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Postgrad Med J. 2017 Aug 9. pii: postgradmedj-2017-135088. doi: 10.1136/postgradmedj-2017-135088. [Epub ahead of print]

Assessing the association between thinking dispositions and clinical error.

Author information

1
Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK.
2
Department of Anaesthetics, Southend University Hospital NHS Foundation Trust, Southend, UK.
3
Department of Anaesthetics, Mid Essex Hospital Trust, Chelmsford, UK.

Abstract

BACKGROUND:

Dual-process theory suggests that type 1 thinking results in a propensity to make 'intuitive' decisions based on limited information. Type 2 processes, on the other hand, are able to analyse these initial responses and replace them with rationalised decisions. Individuals may have a preference for different modes of rationalisation, on a continuum from careful to cursory. These 'dispositions' of thinking reside in type 2 processes and may result in error when the preference is for 'quick and casual' decision-making.

METHODS:

We asked clinicians to answer a cognitive puzzle to which there was an obvious, but incorrect, answer, to measure their propensity for 'quick and casual' decision-making. The same clinicians were also asked to report the number of clinical errors they had committed in the previous two weeks. We hypothesised an association between committing error and settling for an incorrect answer, and that the cognitive puzzle would have predictive capability.

RESULTS:

90 of 153 (59%) clinicians reported that they had committed error, while 103 (67%) gave the incorrect 'intuitive' answer to the cognitive puzzle. There was no statistically significant difference between clinicians who committed error and answered incorrectly, and those who did not and answered correctly (χ2(1, n=1153)=0.021, p=0.885).

CONCLUSIONS:

The prevalence of clinical error in our study was higher than previously reported in the literature, and the propensity for accepting intuitive solutions was high. Although the cognitive puzzle was unable to predict who was more likely to commit error, the study offers insights into developing other predictive models for error.

KEYWORDS:

medical education and training

Conflict of interest statement

Competing interests: None declared.

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