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

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

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

Paramedics in Training 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 Government Supervisors Pharmacy Students Socio-Legal Groups Nurses Residents Blunt End Paramedics in Training Educators Medical Students Multidisciplinary Training Groups

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

Abilities that contribute to competence

What kinds of abilities?

Critical Thinking and Decision Making

Critical Thinking

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

‘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

Decision making

The Emergence of Dual Process Theory

System 1 and System 2 (how your brain works)

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 Low Slow Few

Blink Malcolm Gladwell (2005) ‘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

Think Michael Legault (2006) ‘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

1 2 Response System Calibration System 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

3 Features of the Model Repetitive operations of System 2 System 2 override of System 1 System 1 override of System 2

Repetitive Operations of System 2

1 2 Response System Calibration System 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

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’

System 2 override of System 1

1 2 Response System Calibration System 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

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

System 1 override of System 2

1 2 Response System Calibration System 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

System 1 override of System 2 Blue threat Dysrational behaviours