Positive Affect Is Associated With Reduced Fixation in a Realistic Medical Simulation

Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities

Psychological research consistently demonstrates that affect can play an important role in decision-making across a broad range of contexts. Despite this, the role of affect in clinical reasoning and medical decision-making has received relatively little attention. Integrating the affect, social cognition, and patient safety literatures can provide new insights that promise to advance our understanding of clinical reasoning and lay the foundation for novel interventions to reduce diagnostic errors and improve patient safety. In this paper, we briefly review the ways in which psychologists differentiate various types of affect. We then consider existing research examining the influence of both positive and negative affect on clinical reasoning and diagnosis. Finally, we introduce an empirically supported theoretical framework from social psychology that explains the cognitive processes by which these effects emerge and demonstrates that cognitive interventions can alter these processes. Such interventions, if adapted to a medical context, hold great promise for reducing errors that emerge from faulty thinking when healthcare providers experience different affective responses.

Decision Making in Obstetric Anesthesia

Obstetric anesthesiologists provide care under unique conditions, where frequently unscheduled cases demand flexibility in thinking and acting. And although most obstetric patients may be healthy, they can quickly deteriorate, necessitating rapid team diagnostic and treatment interventions. Examining decision making is a critical step in improving care to these patients. This article reviews evidence-based models of decision making both with individuals and with teams, and presents strategies to improve decision making under any circumstance.

Cross-task cue utilisation and situational awareness in learning to manage a simulated rail control task

Cue utilisation and situational awareness share similar properties since both constructs are dependent upon the application of feature-event associations in memory. The aim of this study was to investigate the extent to which cue utilisation and situational awareness contribute to learning a simplified, simulated rail control task incorporating an implicit pattern of train movements. Fifty-five undergraduate students completed an assessment of cue utilisation prior to completing the rail control task during periods of lower and higher task demands. Situational awareness was assessed using Situation Awareness Global Assessment Technique (SAGAT) queries. The results indicated that, while both cue utilisation and situational awareness were related to the detection of the implicit pattern of train movements, they contributed separately to performance on the simulated rail control task. The outcomes suggest that cue utilisation and situational awareness may be separate constructs, where cue utilisation constitutes a capacity variable that is associated with changes in response to task demand and situational awareness constitutes an outcome variable that emerges through task exposure.

Analog Resonance Computation: A New Model for Human Cognition

Early models of human cognition appeared to posit the brain as a collection of discrete digital computing modules with specific data processing functions. More recent theories such as the Hierarchically Mechanistic Mind characterize the brain as a massive hierarchy of interconnected and adaptive circuits whose primary aim is to reduce entropy. However, studies in high workload/stress situations show that human behavior is often error prone and seemingly irrational. Rather than regarding such behavior to be uncharacteristic, this paper suggest that such "atypical" behavior provides the best information on which to base theories of human cognition. Rather than using a digital paradigm, human cognition should be seen as an analog computer based on resonating circuits whose primary driver is to constantly extract information from the massively complex and rapidly changing world around us to construct an internal model of reality that allows us to rapidly respond to the threats and opportunities.

"Experience Isn't Everything": How Emotion Affects the Relationship Between Experience and Cue Utilization

OBJECTIVE

This research examined whether negative and positive arousal emotions modify the relationship between experience level and cue utilization among anesthetists.

BACKGROUND

The capacity of a practitioner to form precise associations between clusters of features (e.g., symptoms) and events (e.g., diagnosis) and then act on them is known as cue utilization. A common assumption is that practice experience allows opportunities for cue acquisition and cue utilization. However, this relationship is often not borne out in research findings. This study investigates the role of emotional state in this relationship.

METHOD

An online tool (EXPERTise 2.0) was used to assess practitioner cue utilization for tasks relevant to anesthesia. The experience of positive and negative arousal emotions in the previous three days was measured, and emotion clusters were generated. Experience was measured as the composite of practice years and hours of practice experience. The moderating role of emotion on the relationship between experience and cue utilization was examined.

RESULTS

Data on 125 anesthetists (36% female) were included in the analysis. The predicted interaction between arousal emotions and the experience level emerged. In particular, post hoc analyses revealed that anxiety-related emotions facilitated the likelihood of high cue utilization in less experienced practitioners.

CONCLUSION

The findings suggest a role for emotions in cue use and suggest a functional role for normal range anxiety emotions in a simulated work-relevant task.

APPLICATION

This research illustrates the importance of understanding the potentially functional effects common negative arousal emotions may have on clinical performance, particularly for those with less experience.

The role of emotion in clinical decision making: an integrative literature review

BACKGROUND

Traditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM.

METHODS

A systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning.

RESULTS

Twenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour - responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement.

CONCLUSIONS

Clinicians' experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.