Medical education should teach heuristics rather than train them away
Medical education should teach heuristics rather than train them away
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DOI：
10.1111/medu.13789
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发表时间：
2019-04-01
影响因子：
6
通讯作者：
Flach, John M.
中科院分区：
文献类型：
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作者：
Feufel, Markus A.;Flach, John M.
背景大量研究表明，大多数决策都是基于启发法（简单的经验法则），违反了逻辑和概率论的规定，因此应该避免。然而，关于日常工作环境中决策制定的研究结果支持这样一种观点：如果启发式方法能够适应特定工作领域的挑战和绩效标准，那么启发式实际上是良好决策的基础。由于传统教学法旨在规避（临床）决策中的启发法，因此很少探索通过（医学）教育改进启发法的使用的方法。目的 描述教学和学习正确使用启发法的基本原理，而不是污蔑它们，并确定设计和改进临床决策培训教学法的原则和潜在影响。结果基于有关日常工作领域启发式决策的理论和证据，我们建议不应将启发式视为非理性或仅仅是错误来源而避免，特别是在错误不可避免的领域。相反，我们应该教授和学习如何使用启发式方法来减少犯“聪明”错误，而不是犯“愚蠢”错误。基于从信号检测和控制理论中借用的概念，我们证明，为了改进启发式决策，教学应侧重于差异诊断以及从反馈和错误中学习，在团队和上下文丰富的环境中，可以体验到不同类型错误（错过与误报）之间的频率、成本和权衡。我们讨论了三种可能的教学形式以及如何根据我们的发现最好地实施它们。结论 培训（未来）医生和其他卫生专业人员进行临床决策的最有希望的方法不是规避启发法或纠正逻辑和概率论的偏差，而是通过提高洞察力来增强启发法的使用，即通过调整作为启发法的特定领域自适应选择和随之而来的错误管理基础的（识别）过程。
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.