Can intuition be taught? YES

Alan Morris Alan.Morris at IMAIL.ORG
Mon Aug 19 20:50:04 UTC 2013


I support education, training, simulator experience and good teaching.  The emphasis on these and other mechanisms for achieving better human performance, however, avoids what I consider the central challenge: overcoming the human decision-making limitations that make human performance fall far short of a desired goal (for example, 95% compliance with credible evidence-based decisions).  Science requires replication to advance our understanding.  This has been a central theme since Francis Bacon and the enlightenment – and is replayed in E.O. Wilson's "Consilience."  I think we should be discussing tools to enable human decision makers to achieve this goal, in addition to our treatment of the different mechanisms of training.  In the end, and regardless of mechanism, non-replicable behavior will continue to impede medical advances and provide a barrier to realization of patient-clinician encounter scale  medicine as a true science.
Have  a nice day.

Alan H. Morris, M.D.
Professor of Medicine
Adjunct Prof. of Medical Informatics
University of Utah

Director of Research
Director Urban Central Region Blood Gas and Pulmonary Laboratories
Pulmonary/Critical Care Division
Sorenson Heart & Lung Center - 6th Floor
Intermountain Medical Center
5121 South Cottonwood Street
Murray, Utah  84157-7000, USA

Office Phone: 801-507-4603
Mobile Phone: 801-718-1283
Fax: 801-507-4699
e-mail: alan.morris at imail.org
e-mail: alanhmorris at gmail.com

From: BRIAN GOLDMAN <drhbg at ROGERS.COM<mailto:drhbg at ROGERS.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, BRIAN GOLDMAN <drhbg at ROGERS.COM<mailto:drhbg at ROGERS.COM>>
Date: Monday, August 19, 2013 1:38 PM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] Can intuition be taught? YES

Intriguing discussion.  Medicine tends to prize left brain functions: language, logic, critical thinking, numbers, and reasoning.  Intuition is more of a right brain function, along with recognizing faces, expressing emotions, music, reading emotions, color, images, and creativity.  Of those, recognizing the strained expression on a patient's face or the fear of death in their eyes help me intuit life threatening distress. The methods being discussed so far to teach intuition strike me as left brain strategies.  I think the most constructive things we can do is foster the proclivity to intuition already possessed by the learner.

Brian Goldman, MD, MCFP(EM), FACEP
Mount Sinai Hospital, Room 206
600 University Avenue
Toronto, ON M5G 1X5
416-822-5044 phone
416-586-4719 fax

________________________________
From: Valerie Thompson <valerie.thompson at USASK.CA<mailto:valerie.thompson at USASK.CA>>
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Monday, August 19, 2013 2:52:24 PM
Subject: Re: [IMPROVEDX] Can intuition be taught? YES

The study was by Gary Klein and is described in his book "Sources of Power".  It is worth noting, though, that even the most experienced firefighters did not rely on intuition alone- they would simulate the consequences of the course of action they were considering and modify and abandon it as required.  A recent study also shows that although experts are better making intuitive judgments that their less experienced counterparts, they made even better ones after a period of reflection (Moxley et al).  Also, if you haven't already read it, Daniel Kahneman and Gary Klein offer an interesting hypothesis about situations in which intuitions (including clinical intuitions) are likely to be reliable and when they are not:

Moxley, J. H., Ericsson, K. A., Charness, N., & Krampe, R. T. (2012). The role of intuition and deliberative thinking in experts' superior tactical decision-making. Cognition, 124,  72-78. doi: 10.1016/j.cognition.2012.03.005

Kahneman, D., & Klein, G. (2009). Conditions for intuitive expertise: A failure to disagree. American Psychologist, 64(6), 515-526. doi: 10.1037/a0016755.


Prof. Valerie Thompson
Department of Psychology
University of Saskatchewan
9 Campus Drive
Saskatoon, SK, Canada.  S7H 3K3

On 19/08/2013 11:03 AM, Kuhn, Gloria wrote:
I would be most interested in learning more about the study you mention.  Can you give us the reference for it?
I am finding this whole discussion thread fascinating and absolutely agree that situational awareness could be described as a form of intuition and could be taught.
Gloria Kuhn

From: Amy Reinert [mailto:amy.reinert at GMAIL.COM]
Sent: Monday, August 19, 2013 11:22 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Can intuition be taught? YES

As an experienced teacher of the development of intuition in a variety of contexts, I want to offer a few points for this discussion.

Krippner described intuition as a shift in attention from observances and interactions with every day reality to awareness of more subtle aspects of situation, self, or environment.  His description is one of many, but one that I find helpful when teaching intuitive development. Because intuition is difficult to define, it is also difficult to study. Despite the fact that when we talk to each other about intuition we tend to agree about what intuition is, we generally do so without actually describing what it means to us individually.  Therefore, when proof is offered that intuition is or is not anything in particular, careful attention must be paid to the definition of intuition stated in that particular context. There are some good studies out there about intuition as a phenomenon, but few about it in the ontological sense. Because it is a subjective experience, it is nearly impossible to distinguish between intuition and desire, belief, impulse, or attachment to particular outcomes. Worldview heavily influences this, and such distinctions are particularly difficult among individuals who have very little experience in accessing intuition or accepting it as a valid way of knowing.

One of the best studies on intuition that I have read involved the use of intuition in professional environments. It focused on the accuracy of intuition when used solely as a decision making tool-- and allowed participants their own perception of their individual intuition, rather than impose a possibly limiting definition. The findings were that individuals who were inexperienced in their profession, as well as those who were inexperienced at utilizing intuition in decision making were highly inaccurate (made incorrect decisions) when relying on intuition alone. However, very experienced professionals were able to use intuition exclusively in certain situations with a high degree of accuracy. An example used in the study was that fire chiefs with 20+ years of experience tended to know exactly the right moment to pull a fire crew from a building before the building collapsed or the fire took an otherwise difficult turn. They did this without stopping to consciously process all of the factors influencing the situation, but rather reported that they could "feel" when the call needed to be made.

