Intuition and deliberation in Australasian paramedics and paramedicine students: An experimental study of applied dual-process theory and thinking styles

Abstract

Paramedics are health professionals who work in a range of settings. Paramedic decision-making impacts patient outcomes, yet little is known about their decision-making processes. Observational studies have emphasised common use of intuitive impressions by paramedics which influence their subsequent deliberative decisions. These observations are consistent with dual-process theories, which argue people use two key cognitive strategies to make decisions: intuitive and deliberative. Recently, a metacognitive process has been proposed to mediate reliance on intuition and deliberation through a 'feeling of rightness' and answer fluency, or the speed the intuition comes to mind. Additionally, research has shown that individuals differ in preference and ability to engage deliberative and intuitive processes, referred to as thinking (or cognitive) styles. This thesis describes four experiments designed to explore factors associated with paramedic decision-making. For all experiments, Australasian paramedics and undergraduate paramedicine students participated. In experiment 1, participants (N = 108) read written vignettes while completing a concurrent navigation task under time pressure, and recorded their impression. The vignettes varied the objective likelihood of a medical condition often encountered by paramedics. Confidence and subjective typicality of the vignette were self-reported while answer fluency was measured. Experiment 1 supported roles for answer fluency and confidence in forming intuition. In experiment 2, participants (N = 148) saw written vignettes in two parts. Participants completed part one under time pressure, alongside a concurrent navigation task before recording their intuitive impression, followed by a deliberative diagnosis with no time pressure or concurrent task. Participants' final diagnosis varied according to their intuitive impression (.85 [95%CI: .78, .90] vs .74 [95%CI: .66, .81]; p = .03). This effect was greater in more experienced paramedics (.94 [95%CI: .78, .99] vs .67 [95%CI: .48, .81]; p = .01). Answer fluency and confidence were associated with the impression, while the impression and confidence were associated with final diagnosis. In experiment 3, participants (N = 204) completed the seven-item Cognitive Reflection Test (CRT) to assess paramedics' and students' abilities to override an attractive, but incorrect, intuitive response. They also completed an instrument measuring four previously validated cognitive styles. Active Open-mindedness (AOT) and decreasing age predicted CRT scores (R2 / R2 adjusted: 0.198 / 0.157; F(10, 192) = 4.752, p < 0.001). Experiment 4 attempted to alter participants' (N = 296) decisions about a clinical vignette, using a theory-based intervention. In a 2x2 fully between-participants experiment, participants saw a written clinical vignette with precise or degraded information, and then chose the single most likely diagnosis from a list, or ranked competing diagnoses. There were no differences across the four stimulus-response conditions (0.75 [0.65, 0.84] vs 0.79 [0.68, 0.87] vs 0.78 [0.65, 0.87] vs 0.72 [0.59, 0.82], p = 0.42). Taken together, these experiments showed that, with increasing experience, paramedics rely on intuition to a greater extent and this intuition influences subsequent deliberative decisions. Answer fluency and confidence partially explained the relationship between intuition and deliberation, along with Active Open-mindedness. These findings are consistent with theoretical explanations of decision-making. However, experiment 4's attempt to alter paramedic decision-making using a theory-based approach was unsuccessful. There are practical implications from these studies for paramedics, students and educators, along with opportunities for future research. Show more