Journal
MEDICAL EDUCATION
Volume 36, Issue 3, Pages 216-224Publisher
WILEY
DOI: 10.1046/j.1365-2923.2002.01140.x
Keywords
education, medical/standards; decision making; professional practice; uncertaintly; prejudice; curriculum
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Context Intuition and uncertainty are inescapable conditions of many instances of clinical decision-making. Under such conditions biases and heuristics may operate, distorting the decision-making process. Physicians and students are generally unaware of these influences. Purpose To review the extant literature regarding the role of uncertainty and intuition and associated biases on medical decision-making, to highlight the implications this holds for medical education. Content Using literature identified via Medline and Bioethicsline searches of the past 3 decades, this paper reviews the sources of uncertainty in clinical practice and the role of intuitive decision-making. A detailed description of associated heuristics and biases is provided, and linked with demonstrable examples from medical decision-making. Conclusions It is argued that although uncertainty can be reduced, it can never be completely eliminated from decision-making. Therefore most decision-making performed in medicine contains an irreducible intuitive element and is thus vulnerable to these biases and heuristics. Given that few medical curricula overtly address the process of medical decision-making, both medical students and physicians remain vulnerable to these effects on their own (and their patients') decision-making. Insight via education appears the major means in which to avoid distorting decision-making processes.
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