• Emerg Med J · Oct 2012

    Comparative Study

    Experiential and rational decision making: a survey to determine how emergency physicians make clinical decisions.

    • Lisa A Calder, Alan J Forster, Ian G Stiell, Laura K Carr, Jamie C Brehaut, Jeffrey J Perry, Christian Vaillancourt, and Patrick Croskerry.
    • Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. lcalder@ohri.ca
    • Emerg Med J. 2012 Oct 1;29(10):811-6.

    BackgroundDual-process psychological theories argue that clinical decision making is achieved through a combination of experiential (fast and intuitive) and rational (slower and systematic) cognitive processes.ObjectiveTo determine whether emergency physicians perceived their clinical decisions in general to be more experiential or rational and how this compared with other physicians.MethodsA validated psychometric tool, the Rational Experiential Inventory (REI-40), was sent through postal mail to all emergency physicians registered with the College of Physicians and Surgeons of Ontario, according to their website in November 2009. Forty statements were ranked on a Likert scale from 1 (Definitely False) to 5 (Definitely True). An initial survey was sent out, followed by reminder cards and a second survey to non-respondents. Analysis included descriptive statistics, Student t tests, analysis of variance and comparison of mean scores with those of cardiologists from New Zealand.ResultsThe response rate in this study was 46.9% (434/925). The respondents' median age was 41-50 years; they were mostly men (72.6%) and most had more than 10 years of clinical experience (66.8%). The mean REI-40 rational scores were higher than the experiential scores (3.93/5 (SD 0.35) vs 3.33/5 (SD 0.49), p<0.0001), similar to the mean scores of cardiologists from New Zealand (mean rational 3.93/5, mean experiential 3.05/5). The mean experiential scores were significantly higher for female respondents than for male respondents (3.40/5 (SD 0.49) vs 3.30/5 (SD 0.48), p=0.003).ConclusionsOverall, emergency physicians favoured rational decision making rather than experiential decision making; however, female emergency physicians had higher experiential scores than male emergency physicians. This has important implications for future knowledge translation and decision support efforts among emergency physicians.

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