Humans, like all animals, have ways of monitoring the environment that are not cognitively based, and are still poorly understood. In my experience, understanding the mechanisms of the process is not necessary for the development of intuition as a useful skill--and this can indeed be taught. As a most basic rule while training in the use of this skill, when intuition, or the "gut check," differs from reason in a given situation, it is a warning flag to step back and reassess what is known about the situation, and to look for missing pieces of information. When this happens, it is likely that the individual has picked up some bit of data that is sitting there the mind, but not yet integrated into the cognitive processes involved in action.

If anyone is going to be at the September conference and wants to take a moment to run through or learn about some basic development skills, I would be happy to oblige. Teaching this skill is one of my joys in life because it is so helpful in improving professional skills, as well quality of life.

--Amy

Amy Ruzicka, Ph.D.

On Sun, Aug 18, 2013 at 8:17 PM, David Gordon, M.D. <davidc.gordon at duke.edu<mailto:davidc.gordon at duke.edu>> wrote:
Sandra,

I am fascinated by your comment that intuition can be quickly transferred to others because I have regarded it as something that requires personal experience (as opposed to vicarious experience) to develop. By what means was the experience of this senior emergency medicine physician transferred?  Lecture? Small group discussion? Role modeling?  Is this a published study?

Also, from your background, do you regard intuition as a general or situational ability - as Gloria Kuhn alluded to? I can imagine an expert clinician bolstering the learner's intuition for diagnosing chest pain but this wouldn't seem to carry over in the diagnosis of abdominal pain.

-David

David Gordon, MD
Assistant Clinical Professor
Division of Emergency Medicine
Duke University

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From: Sandra Tice [sandra.tice at MIPCORP.COM<mailto:sandra.tice at MIPCORP.COM>]
Sent: Sunday, August 18, 2013 5:30 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Can intuition be taught? YES
Research has shown that intuition is not innate -- it is a learned skill, which means that it can be taught to others.  It is automatic thinking that has become a part of a physician’s unconscious mind through years of experience.  Automatic unconscious thinking is often called intuition or wisdom – the expert clinical reasoning that is required to accurately identify and correctly use relevant knowledge, information, data and cues from tacit interactions to consistently make the right judgments and decisions.
Not only can intuition be taught but we have been capturing and documenting it so that it can be read, learned, improved and quickly transferred to others.  This has been tested in medicine by a physician with over 35 years of experience in emergency medicine who transferred his intuition to residents and medical students.  Within several days, they were diagnosing patients as if they had many years of experience.  Their average diagnostic accuracy immediately improved by roughly 20% and the time required to accurately diagnose a patient dropped from over 1 hour to less than 5 minutes.

Sandra Tice
Cognitive Scientist & Managing Partner
Direct Phone: 773-975-6555
MIP Corporation
www.mipcorp.com<http://www.mipcorp.com/>

From: Lorri Zipperer [mailto:Lorri at ZPM1.COM<mailto:Lorri at ZPM1.COM>]
Sent: Friday, August 16, 2013 2:06 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Can intuition be taught?

Forwarded by the moderator

From: Peggy Zuckerman [mailto:peggyzuckerman at gmail.com]
Sent: Friday, August 16, 2013 12:26 PM
To: Society to Improve Diagnosis in Medicine; John Brush
Subject: Re: [IMPROVEDX] FM: Crowd Wisdom .... lack of dx error in the curriculum
Intuition is just that.  One can learn to respond to one's intuition, usually by practicing doing just that.  Just asking, "Why does that still worry me?  What am I not getting?" etc.  We as a species learned to avoid being eaten by accepting that intuition, which is probably endless amounts of data being processed in the background.
A great book to give a non-medical perspective this is "The Gift of Fear", which reminds us that our fear responses are often overridden by our socialized responses, leaving us vulnerable to danger.  We all have said something to the effect, "I just knew something was wrong, and didn't respond soon enough." This applies to avoiding the odd situation on the street, as well as in the medical setting.
Peggy Zuckerman
On Fri, Aug 16, 2013 at 11:01 AM, John Brush <jebrush at mac.com<mailto:jebrush at mac.com>> wrote:
There are others on this listserv, who are much more qualified than me to answer the question: "Can intuition be taught?"
My two cents: I suspect that intuition is a form of intelligence that is innate, but can be shaped, honed, improved, and recalibrated. Intuition is a talent that can be developed through deliberate practice.
I also think that metacognition can be taught. The goal of education in any domain should be to encourage students to be more thoughtful - to actively and critically think about what they are doing. Students need a vocabulary and some background to get them started, though. I think our goal should be to make this educational process more explicit. What are the core competencies of good medical reasoning, and how can we effectively, reliably, and efficiently teach those competencies?
John

On Aug 16, 2013, at 9:08 AM, Graber, Mark wrote:

Garry's comments raise a very important and fundamental question in our field that someone out there may know the answer to. If not, add it to the growing list of research priorities:

In the traditional paradigm, the expert evolves from years of training and experience, the 'right' education as Garry phrases it.  The expert becomes so because they've made all the errors there are to make, or have seen them.  The opposing view is that we can shortcut this process if we teach principles of metacognition, present all the cognitive biases and their antidotes, and teach error prevention strategies.  Robin Hogarth has a book "Educating Intuition" and Mark Quirk makes many of the same points in his "Intuition and Metacognition in Medical Education."

The question boils down to whether you believe that you really CAN educate intuition, or do you have to acquire it the 'old fashioned' way, through experience.

Mark Graber









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