Can intuition be taught? YES

Quirk, Mark Mark.Quirk at UMASSMED.EDU
Sat Aug 24 11:12:54 UTC 2013


I agree with David about training -- we do need to focus on both the intuitive and analytic processes. There is good evidence to suggest that 'training for intuition' is essentially the same as training for analytic reasoning or reflection.  It's like learning to walk before riding a bike.   If we train learners to be more reflective or metacognitive (using 'think aloud'; Pat's cognitive forcing strategies focusing on biases, etc.)  they will possess the core component of intuition.  In essence intuition is an artifact of metacognition; operating at the subconscious level.  The difference between the conscious process of metacognition and the subconscious process of intuition is  more affective than cognitive which many of the comments suggest.  To foster intuition then -- we should also be training our learners to deal with uncertainty, tolerate ambiguity and cope with discomfort.

Mark Quirk, Ed.D.
Professor
University of Massachusetts Medical School
Vice President for Educational Outcomes
American Medical Association

________________________________________
From: David Gordon, M.D. [davidc.gordon at DUKE.EDU]
Sent: Friday, August 23, 2013 2:47 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Can intuition be taught? YES

I think most of the discussion on the role of intuition thus far has centered on its efficiency and reliability in accurate diagnosis.  But I want to piggy back off the notion most recently made by Rob of intuition's role in identifying when something is out of the norm. In emergency medicine, this can be a physician's best friend because - amidst all the chaos and numerous patients being seen at once- it helps guide the physician in deciding where to focus one's attention or in which patient we really need to stop and make sure we are applying sound reasoning and science.



In acute care settings, diagnosis must not only be accurate but timely. Not sure if people are using intuition and intuitive reasoning synonymously here, but rapid, subconscious thinking can be a vital asset.  Sometimes it should be credited with immediately identifying a life threatening diagnosis in which there is extreme time sensitivity to the initiation of therapy. Other times it serves more as a warning system which can either direct the physician's global attention (e.g., this is the patient you need to see next) or be used to activate analytical reasoning (e.g., you need to think twice about this patient because something doesn't "feel"right).



In the beginning, I think we need to make sure our learners are developing skills in both intuitive and analytic reasoning. In the end, I think expertise comes in being able to navigate between the two modes of thinking and to apply the right one at the right time.



Thanks for this this interesting discussion,

David





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

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From: robert bell [rmsbell at ESEDONA.NET]
Sent: Monday, August 19, 2013 1:44 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Can intuition be taught? YES

Dear Alan and others,

I agree that practice and training are very valuable - that is why I believe that simulation like training (time and time again), a bit like in the airline industry is the way to go, particularly if all the hurdles can eventually be overcome.

As far as intuition is concerned it seems that intuition is the ability to appreciate that something is out of the norm, and that in turn prompts a different line of thinking. Is extrasensory perception related?!  http://en.wikipedia.org/wiki/Extrasensory_perception

To me it seems dangerous to rely just on intuition as biases can more easily take you in the wrong direction.

I would hate for my plane pilot to be relying too much on intuition as he was landing. But equally I would appreciate her/him reacting to something that was not right, but not reacting dramatically to something that was just a gut feeling of unease that may or may not be important. So the more we can replace intuition with good facts the better. And I think that requires standard repetitive training.

For example how likely are you to see a case of pyridoxine dependent neonatal seizures in one's career to be able to know how to handle (1 in 50 - 100,000 births). Just knowing that pyridoxine dependent seizures are not usually responsive to standard anti-epileptic drugs may be all you need to know to be able save a child's life. A simple fact.

As an aside, does retraining and repeat training (CMEs) have totally different retention patterns?

Medicine with its increasing complexity, staffing reductions, litigation climate, and management culture is not getting anywhere fast with errors of all kinds being so common. We really need dramatic changes AND FUNDING!

Fun discussion.

Rob Bell


On Aug 18, 2013, at 4:25 PM, Alan Morris wrote:

Admittedly, we can all learn – and practice/training is valuable .  However, human limitations being what they are, our performance is not likely to reach desired goals, whatever our training.
See the recent paper below to see how little effect academic marketing has on clinician performance:

Gjelstad S, Høye S, Straand J, Brekke M, Dalen I, Lindbæk M. Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study). BMJ. 2013 2013-07-26 11:41:54;347

RESULTS:

The baseline prescribing rates were 33.2% (20 094 prescriptions for 60 541 episodes of acute respiratory tract infection) in the intervention arm and 33.4% (21 216/63 548) in the control arm. Post-intervention rates decreased to 31.8% (21 246/66 757) in the intervention arm and increased to 35.0% (23 307/66 501) in the control arm.

The small observed improvement in this and in other studies hardly moves us close to the 95% compliance obtained with adequately explicit decision-support tools.


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<mailto:alan.morris at imail.org>
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From: Sandra Tice <sandra.tice at MIPCORP.COM<mailto:sandra.tice at MIPCORP.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Sandra Tice <sandra.tice at MIPCORP.COM<mailto:sandra.tice at MIPCORP.COM>>
Date: Sunday, August 18, 2013 3:30 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

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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