Enhancing Patient Safety: Critical Thinking and Decision Making in Healthcare Education

1. Health Profession Education for Patient Safety” Blink or Think? Pat Croskerry MD, PhD The Safety Competencies Enhancing Patient Safety Across the Health Professions, Ottawa, October 2007

2. Health Profession Education for Patient Safety: Blink or Think? Pat Croskerry MD, PhD The Safety Competencies Enhancing Patient Safety Across the Health Professions Ottawa, October 2007

3. Canadian inter-professional competency-based framework (institutional) • Medicine • Nursing • Pharmacy • The therapy groups (PT, OT, RT)

4. Federal Government Four spheres of educational influence Provincial Government Local Government Ethicists Media Legal System General Public Advisory Groups Equipment Suppliers Professional Groups Administrators Managers Health Advisors Current Practitioners Supervisors Government Pharmacy Students Nurses Socio-Legal Groups Residents Blunt End Paramedics in Training Educators Medical Students Multidisciplinary Training Groups

5. To identify the key knowledge, skills and attitudes related to patient safety competencies for all health-care professionals

6. Abilities that contribute to competence

7. What kinds of abilities?

8. Critical Thinking andDecision Making

9. Critical Thinking

10. Specific Abilities underlying Critical Thinking • to know and understand Dual Process Theory • to recognize distracting stimuli, propaganda, bias, irrelevance • to identify, analyze, and challenge assumptions in arguments • to be aware of cognitive fallacies and poor reasoning • to recognize deception, deliberate or otherwise • to assess credibility of information • to monitor and control own thought processes • to monitor and control own affective state • to be aware of the impact of fatigue and sleep deprivation on decision making • to be able to imagine and explore alternatives • to effectively work through problems • to be aware of the importance of the context under which decisions are made • to make effective decisions • to anticipate the consequences of decisions

11. ‘Those who are responsible for teaching students and residents …should try to identify clearly, separate, and then extract these critically important cognitive tasks from courses that encompass myriad unrelated skills and knowledge..’Kassirer, 1995

12. Decision making

14. The Emergence of Dual Process Theory

15. System 1 and System 2(how your brain works)

16. System 1 (intuitive) Cognitive style Heuristic Cognitive awareness Low Cost Low Automaticity High Rate Fast Reliability Low Errors Usually Effort Low Predictive power Low Emotional component High Scientific rigour Low System 2 (analytical) Systematic High High Low Slow High Few High High Low High

18. ‘We really only trust conscious decision making. But there are moments, particularly in times of stress, when haste does not make waste, when our snap judgments and first impressions can offer a much better means of making sense of the world. The first task of Blink is to convince you of a simple fact: decisions made very quickly can be every bit as good as decisions made cautiously and deliberately’ P 14 BlinkMalcolm Gladwell (2005)

20. ‘The technique by which we make good decisions and produce good work is a nuanced and interwoven mental process involving bits of emotion, observation, intuition, and critical reasoning. The emotion and intuition are the easy, “automatic” parts, the observation and critical reasoning skills the more difficult, acquired parts. The essential background to all this is a solid base of knowledge.’ P 12 ThinkMichael Legault (2006)

21. Context Ambient conditions Modular responsivity Task difficulty Task ambiguity Affective state System 1 RECOGNIZED Pattern Recognition Patient Safety Problem Pattern Processor Rational override Dysrationalia override Calibration Response Repetition System 2 NOT RECOGNISED Education Training Critical thinking Logical competence Rationality Feedback Intellectual ability

23. 3 Features of the Model • Repetitive operations of System 2 • System 2 override of System 1 • System 1 override of System 2

24. Repetitive Operations of System 2

25. Context Ambient conditions Modular responsivity Task difficulty Task ambiguity Affective state System 1 RECOGNIZED Pattern Recognition Patient Safety Problem Pattern Processor Rational override Dysrationalia override Calibration Response Repetition System 2 NOT RECOGNISED Education Training Critical thinking Logical competence Rationality Feedback Intellectual ability

27. Repetitive Operations of System 2 • Katecheo • Allows us to avoid redundancy • Saves considerable time and resources • Frees up our cognitive space • Danger of being ‘too automatic’

28. System 2 override of System 1

29. Context Ambient conditions Modular responsivity Task difficulty Task ambiguity Affective state System 1 RECOGNIZED Pattern Recognition Patient Safety Problem Pattern Processor Rational override Dysrationalia override Calibration Response Repetition System 2 NOT RECOGNISED Education Training Critical thinking Logical competence Rationality Feedback Intellectual ability

30. System 2 override of System 1 • Feral vigilance • Avoiding gut reaction • Stop and think • Sleep on it

32. System 1 override of System 2

33. Context Ambient conditions Modular responsivity Task difficulty Task ambiguity Affective state System 1 RECOGNIZED Pattern Recognition Patient Safety Problem Pattern Processor Rational override Dysrationalia override Calibration Response Repetition System 2 NOT RECOGNISED Education Training Critical thinking Logical competence Rationality Feedback Intellectual ability

34. System 1 override of System 2 • Blue threat • Dysrational behaviours