ANZICS NZ Regional Meeting 2017

This page collates the resources for my talks at the ANZICS New Zealand Regional Meeting in Wellington, 2017.

All doctors are jackasses: cognitive biases and clinical decision making

It will come as no surprise that the title of this talk was not taken from ‘How to win friends and influence people’. The subject may make you feel uneasy, and so it should, but no critical care practitioner can afford to ignore it. You might think that you are not a ‘jackass’, but cognitive science tells us to expect that – the ‘blindspot bias’ is universal. I will convince you that you are indeed a ‘Jackass’ and I will show you why. Together we will delve into the workings of the human mind to understand how we think, and how our minds can (and frequently do) sabotage us in critical situations. Finally, we will explore ways we can overcome our universal ‘Jackassness’ so that we can keep patients safe and help save lives.

Resources:

• Croskerry P. Diagnostic Failure: A Cognitive and Affective Approach. In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb. PubMed PMID: 21249816. [Free Full Text]
• Croskerry P. From mindless to mindful practice–cognitive bias and clinical decision making. N Engl J Med. 2013 Jun 27;368(26):2445-8. doi: 10.1056/NEJMp1303712. PubMed PMID: 23802513.
• Croskerry P. Context is everything or how could I have been that stupid? Healthc Q. 2009;12 Spec No Patient:e171-6. PubMed PMID: 19667765. [Free Full Text]
• Croskerry P, Cosby KS, Schenkel SM, Wears RL. Patient Safety in Emergency Medicine, Lippincott Williams & Wilkins, 2009. [Google Books Preview]
• Kahneman D. Thinking, Fast and Slow. Farrar, Straus and Giroux 2011 [Google Books Preview]
• Spiegel R, Johnston M, Ercleve T, Nickson CP. All doctors are jackasses. Emerg Med Australas. 26(6):527-529. 2014. [article]
• litfl.com resources
  • CCC — Affective Dispositions to Respond
  • CCC — Cognitive Dispositions To Respond
  • To Err is Human 001 — Entrapped
  • To Err is Human 002 — Are You Satisficed?

How we learn and why it matters: the new science of learning

Critical care is a complex, dynamic field with a rapidly evolving knowledge base. If we want to do our best for our patients we need to ‘learn how to learn’. Although medical education has been slow to evolve, the science of learning is starting to mature. I will highlight effective learning strategies from the fields of educational psychology and cognitive science that we can all use. I will also explore emerging concepts such as the importance of ‘unlearning’, ‘collective competence’ and why we must learn to fail if we want to succeed.

Resources:

• Effective learning techniques are not widely taught, are not widely known and are not widely performed
• Cognitive science highlights some promising techniques, although definitive evidence of their effectiveness in the medical setting is generally lacking
• We construct knowledge, it isn’t transferred
• Use these techniques:
  • retrieval practice and take advantage of the ‘test effect’ (putting things into our brains isn’t that hard, being able to retrieve it at the right time can be – practice retrieval, ideally in the context in which you want to be able remember something)
  • spaced repetition (try to practice retrieval at just the time you are about to forget something to promote durable learning)
  • elaboration (channel your inner 3 year-old: ask ‘why?’ and explain things to yourself and others)
  • generation (test your knowledge of a topic before learning about it – ask yourself questions and try to predict what will be said before reading a section of a book or article)
  • reflection (reflect on your experience – combines retrieval practice and elaboration and is a way of giving feedback to yourself)
  • calibration (get objective feedback so you are not deluding yourself as a learning)
  • interleaved practice (mix up problem types and topics during practice to prepare you for the real world)
• Dunlosky J, et al. Improving Students’ Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychological Science in the Public Interest, 2013; 14 (1): 4 DOI:10.1177/1529100612453266 [Free Full Text] (great review of the science of effective learning techniques)
• Brown PC, Roedinger HL, McDaniel MA. Make It Stick. Harvard University Press, 14 Apr 2014 [Google Books] (excellent popularisation of the ‘new learning science’)
• Education Theory for the #MedEd Clinician (key insights from Jonathan Sherbino, a master clinician educator)
•  litfl.com resources
  • Deliberate Practice
  • Cognitive Load Theory
  • Cognitive Theory of Multimedia Learning
  • Collective competence
  • Learning from failure
  • Unlearning
  • Learning by Spaced Repetition (I used software called Anki to help me remember key facts for exams)

Learn to take the heat: training for stress

Have you ever had to perform under pressure? Were you ever taught how to ‘take the heat’? As critical care practitioners we need to be able to perform in high stakes, time critical life-or-death situations. I will discuss the causes of acute stress reactions and how they affect performance. With that understanding, we will then develop a toolkit of techniques that will help us prepare in advance, maintain performance under pressure, and recover afterwards so that we are ready for the next crisis.

Resources:

•  Learning to the heat at #SMACCUS
•  An Englishman in South Africa: Robert Lloyd
• First10EM — Performance under pressure (2017)
• EMCRIT stuff by the brilliant Mike Lauria, as well as Scott Weingart and Cliff Reid (who are also brilliant of course!):
  • Imperturbability: William Osler, Resilience, and Redefining Mental Toughness by Mike Lauria (2014)
  • Podcast 132 – MoTR – Toughness Part I with Michael Lauria (2014)
  • Podcast 118 – EMCrit Book Club – On Combat by Dave Grossman (2014)
  • Part I: Going with the Flow by Mike Lauria  (2014)
  • Part II: The Tao of Resuscitation Performance by Mike Lauria (2014)
• TED talks:
  • Grit is the key to success by Angela Duckworth
  • How to make stress your friend by Kelly McGonigal
  • Your body language shapes who you are by Amy Cuddy
• … and an excellent summary of mental practice on Podium, Enhancing Sports Performance Using PETTLEP Imagery by David Smith (2010)
• Burnout