Transcript Powerpoint - Canadian Patient Safety Institute

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)
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Medicine
Nursing
Pharmacy
The therapy groups (PT, OT, RT)
Federal
Government
Four spheres of
educational
influence
Provincial
Government
Local
Government
Ethicists
Media
Legal
System
General
Public
Advisory
Groups
Equipment
Suppliers
Professional
Groups
Government
Socio-Legal Groups
Blunt End
Multidisciplinary
Training Groups
Administrators
Managers
Health
Advisors
Current
Practitioners
Pharmacy
Students
Nurses
Supervisors
Residents
Paramedics in
Training
Medical
Students
Educators
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
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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
How well do we
make decisions?
The Emergence
of
Dual Process Theory
System 1 and System 2
(how your brain works)
Cognitive style
Cognitive awareness
Cost
Automaticity
Rate
Reliability
Errors
Effort
Predictive power
Emotional component
Scientific rigour
System 1
(intuitive)
Heuristic
Low
Low
High
Fast
Low
Usually
Low
Low
High
Low
System 2
(analytical)
Systematic
High
High
Low
Slow
High
Few
High
High
Low
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
RECOGNIZED
Patient Safety
Problem
Pattern
Processor
System
1
Pattern
Recognition
Repetition
NOT
RECOGNISED
System
2
Education
Training
Critical thinking
Logical competence
Rationality
Feedback
Intellectual ability
Rational
override
Dysrationalia
override
Calibration
Response
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
RECOGNIZED
Patient Safety
Problem
Pattern
Processor
System
1
Pattern
Recognition
Repetition
NOT
RECOGNISED
System
2
Education
Training
Critical thinking
Logical competence
Rationality
Feedback
Intellectual ability
Rational
override
Dysrationalia
override
Calibration
Response
Repetitive Operations of System 2
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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
RECOGNIZED
Patient Safety
Problem
Pattern
Processor
System
1
Pattern
Recognition
Repetition
NOT
RECOGNISED
System
2
Education
Training
Critical thinking
Logical competence
Rationality
Feedback
Intellectual ability
Rational
override
Dysrationalia
override
Calibration
Response
System 2 override of System 1
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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
RECOGNIZED
Patient Safety
Problem
Pattern
Processor
System
1
Pattern
Recognition
Repetition
NOT
RECOGNISED
System
2
Education
Training
Critical thinking
Logical competence
Rationality
Feedback
Intellectual ability
Rational
override
Dysrationalia
override
Calibration
Response
System 1 override of System 2
 Blue threat
 Dysrational behaviours