Can intuition be taught? YES

Sandra Tice sandra.tice at MIPCORP.COM
Mon Aug 19 21:31:58 UTC 2013


David.

 

Thank you for your excellent questions.

 

You are correct that a quick transfer requires personal experience.  That is
why the transfer takes place as residents and medical students are doing
their job.  In the case mentioned, the transfer took place while they were
making rounds with the expert emergency medicine physician.  He taught them
personally and that is no doubt why they learned so fast.  If the expert is
not available, residents and medical students could use a tablet but the
transfer would take a few weeks instead of a few days.

   

The study was not published, primarily because our goal was not to publish
but to see if it would work for physicians.

 

General vs. situational is more difficult to explain because within a
physician's context, intuition is both general and specific.  First, you
must understand the difference between knowledge and intuition.  We define
knowledge to be specific information about a patient, condition or
situation.  While intuition is a thinking process that creates insights or
judgments that lead to decisions and actions.  Intuition is not general
problem solving rules, which as Gloria Kuhn pointed out do not work.

 

At the same time clearly physicians do not develop different intuition for
each patients and condition.  (I call very experienced physicians, who make
the right diagnosis at least 90% of the time, experts.  These experts have
usually spent 30+ years refining the intuition in their diagnostic
decision-making processes.)

Experts often use intuition that puts patients into general categories,
e.g., Urgent and Not-Urgent are general categories that work for most
patients and conditions.  If the physician intuitively classifies the
patient's condition as Urgent and classifies the patient's perception of
his/her own condition as Not-Urgent then clearly this creates an
Urgent-Mismatch, which is also a general category.  However, the expert
handles this Urgent-Mismatch in a specific manner. 

 

The judgments made and the actions taken do not come out of the ether.  Many
of you may recognize that Urgent and Not-Urgent intuitive thinking and use
something similar.  A key aspect of intuition is that physicals recognize
their own intuition when they see it or something similar and they can
always correctly you when you get it wrong. 

 

Sandra Tice

Cognitive Scientist & Managing Partner
Direct Phone: 773-975-6555
MIP Corporation

 <http://www.mipcorp.com/> www.mipcorp.com

 

 

From: David Gordon, M.D. [mailto:davidc.gordon at DUKE.EDU] 
Sent: Sunday, August 18, 2013 7:18 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Can intuition be taught? YES

 

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]
Sent: Sunday, August 18, 2013 5:30 PM
To: 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

 <http://www.mipcorp.com/> www.mipcorp.com

 

From: Lorri Zipperer [mailto:Lorri at ZPM1.COM] 
Sent: Friday, August 16, 2013 2:06 PM
To: 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> 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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Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
for Improving Diagnosis in Medicine

To learn more about SIDM visit:
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Save the date: Diagnostic Error in Medicine 2013. September 22-25, 2013 in
Chicago, IL. 
http://www.dem2013.org 

 

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Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


Save the date: Diagnostic Error in Medicine 2013. September 22-25, 2013 in
Chicago, IL. 
http://www.dem2013.org








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