Prepared for NS5001 EAD Daniela Lehwaldt

 Provide a paradigm for (clinical) decision making  Development of decision making models  Hammond’s cognitive continuum theory Decisions vary in the degree to which they rely on intuition and analytical processes The amount of information and the time available determine where decisions fall within the continuum

 Research is carried out in ‘lab’ settings  Research focuses on identifying ‘optimal’ ways of making decisions  Research based on ‘ideal’ choice strategies  Much of Kahneman’s work demonstrates that practitioners do not adhere to the principles of optimal performance  Research participants relied on heuristics as opposed to algorithmic strategies

 Describes how people make decisions in ‘real world’ settings  Instead of testing models of decision making in controlled lab settings, NDM looks at how people make decisions in dynamic practice environments  People’s actions are not described as suboptimal, if they don’t fit into a model  Looking at practitioners working under difficult conditions  Limited time  Uncertainty  Unstable conditions

 People do not generate and compare option sets  People use prior experience to rapidly categorise situations  People rely on synthesis of their experience  Pattern recognition  Pattern matching  Mental simulation of action  Action

from Klein (1989) Recognition-Primed Decisions

Novice: no experience, rule-governed behaviour, performance. Advanced beginner: some prior experience. Mainly rule- governed behaviour. Competent: demonstrates competence in performance / behaviour (more technically, not necessarily holistically). Proficient: Practices on the basis of principles (holistic understanding) which may be applied in various situations. Expert: deep understanding and seamless performance of simple and complex skills. Also demonstrates an ability to consider the wider aspects of health care. Demonstrates precision, efficiency, smoothness, adaptability, timing and ease when performing a skill. Has developed insight and clinical forethought; intuitive grasp is based on experiential background of similar and dissimilar situations.