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

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?

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

Four spheres of educational educational influence influence Educators Nurses Manag ers Legal System Federal Government Med ia Medical Students Supervisors Administrators General Public Current Practitioners Paramedics in Training Equipment Suppliers Residents Health Advisors Professional Groups Ethicists Local Government Advisory Groups Pharmacy Students Multidisciplinary Training Groups Blunt End Socio-Legal Groups Government Provincial Government

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..’ ‘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 System 2 (analytical) (analytical) Systematic Systematic High High Low Low Slow Slow High High Few Few High High Low Low High High

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

Context Ambient conditions Modular responsivity Task difficulty Task ambiguity Affective state Education Training Critical thinking Logical competence Rationality Feedback Intellectual ability Pattern Recognition Repetition Rational override Dysrationalia override Calibration Response Patient Safety Problem Pattern Processor RECOGNIZED NOT RECOGNISED System1 2

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

Context Ambient conditions Modular responsivity Task difficulty Task ambiguity Affective state Education Training Critical thinking Logical competence Rationality Feedback Intellectual ability Pattern Recognition Repetition Rational override Dysrationalia override Calibration Response Patient Safety Problem Pattern Processor RECOGNIZED NOT RECOGNISED System1 2

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

Context Ambient conditions Modular responsivity Task difficulty Task ambiguity Affective state Education Training Critical thinking Logical competence Rationality Feedback Intellectual ability Pattern Recognition Repetition Rational override Dysrationalia override Calibration Response Patient Safety Problem Pattern Processor RECOGNIZED NOT RECOGNISED System1 2

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

System 1 override of System 2

Context Ambient conditions Modular responsivity Task difficulty Task ambiguity Affective state Education Training Critical thinking Logical competence Rationality Feedback Intellectual ability Pattern Recognition Repetition Rational override Dysrationalia override Calibration Response Patient Safety Problem Pattern Processor RECOGNIZED NOT RECOGNISED System1 2

System 1 override of System 2  Blue threat  Dysrational behaviours