Guess or Gestalt by Simon Carley
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Transcript of Guess or Gestalt by Simon Carley
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Guess Gestalt or Genius
Simon Carley
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MedicineEvidenceBasedEBM
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Medicine
Evidence
Based
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Me
Evidence
Belief
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Me
Evidence
Belief
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“The most common cognitive problems involved faulty synthesis…. in 74% of cases ”
– Graber ML. et al. Arch Intern Med. 2005;165(13):1493-1499
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Crosskerry 2009
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Crosskerry 2009
Time Critical Information Light
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“Few specialities are judged on the basis of their practitioner’s immediate impressions”
–Karen Cosby & Pat Crosskerry
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http://lifeinthefastlane.com/pulmonary-puzzle-016/
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http://lifeinthefastlane.com/pulmonary-puzzle-016/
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Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency
care setting
Emerg Med J doi:10.1136/emermed-2014-203602 Decreased facial expression variability in patients with
serious cardiopulmonary disease in the emergency care setting Jeffrey A Kline1, Dawn Neumann2, Melissa A Haug3,
David J Kammer4, Virginia A Krabill5
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Injury. 2015 May;46(5):807-13. doi: 10.1016/j.injury.2014.12.026. Epub 2015 Feb 4. Clinical gestalt and the prediction of massive transfusion after trauma.
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Another spoken example Ministry of silly walks picture
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Kurt Koffka Wolfgang Kohler Max Wertheimer
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Judgement
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Judgement
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Does exist
We measure the measurable We perceive the immeasurable We formulate
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Part 3: Education
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• 2. Ask the right questions
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What were you thinking….
Why did that seem to be the right idea at the time…..
How did you/we decide that…
What else were you thinking about….
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m&m
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Me
Evidence
Belief
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Evidence
Belief
Me
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Can we teach clinical judgement?
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Another spoken example Ministry of silly walks picture
Gestalt: ‘A structure, configuration, or pattern of physiological, biological or psychological phenomena so integrated as to constitute a functional unit with
properties not derivable by summation of it’s parts.’
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Read
Patient safety in
Kahneman
Gigerenzer
What the gorilla saw
Irrationality
Bowen JL.Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006;355(21):2217-25.
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Teaching and learning Gestalt/Clinical Judgement?
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Emergency Situation
Situation typical?
Diagnostic uncertainty
Shot-gunning
Analytical reasoning
Heuristics
AnomalyCognitiveCheckpoint
Action
no
yes
sure
unsure
Klein G. Decision making in action: Models and Methods. Norwood, NJ: Ablex Publishing 1993 via Scott Weingart
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system 1 and 2 thinking
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Clinical gestalt and the prediction of
massive transfusion after trauma.
Injury. 2015 May;46(5):807-13. doi: 10.1016/j.injury.2014.12.026. Epub 2015 Feb 4. Clinical gestalt and the prediction of massive transfusion after trauma.
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Clinical gestalt and the prediction of
massive transfusion after trauma.
Injury. 2015 May;46(5):807-13. doi: 10.1016/j.injury.2014.12.026. Epub 2015 Feb 4. Clinical gestalt and the prediction of massive transfusion after trauma.
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Reification
EmergenceInvariance
Multistability