Medical education should teach heuristics rather than train them away

Abstract

Context Ample research suggests that most decisions are based on heuristics—simple rules of thumb—that violate prescriptions of logic and probability theory and should therefore be avoided. Yet findings on decision making in everyday work contexts support the idea that heuristics are in fact the very basis of good decision making if adapted to the challenges and performance criteria of the specific work domain. Because traditional pedagogies aim at circumventing heuristics in (clinical) decision making, ways in which to improve the use of heuristics via (medical) education have rarely been explored. Objective To describe the rationale for teaching and learning proper use of heuristics, rather than stigmatising them, and to identify principles and potential implications for the design and improvement of pedagogies for training in clinical decision making. Results Based on theory and evidence concerning heuristic decision making in everyday work domains, we suggest that heuristics should not be avoided as irrational or a mere source of errors, in particular in domains where errors are unavoidable. Instead, we should teach and learn how to use heuristics to make fewer and ‘smarter’ mistakes rather than ‘dumb’ ones. Based on concepts borrowed from signal detection and control theory, we demonstrate that, to improve heuristic decision making, teaching should focus on differential diagnoses and learning from feedback and mistakes, in teams and in contextually rich settings where the frequencies, costs and trade‐offs between different types of errors (misses versus false alarms) can be experienced. We discuss three possible teaching formats and how to best implement them based on our findings. Conclusions The most promising way to train (future) physicians and other health professionals in clinical decision making is not to circumvent heuristics or correct deviations from logic and probability theory but to enhance the use of heuristics by improving perspicacity, that is, by tuning the (recognition) processes that underlie the domain‐specific adaptive selection of heuristics and management of ensuing errors.

Person- and job-specific factors of intuitive decision-making in clinical practice: results of a sample survey among Hungarian physicians and nurses

“…A more radical position asserts that relying solely on evidence-based evaluation and analytical reasoning is impracticable as a method of CDM (Bodemer, Hanoch, & Katsikopoulos, 2015 ; Feufel & Flach, 2019 ; Stolper et al, 2011 ). This view is supported by evidence showing that simplified, heuristic ways of DM in real-life situations often outperform more complex, analytical methods (Gigerenzer & Gaissmaier, 2011 ; Marewski & Gigerenzer, 2012 ).…”

“…Adopting Simon’s ( 1956 ) ecological rationality paradigm, Bodemer et al ( 2015 ) and Marewski and Gigerenzer ( 2012 ) argue that heuristic methods are adaptive under the usual conditions of CDM, which are: inherent unpredictability, incompleteness of information, and limited time and capacity for information processing. Proponents of this approach advocate that the applicability of non-analytical CDM techniques should be investigated, those found viable should be described and further refined, and their usage should be taught to medical students (Bodemer et al, 2015 ; Feufel & Flach, 2019 ).…”

Under-triage: A New Trigger to Drive Quality Improvement in the Emergency Department

“…Interventions to improve the use of heuristics among triage nurses include partnering senior nurses with training nurses. 27 Additionally, a list of common heuristics can be developed over time and shared with orienting staff.…”

Heuristics, language and medical errors

“…Язык и эвристика могут быть причинами диагностических ошибок. Информирование врачей о том, что может повлиять на процесс принятия решений, будет способствовать уменьшению количества ошибок [26,27]. В этой статье мы обсудили аффективную эвристику («висцеральная предвзятость»), ошибку атрибуции, предвзятость доступности и «различные смыслы одного слова».…”