Guess Gestalt or Genius

Simon Carley

MedicineEvidenceBasedEBM

Medicine

Evidence

Based

Me

Evidence

Belief

Me

Evidence

Belief

“The most common cognitive problems involved faulty synthesis…. in 74% of cases ”

– Graber ML. et al. Arch Intern Med. 2005;165(13):1493-1499

Crosskerry 2009

Crosskerry 2009

Time Critical Information Light

http://cdn.lifeinthefastlane.com/

http://cdn.lifeinthefastlane.com/

“Few specialities are judged on the basis of their practitioner’s immediate impressions”

–Karen Cosby & Pat Crosskerry

http://lifeinthefastlane.com/pulmonary-puzzle-016/

http://lifeinthefastlane.com/pulmonary-puzzle-016/

Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency

care setting

Emerg Med J doi:10.1136/emermed-2014-203602 Decreased facial expression variability in patients with

serious cardiopulmonary disease in the emergency care setting Jeffrey A Kline1, Dawn Neumann2, Melissa A Haug3,

David J Kammer4, Virginia A Krabill5

Injury. 2015 May;46(5):807-13. doi: 10.1016/j.injury.2014.12.026. Epub 2015 Feb 4. Clinical gestalt and the prediction of massive transfusion after trauma.

Another spoken example Ministry of silly walks picture

Kurt Koffka Wolfgang Kohler Max Wertheimer

Judgement

Judgement

Does exist

We measure the measurable We perceive the immeasurable We formulate

Part 3: Education

• 2. Ask the right questions

What were you thinking….

Why did that seem to be the right idea at the time…..

How did you/we decide that…

What else were you thinking about….

m&m

Me

Evidence

Belief

Evidence

Belief

Me

Can we teach clinical judgement?

Another spoken example Ministry of silly walks picture

Gestalt: ‘A structure, configuration, or pattern of physiological, biological or psychological phenomena so integrated as to constitute a functional unit with

properties not derivable by summation of it’s parts.’

Read

Patient safety in

Kahneman

Gigerenzer

What the gorilla saw

Irrationality

Bowen JL.Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006;355(21):2217-25.

Teaching and learning Gestalt/Clinical Judgement?

Emergency Situation

Situation typical?

Diagnostic uncertainty

Shot-gunning

Analytical reasoning

Heuristics

AnomalyCognitiveCheckpoint

Action

no

yes

sure

unsure

Klein G. Decision making in action: Models and Methods. Norwood, NJ: Ablex Publishing 1993 via Scott Weingart

system 1 and 2 thinking

Clinical gestalt and the prediction of

massive transfusion after trauma.

Injury. 2015 May;46(5):807-13. doi: 10.1016/j.injury.2014.12.026. Epub 2015 Feb 4. Clinical gestalt and the prediction of massive transfusion after trauma.

Clinical gestalt and the prediction of

massive transfusion after trauma.

Injury. 2015 May;46(5):807-13. doi: 10.1016/j.injury.2014.12.026. Epub 2015 Feb 4. Clinical gestalt and the prediction of massive transfusion after trauma.

Reification

EmergenceInvariance

Multistability