Critical Thinking, Biases and dual

processing: The enduring myth of

generalizable skills
Sandra Monteiro, Jonathan Sherbino, Mathhew Sibbald &
Geoff Norman
(2019), Medical Education
 The essence of expertise is the possession of large, Brief History of the
rise and fall and rise
organized and retrievable body of both formal and again providing the
experiential knowledge not any kind of general thinking perspective from both
cognitive psychology
skills. and medical education

Problem
Solving
Critical
Thinking
General Thinking
Skills in Medicine Reflection
Clinical
Reasoning

Teaching and learning should be about thinking, not knowledge, is not unique to
medicine

Classical European Early Psychologists Mechanistic and

Educationists There is no Mental faculties, focused of Reductionists
Development of Mental Faculties, typical transfer effect Patterning leads to cognitive psychology
exemplified by the study of Latin, Greek (Thorndike-1960)/Behaviorism
and Logic
 General Problem Solver: based on the premise that
The emergence of human (and machine) problem solving was a matter
of adopting general strategies that could then
information – mobilized with specific knowledge to solve problem
Processing Models
Mind as
Cognitive Information
Processor Strategies: Brain storming, lateral thinking,
Psychology Synectic---Increased Problem Solving and
Creativity

The Renaissance
1960-1980 Medical
Critique: Human Minds do not work in the
Education same way as computer that were designed
in the 1970 and 1980.

Expert Diagnostic
Reasoning

Critique: Success on one problem was not

Hypothesis Generation: Encounter, guarantee of success on another. (Typical
followed by long, sequential and Correlation 0.1-0.3), thus the notion of
general problem-solving strategies failed an
Careful Observation of experts systematic search for additional
empirical test.
clinicians would help identifying a set of confirmatory data
Domain specific knowledge must lie behind
expert problem solving that could be
the ability to generate better hypothesis in
taught directly to trainees
Outcome of the process: Diagnostic specific cases.
accuracy- was examined , it was found
to relate primarily to only one variable:
the content of the hypothesis
The Enlightenment: 1980-2000
The role of knowledge and specificity of
Skills
Cognitive Psychology Medical Education
• Deliberate Practice: Expertise has • Clinical Reasoning: to explore the
nothing to do with general strategies kind of knowledge structures that
and everything to do with experiential experts use. One hallmark of expertise
knowledge acquired from practice is the mastery of vast domains of
with many , indeed, thousands of knowledge ranging from analytical-
problems. base rates and physiological
• Means-end analysis mechanism –to experiential.
• Decision Support System-Artificial
Intelligence
 The Counter- Enlightenment : 2000 to the Present
Cognitive Medical
Psychology The Re-emergence of Thinking Skills Education

Critical Metacognition Dual Process

Critical Dual Process Thinking and Biases
Metacognition
Thinking and Biases

Clinical decision
Assumption 1 Assumption 2
Context- System making or Clerkship
Independent Awareness of System 1 2 or performance, Trait –
set of skills one’s thinking Type 2 like which improve
or Type 1
with years of
1. Availability Bias
Strategy: General education
2. Confirmation Bias
Self-regulatory
3. Hindsight Bias
activities
Strategy: Critique: it look at
Watson-Glaser • Slow, Conscious, Act of
general processes, • Fast, Unconscious,
Critical Thinking effortless, Reflection
there are contextually
Appraisal decontextualize
occasional bound process
Critique: d process
acknowledgement • Default Effectively use of
General vs • Backup with
System 2 reasoning
Content-specific
interventionist which to A general strategy of meta-awareness to correct error
• Heuristics as intervene as and reflection is to mobilize relevant
thinking create
consequences of appropriate to knowledge using questions like “ What
multiple problems
the limitation of correct the features go against your diagnosis? And
in interpretation
human inevitable error what other diagnose might be relevant.
information • Resolved Biases Critique: Students, Residents and
processing by using Physicians were consistently
• Lead to biases analytical overconfident
menthod
Conclusion & Critique

• Errors derived not from inadequate thinking skills but from inadequate knowledge.
• Reflection Strategies may have small benefits
• Debiasing Strategies have uniformly null effect.
Why the myth of general skills persisted in Medical
Education

• A shortcut to mastery of many area of knowledge

• Medical Education curricular suffer from restricted time and resources
• Debiasing strategies based on the root cause of error is cognitive biases

Current Era Challenge: “Central focus of education

should be inculcate general skills (CT, PS, CR, & R)”
“Wise Man” should Replaced by “Knowing Man”
Applying the Science of learning to medical
Education
Richard E.Mayer
(2010), Medical Education