the strong optical field.
We have numerically explored the asymmetry in the branching ratio of the photofragments in the photodissociation of HD + (neutral D and neutral H), leading to the possibility of localization of the electron on a chosen nucleus by careful tuning of the laser parameters. For two different frequencies we show that, starting from an initial stationary wave function, proper tuning of the pulse duration (2σ ) and peak intensities (I 0 ) of the laser pulses can lead to very different branching ratios of the two reaction channels. The results are interpreted in terms of the propagation of the nonstationary wave packet through regions having dominant radiative or nonradiative interactions at different times. We also investigate what effect the choice of initial vibrational state has on the overall asymmetry in the branching ratio of the dissociation products.
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