It is generally accepted that human reasoning is consistent with a “dual process” model and that cognitive errors are associated with a rapid, non-analytical “System 1” process (Kahneman, 2012). Reflective practice (Schön, 1983) on the other hand is associated with analytical thinking (System 2) and is generally assumed to result in fewer errors (Mamede et al. 2004, 2007). This dual-process model, made popular by Daniel Kahneman has been highly influential in medical education and several authors recommend higher education interventions that help medical residents identify cognitive biases and encourage analytic thought (Croskerry, 2003). A series of experiments investigated several key assumptions of the cognitive biases approach to medical reasoning, demonstrating that diagnostic accuracy is not affected by instruction in generalizable reasoning strategies (Monteiro et al. 2015; Norman et al. 2014.; Sherbino et al., 2014; Sherbino et al., 2012). In one study, participants instructed to be more careful and analytic were not significantly more accurate (45%) than participants instructed to diagnose quickly (44.5%) (Norman et al., 2014). In another study, revising a previous incorrect diagnosis resulted in a small benefit, increasing accuracy from 32% to 45% (p< 0.05) for revised diagnoses (Monteiro et al.). However diagnoses that were not revised were far more accurate (62.5%). We will discuss the results of these studies in the context of reflective practice in higher education more broadly.
1. Kahneman, D. (2011). Thinking. Fast and Slow, Farrar, Straus and Giroux.
2. Norman, G., Sherbino, J., Dore, K., Wood, T., Young, M., Gaissmaier, W., ... & Monteiro, S. (2014). The etiology of diagnostic errors: a controlled trial of system 1 versus system 2 reasoning. Academic Medicine, 89(2), 277-284.
3. Monteiro, S.D., Sherbino, J., Patel, A., Mazzetti, I., Norman, G. and Howey E. Reflecting on diagnostic errors: Taking a second look is not enough. Journal of General Internal Medicine. In Press.
