Reviewing intuitive decision-making and uncertainty: the implications for medical education.
BACKGROUND
Intuition and uncertainty are inescapable conditions of many instances of clinical decision- making. Under such conditions biases and heuristics may operate, distorting the decision-making process. Physicians and students are generally unaware of these influences.


OBJECTIVE
To review the extant literature regarding the role of uncertainty and intuition and associated biases on medical decision-making, to highlight the implications this holds for medical education.


BACKGROUND
Using literature identified via Medline and Bioethicsline searches of the past 3 decades, this paper reviews the sources of uncertainty in clinical practice and the role of intuitive decision-making. A detailed description of associated heuristics and biases is provided, and linked with demonstrable examples from medical decision-making.


CONCLUSIONS
It is argued that although uncertainty can be reduced, it can never be completely eliminated from decision-making. Therefore most decision-making performed in medicine contains an irreducible intuitive element and is thus vulnerable to these biases and heuristics. Given that few medical curricula overtly address the process of medical decision-making, both medical students and physicians remain vulnerable to these effects on their own (and their patients') decision-making. Insight via education appears the major means in which to avoid distorting decision-making processes.
Hall
Katherine H
KH
Department of General Practice, Dunedin School of Medicine, University of Otago, New Zealand. katherine.hall@chmeds.ac.nz
D002983:Clinical Competence; D003657:Decision Making; D004501:Education, Medical / Q000592:standards; D006801:Humans; D011939:Mental Recall; D011287:Prejudice