1. Lecture 3 The cognitive continuum
Dr Carl Thompson, University of York

2. Dr Carl Thompson, University of York
Cognitive continuum (cf. Hammond, Hamm, Dowie )
‘pure’ scientific experiment
Control trial & statistics
Quasi experiment with relaxed controls +
Time,
Visibility
Of process -
good
Task
Structure
poor
System aided judgement
Peer aided judgement
intuition
normative (as well as descriptive) model of decision making
tries to link the information and ways of thinking required for ‘good’ decisions with the nature of the decision faced
It moves away from the ‘one expert’ fits all approach which the analysis through intuition expertise model of Dreyfus and Dreyfus and Patricia Benner fosters.
This is especially pertinent to primary care where clinicians often expressed the feeling that a generalist perspective made particular demands in terms of information provision to support decision making.
Breadth of decisions to be made building up expertise in a single area was difficult.
Examples of different modes of cognition and the information-related consequences are for example the reasonably well structured pharmaceutical decision of dose x versus dose y for asthma medication in an otherwise fit adult in a nurse practitioners clinic – good structure and reasonably amenable to searching for information (BNF easily available, no translation required and ‘fits’ with the expected behaviour of clinicians in a primary care setting both on the part of clinicians and patients).
A peer aided judgement was the most common response to seeking external information in situations of decision related uncertainty. As decisions had less structure (for example, where previous experience failed to offer patterns of similar signs and symptoms, or the limits of individual expertise were found or being approached and in which decisions are now ‘messier’; finally the intuitive mode which is where most practitioners operate most of the time occurs when decisions become so complex, time is limited and there is little need to demonstrate a rationale (proactively) for the decisions you make. It is worth pointing out that at each point in the continuum there are epistemological safeguards so you can see that in the generation of knowledge from the mid point onwards there are increasing controls and moves towards what might be called the crucial experiment. But as we move towards the intuitive end of the continuum the safeguard is simply an individuals opinion justified by the authority of their experience.
What determines a decisions structure?
It’s a function of a decisions complexity:
number of cues – more cues greater movement towards intuition
redundancy of cues – more cues predict other cues greater chances of intuition
identity of the organising principle – if simple linear rules work then more likely that intuition will be used if a more complicated way of combining information works then more likely to be analytical (but only if you know about it)
Ambiguity of its content
if organising principle is available then more likely to use it.
unfamiliarity of decision task induces intuition (no organising principles exist for combining information cues)
possibility of accuracy: if the possibility exists that it is possible to be highly accurate using a procedure then people will use it and be more analytical
Task presentation
task decomposition: if decisions are structured in ways that guide nurses towards a sequence of subtasks then that will induce analysis
cue definition: quantitative cues induce analysis; images and qualitative cues induce intuition
response time: short time – intuition; longer time = analysis
Other factors that can induce shifts along the continuum include social factors (such as expected behaviour), institutional factors (such as access to information on ways of combining cues and vitally, what the decision maker actually knows more knowledge of principles available generally means more analysis.
Dr Carl Thompson, University of York
intuition
Analysis

3. Dr Carl Thompson, University of York
INTUITION
Quality Of
Analysis
Quality Of
intuition
ANALYSIS
Least
Precise/
explicit
Definition of concepts
Specification of relationships
Measurement of magnitudes
most
Precise/
explicit
MODE “7”
KNOWLEDGE non clinical expert descriptive case randomised scientific
GENERATION cognitive judgement consensus (positive) control controlled experiment
“judgement” judgement model study trial
DECISION non-cognitive clinical expert decision
MAKING “decision” judgement consensus (normative)
decision model
Dr Carl Thompson, University of York
© dowie2002

4. Dr Carl Thompson, University of York
5 premises
Cognition moves on an intuitive-analytical continuum
Quasi-rationality is the middle ground in a cognitive continuum
Cognitive (judgement and decision) tasks move along a continuum parallel to cognition itself
Cognition moves along the intuitive-analytical continuum as a function of time
Cognition is selectively capable of relying on pattern recognition and on the use of functional relations conditional upon task characteristics
5 premises of cognitive continuum theory
Lets explore each of these assumptions in turn
Dr Carl Thompson, University of York

5. Dr Carl Thompson, University of York
INTUITION
QUASI RATIONALITY
ANALYSIS
CHARACTERISTICS
RAPID INFO PROCESSING
SIMULTANEOUS CUE USE
JUDGEMENT PROCESS NOT RETRACEABLE
HIGH CONFIDENCE IN OUCOIME
LOW CONFIDENCE IN PROCESS
ERRORS NORMALLY DISTRIBUTED
INCONSISTENT (LOW COGNITIVE CONTROL)
LOW COGNITIVE EFFORT NEEDED
LEADS TO INTERPERSONAL CONFLICT
RELIANCE ON PICTORIAL/NON VERBAL CUES
RAW CUE DATA/EVENTS STORED IN MEMORY
RESISTANT TO NEW CUES
CUES EVALUATED AT PERCEPTUAL LEVEL
WEIGHTED AVERAGE ORGANISING PRINCIPLE
SLOW INFO PROCESS
SEQUENTIAL CUE USE
JUDGEMNENT PROCESS RETRACEABLE
LOGICAL RULES AVAILABLE AND USED
LOW CONFIDENCE IN OUTCOME
HIGH CONFIDENCE IN PROCESS
ERRORS FEW, BUT LARGE WHEN THEY OCCUR
CONSITENT (HIGH COGNITIVE CONTROL)
LEADS TO RESOLVABLE CONFLICT
RELIANCE ON QUANTITATIVE CUES
COMPLEX ORGAINSING PRINCIPLES STORED IN MEMORY
RESPONSIVE TO NEW CUES
CUES EVALUATED AT MEASUREMENT LEVEL
TASK SPECIFIC ORGAINSING PRINCIPLE
INVOLVES ASPECTS OF BOTH POLES OF THE CONTINUUM – A BLEND. WE TEND TO OPERATE IN THIS REGION OF THE CONTINUUM IN DAILY LIFE. QUASI RATIONALITY MAY BE MORE OR LESS ANALYTICAL OR INTUIIVE DEPENDING ON THE RELATIVE MIX OF INTUITIVE AND ANALYTICAL CHARACTERISTICS DEMANDED BY THE INFORMATION ENVIRONMENT
PREMISE 1
Dr Carl Thompson, University of York

