Group items tagged

"The purpose of this paper is to introduce the concept of mental workload as a key determinant of the type of cognitive processing used by clinicians. Published research appears to be consistent with 'schemata' based cognition as the principle mode of working for those engaged in complex tasks under time pressure. Although conscious processing of factual data is also used, it may be the primary mode of cognition only in situations where time pressure is not a factor. "

"Of course, cognitive simulation and cognitive rehearsal are important for improving physician performance in any specialty of medicine-surgical and non-surgical alike-no matter what the proportion of cognitive and procedural services. And simulation applications that could support the teaching and assessment of expert judgment would be valuable to medical education programs across all disciplines and throughout the continuum of medical education."

"Education and cognitive psychology have tended to pursue parallel rather than overlapping paths. Yet there is, or should be, considerable common ground, since both have major interests in learning and memory. This paper presents a number of topics in cognitive psychology, summarizes the findings in the field, and explores the implications for teaching and learning."

"Cognitive bias, previously discussed here, is common in medicine and emergency medicine (EM). Metacognition, discussed in this post, can mitigate cognitive error by evaluating one's thinking. Although this seems esoteric, especially to the trainee, there are some concrete ways to go work though this process. "

"Thirty are catalogued in this article, together with descriptions of their properties as well as the impact they have on clinical decision making in the ED. Strategies are delineated in each case, to minimize their occurrence. Detection and recognition of these cognitive phenomena are a first step in achieving cognitive de-biasing to improve clinical decision making in the ED."

"Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People"

I heard Trojanowski (the senior author) talk about this last month at the annual meeting of the American Association for Clinical Chemistry. It's a very interesting topic with a lot of social ramifications. The statement in the absrract that among people with mild cognitive impairment, the biomarker profile had a 100% sensitivity for development of AD needs to be carefully considered. First, the metric that is of greater interest is the positive predictive value. Second, it is known that some patients who have the classic AD findings at autopsy did not have mental impairment in life. We know this from the Nun study.

"The study results further indicated that VPs reduced cognitive load, focused attention, encouraged interaction, motivated participants, stimulated reflection, and supported analytical reasoning. The tutor played a significant role in promoting reflection-on-action and resolving cognitive conflict."

"The authors present principles derived from three basic theories of human cognition that may help to guide clinicians' instruction of parents and patients."

A song about various types of cognitive bias

Diagnosis is the foundation of medicine. Effective treatment cannot begin until an accurate diagnosis has been made. Diagnostic reasoning is a critical aspect of clinical performance. It is vulnerable to a variety of failings, the most prevalent arising through cognitive and affective influences. The impact of diagnostic failure on patient safety does not appear to have been fully recognized. Ideally, all information used in diagnostic reasoning is objective and all thinking is logical and valid, but these conditions are not always met.

"In this blog, we discussed diagnostic tests and their relationship with likelihood ratios as well as heuristics and cognitive errors."

"There are three types of empathy (Goleman, 2007): Cognitive: knowing how another person feels and what they might be thinking Emotional: physically feeling what another person is feeling Compassionate: not only understanding a person's situation and feeling with them, but being moved to help them"

"As science faculty, we naturally emphasize the cognitive domain in our teaching. After all, students think and learn with their brains (we hope!). Yet the affective domain can significantly enhance, inhibit or even prevent student learning. The affective domain includes factors such as student motivation, attitudes, perceptions and values. Teachers can increase their effectiveness by considering the affective domain in planning courses, delivering lectures and activities, and assessing student learning."

"Exploratory behaviors during learning determine what is studied and when, helping to optimize subsequent memory performance. To elucidate the cognitive and neural determinants of exploratory behaviors, we manipulated the control that human subjects had over the position of a moving window through which they studied objects and their locations. Our behavioral, neuropsychological and neuroimaging data indicate that volitional control benefits memory performance and is linked to a brain network that is centered on the hippocampus."

"Overall, medical student respondents, including many who do not play video games, held highly favorable views about the use of video games and related new media technology in medical education. Significant gender differences in game play experience and attitudes may represent male video game design bias that stresses male cognitive aptitudes; medical educators hoping to create serious games that will appeal to both men and women must avoid this."

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

"The two major products of clinical decision making are diagnoses and treatment plans. If the first is correct, the second has a greater chance of being correct too. Surprisingly, we don't make correct diagnoses as often as we think: the diagnostic failure rate is estimated to be 10 to 15%. "

" We stress the importance of ambient and contextual influences on the quality of individual decision making and the need to address factors known to impair calibration of the decision maker. We also emphasise the importance of introducing these concepts and corollary development of training in critical thinking in the undergraduate level in medical education. "