title: Conscious versus unconscious thinking in the medical domain: the deliberation-without-attention effect examined.
abstract: Previous studies have shown that with important decisions, unconscious thought has surprisingly led to better choices than conscious thought. The present study challenges this so-called 'deliberation-without-attention effect' in the medical domain. In a computerized study, physicians and medical students were asked, after either conscious or unconscious thought, to estimate the 5-year survival probabilities of four fictitious patients with varying medical characteristics. We assumed that experienced physicians would outperform students as a result of their superior knowledge. The central question was whether unconscious thought in this task would lead to better performance in experts or novices, in line with the deliberation-without-attention effect. We created four fictitious male 60-year-old patients, each of whom with signs and symptoms related to likely prognosis, from 12 (Complex) or 4 (Simple) categories. This manipulation resulted in objectively different life expectancies for these patients. Participants (86 experienced physicians and 57 medical students) were randomly allocated to the Simple or Complex condition. Statements were randomly presented for 8 s. Next, each participant assessed the life expectancies after either conscious or unconscious thought. As expected, experienced physicians were better in assessing life expectancies than medical students. No significant differences were found in performance between conscious and unconscious thought, nor did we detect a significant interaction between expertise level and mode of thought. In a medical decision task, unconscious thought did not lead to better performance of experienced physicians or medical students than conscious thought. Our findings do not support the deliberation-without-attention effect.
authors.affiliation: Unit of Medical Psychology & Psychotherapy, Department of Psychiatry, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands. b.bonke@erasmusmc.nl.
authors.forename: Benno
authors.initials: B
authors.lastname: Bonke
authors.affiliation: Department of Internal Medicine, Nephrology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Zietse
authors.affiliation: Program for Educational Research and Development, McMaster University, Hamilton, ON, Canada.
authors.forename: Geoff
authors.initials: G
authors.lastname: Norman
authors.affiliation: Department of Psychology, Social Sciences, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
authors.forename: Henk G
authors.initials: HG
authors.lastname: Schmidt
authors.affiliation: Department of Psychology, Social Sciences, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
authors.forename: Roger
authors.initials: R
authors.lastname: Bindels
authors.affiliation: Department of Psychology, Social Sciences, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Mamede
authors.affiliation: Department of Psychology, Social Sciences, Erasmus University, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
authors.forename: Remy
authors.initials: R
authors.lastname: Rikers