6. Dr Carl Thompson, University of York
PREMISE 2:Quasi rationality is the middle ground in the cognitive continuum
Six points of diversity within ‘quasi rationality’:
Cognitive method – from intuition to analysis
Feasibility – of using each mode of cognition
Degree of control – from intervention to representation
Potential for interpersonal conflict – low (analysis) high (intuition)
Covertness – more intuition more covertness
Correspondence vs. coherence – intuition emphasises correspondence, analysis emphasises coherence
Dr Carl Thompson, University of York

7. Dr Carl Thompson, University of York
INDUCING
INTUITION
INDUCING
QUASI RATIONALITY
INDUCING
ANALYSIS
CHARACTERISTICS
COMPLEXITY OF TASK STRUCTURE
JUDGEMENT SCALE HAS MANY ALTERNATIVES/STEPS TO SOLUTION
LARGE N (>5) CUES DISPLAYED SIMULTANEOUSLY
JIGH REDUNDANCY AMONGST CUES
CONITUOS HIGHLY VARIABLE CUE VALUE DISTRIBUTIONS
EQUAL WEIGHTING OF CUES IN ECOLOGY
LINEAR RELATIONS BETWEEN CUES AND CRITERION
AMBIGUITY OF TASK CONTENT
ORGANISING PRINCIPLE UNAVAILABLE
TASK OUTCOME NOT AVAILABLE
UNFAMILAR TASK CONTENT
NO FEEDFORWARD/MINIMAL FEEDBACK
HIGH ACCURACY UNLIKELY
FORM OF TASK PRESENTATION
A POSTERIORI TASK AND COGNITIVE DECOMPOSITION
CONTINUOUS CUE DATA
PICTORIAL CUE DEFINITIONS, PERCEPTUALLY MEASURED
BRIEF TIME AVAILABLE FOR JUDGEMENT OR DECISION
COMPLEXITY OF TASK STRUCTURE
JUDGEMENT SCALE HAS FEW ALTERNATIVES/STEPS TO SOLUTION
SMALL N (2-4) CUES DISPLAYED SIMULTANEOUSLY
LOW REDUNDANCY AMONGST CUES
DICHOTOMOUS OR DISCRETE CUES DISTRIBUTIONS UNKNOWN
UNEQUAL WEIGHTING OF CUES IN ECOLOGY
NON LINEAR RELATIONS BETWEEN CUES AND CRITERION
AMBIGUITY OF TASK CONTENT
ORGANISING PRINCIPLEREADILY UNAVAILABLE
TASK OUTCOME READILY AVAILABLE
FAMILAR TASK CONTENT
FEEDFORWARD AND FEEDBACK
HIGH ACCURACY LIKELY
FORM OF TASK PRESENTATION
A PRIORI TASK AND COGNITIVE DECOMPOSITION
DICHOTOMOUS OR DISCRETE CUE DATA
QUANTITATVE CUE DEFINITIONS, OBJECTIVELY MEASURED
LONG TIME AVAILABLE FOR JUDGEMENT OR DECISION
TASKS WHICH INDUCE QUASI RATIONALITY WILL SHOW A MIXTURE OF INTUITION-INDUCING ELEMENTS AS WELL AS ANALYSIS INDUCING ELEMENTS. RELATIVE BALANCE IN THE MIXTURE WILL PREDICT THE POLE TOWARD WHICH COGNITION WOULD MOVE
PREMISE 3
Dr Carl Thompson, University of York

8. Dr Carl Thompson, University of York
Premise 4:Cognition moves along the intuitive-analytical continuum as a function of time
Cognitive activities may move along the intuitive-analytic continuum over time; as they do, the relative contributions of intuitive and analytical components to quasi-rationality will change. Successful cognition inhibits movement, failure stimulates it. (Hammond 1980 p72)
Premise 4
Dr Carl Thompson, University of York

9. Dr Carl Thompson, University of York
activity
Think of two ‘very different’ (qualitatively I.e. they feel different) but common decisions you face in clinical practice
Try and describe (for each, on paper) the:
Complexity of task structure (number of cues; if they are redundant; any organising principle?)
Ambiguity of task content (availability of organising principle; familiarity of what task content; possibility of accuracy)
Form of task presentation (task decomposition; cue definition; permitted or implied response time).
Think about which mode of cognition you SHOULD use for the problem and which you ACTUALLY use in practice – what’s the impact of social factors?
Dr Carl Thompson, University of York