Can intuition be taught? YES

James Oldham James.Oldham at SESIAHS.HEALTH.NSW.GOV.AU
Mon Aug 19 22:08:49 UTC 2013


Dear Sandra

One aspect that is important is developing intuition by unconscious modelling is that  there is reliable accurate feedback about the correct outcome(or not)  of the type one strategy. Some illnesses are easier to calibrate than others. In psychiatry in the Emergency Department the distinction between acute psychosis (no obvious medical cause) and delirium (no immediately obvious medical cause) can be difficult because the distinction may only be made reliably  some days after presentation.

I am reminded by some of the early work of John Grinder in neuro-linguistic programming (NLP)

Yours sincerely

James Oldham

James Oldham

Chief Psychiatrist | Mental Health Services Illawarra Shoalhaven Local Health District
Clinical Associate Professor University of Wollongong

From: Sandra Tice [mailto:sandra.tice at MIPCORP.COM]
Sent: Tuesday, 20 August 2013 7:32 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Can intuition be taught? YES

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
www.mipcorp.com<http://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<mailto: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<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]
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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