Opening the black box: cognitive strategies in family practice.
OBJECTIVE
We wanted to describe the cognitive strategies used by family physicians when structuring the decision-making tasks of an outpatient visit.


METHODS
This qualitative study used cognitive task analysis, a structured interview method in which a trained interviewer works individually with expert decision makers to capture their stages and elements of information processing.


RESULTS
Eighteen family physicians of varying levels of experience participated. Three dominant themes emerged: time pressure, a high degree of variation in task structuring, and varying degrees of task automatization. Based on these data and previous research from the cognitive sciences, we developed a model of novice and expert approaches to decision making in primary care. The model illustrates differences in responses to unexpected opportunity in practice, particularly the expert's use of attentional surplus (reserve capacity to handle problems) vs the novice's choice between taking more time or displacing another task.


CONCLUSIONS
Family physicians have specific, highly individualized cognitive task-structuring approaches and show the decision behavior features typical of expert decision makers in other fields. This finding places constraints on and suggests useful approaches for improving practice.
Christensen
Robert E
RE
Department of Family Medicine, University of Michigan Medical School, Ann Arbor, USA.
Fetters
Michael D
MD
Green
Lee A
LA
D000328:Adult; D019336:Cognitive Science; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires