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"Dual Processing Models in Medical Diagnosis: The Advantage of Thinking Fast over Slow"

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Uploaded on Dec 10, 2013

Perhaps as a result of the popularity of Kahneman's bestselling book, Thinking Fast and Slow, dual - processing models, which are ubiquitous in psychology, have achieved fame (or perhaps notoriety) as a model of clinical diagnostic reasoning. Although many applications of dual processing to psychology are explanatory, with no evident superiority of automatic or analytical processing, the particular model espoused by Kahneman, a so-called "default interventionist" model, postulates a clear superiority of analytical over automatic reasoning. However, the evidence for the superiority of analytical reasoning in everyday reasoning tasks is derived from the longstanding research program of Tversky and Kahneman, where special cases were devised to "trick" everyday reasoning. It remains to be seen whether everyday judgment is as inadequate as claimed in a more representative task domain.

This theoretical framework has been exported more or less intact into medical diagnosis by Croskerry and a number of others, who claim unequivocally that diagnostic errors originate from cognitive biases related to System 1 (non-analytical) reasoning and are corrected (or not) by System 2 (analytical reasoning). Surprisingly the evidence for these assertions is essentially absent. By contrast, I, and others, have conducted a series of studies showing that analytical reasoning has minimal or no effect on diagnostic accuracy. Implications for education will be discussed.

Dr. Geoff Norman is Professor of Clinical Epidemiology and Biostatistics, McMaster University. He received a Ph.D. in nuclear physics from McMaster University in 1971, and subsequently a M.A. in educational psychology form Michigan State University in 1977. He is the author of 10 books in education, measurement and statistics, and 300 journal articles. His primary research interest is in cognitive psychology applied to problems of learning and reasoning. He has won numerous awards, including the Hubbard Award from the National Board of Medical Examiners in 1989, the Award of Excellence of the Canadian Association for Medical Education in 1997, the Distinguished Scholar Award of the American Educational Research Association, Division I, in 2000, the Award for Outstanding Achievement of the Medical Council of Canada in 2001.

He presently holds a Canada Research Chair. He was elected a Fellow of the Royal Society of Canada in 2007. In 2008, he won the prestigious Karolinska Prize for lifetime achievement in medical education research. He received an honorary degree from Erasmus University in 2010. In 2012, he was appointed the Querido Chair at Erasmus University.

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