Cognitive schema and naturalistic decision making in evidence-based practices

Abstract

A recent article in this journal proposed a naturalistic approach to decision making that overcomes problems intrinsic to classical decision theory. The approach emphasizes cognitive and multi-level processes, the development of expert reasoning, and the role of decision support in individual and organizational decision making. The current paper builds on this effort by suggesting a naturalistic, multi-level, theory that can facilitate the dissemination of evidence-based practices (EBPs). The paper presents "Image Theory," a theory that has been extensively investigated in other disciplines, but has yet to be utilized in medical decision research. It is suggested that its rich, empirically tested, distinctions among kinds of cognitive and organizational processes and types of decisions and tasks make Image Theory especially valuable in describing impediments to implementing EBPs. The paper discusses how naturalistic theory can assist clinicians, administrators, researchers, and policy makers in achieving a balance between evidence-based medicine and patient-centered practice.

Information processing and intuitive decision-making on the fireground: towards a model of expert intuition

“…It has been widely reported that experts, due to their long years of active practice, possess a broader knowledge-base than novices (Shanteau 1992;Falzer 2004;Gobet 2005;Paley 2006;Feldon 2007;Ericsson et al 2007). However, other authors have argued that the basis of experts' competence cannot exactly be explained by simply stating that they possess extensive domain knowledge (Perry and Wiggins 2008;Pollock et al 2002).…”

“…A typical example of such fast paced and high-staked environment is firefighting, where managing complex fire incidents is seen to pose numerous challenges to professionals. Decision-makers in such an environment are therefore expected to perform under moderately highto-extreme conditions, which include coping with intense time pressure, managing uncertainty, assessing and reassessing continuously and rapidly changing conditions, managing ill-defined and conflicting goals (see Orasanu and Connolly 1993;Klein 2008;Lipshitz et al 2007;Falzer 2004). The descriptive decision model therefore describes how decisions are actually made and emphasizes the reasons why the normative model will not work in timepressured and dynamic environments (Simon 1956;Dreyfus 2004;Wong 2000;Klein 2008;Okoli et al 2013).…”

How do Iranian emergency doctors decide? Clinical decision making processes in practice

“…Regardless, the benefits of event-driven decision making in symptomatic treatment, and the number of event-driven decisions in the study, shows that the urgency of patients may make doctors attempt to stabilise patients before diagnosis 24 25. The knowledge-based process needs more intellectual and information process activities.…”

“…Treating patients' abnormal presentations to move them from an unstable to a stable status before using a diagnostic approach makes emergency medicine different from the other specialties 23 24. When there is no clear pattern with an unstable patient, doctors will try possible solutions.…”

A fuzzy logic-based computational recognition-primed decision model

“…Image Theory [2] is one of the well-developed NDM approaches, where three different images are used to organize experts' thinking about decisions. It was recently used, among other applications, to assist clinicians in understanding medical decisions and developing ways to overcome the disparity between principle and clinical practice [9]. Another method is called Task Analysis where human decision processes are explored by analyzing a specific task in the natural environment of interest [35].…”