Lecture 3 The cognitive continuum Dr Carl Thompson, University of York

Dr Carl Thompson, University of York Cognitive continuum (cf. Hammond, Hamm, Dowie 1963-2002) ‘pure’ scientific experiment Control trial & statistics Quasi experiment with relaxed controls + Time, Visibility Of process - good Task Structure poor System aided judgement Peer aided judgement intuition normative (as well as descriptive) model of decision making tries to link the information and ways of thinking required for ‘good’ decisions with the nature of the decision faced It moves away from the ‘one expert’ fits all approach which the analysis through intuition expertise model of Dreyfus and Dreyfus and Patricia Benner fosters. This is especially pertinent to primary care where clinicians often expressed the feeling that a generalist perspective made particular demands in terms of information provision to support decision making. Breadth of decisions to be made building up expertise in a single area was difficult. Examples of different modes of cognition and the information-related consequences are for example the reasonably well structured pharmaceutical decision of dose x versus dose y for asthma medication in an otherwise fit adult in a nurse practitioners clinic – good structure and reasonably amenable to searching for information (BNF easily available, no translation required and ‘fits’ with the expected behaviour of clinicians in a primary care setting both on the part of clinicians and patients). A peer aided judgement was the most common response to seeking external information in situations of decision related uncertainty. As decisions had less structure (for example, where previous experience failed to offer patterns of similar signs and symptoms, or the limits of individual expertise were found or being approached and in which decisions are now ‘messier’; finally the intuitive mode which is where most practitioners operate most of the time occurs when decisions become so complex, time is limited and there is little need to demonstrate a rationale (proactively) for the decisions you make. It is worth pointing out that at each point in the continuum there are epistemological safeguards so you can see that in the generation of knowledge from the mid point onwards there are increasing controls and moves towards what might be called the crucial experiment. But as we move towards the intuitive end of the continuum the safeguard is simply an individuals opinion justified by the authority of their experience. What determines a decisions structure? It’s a function of a decisions complexity: number of cues – more cues greater movement towards intuition redundancy of cues – more cues predict other cues greater chances of intuition identity of the organising principle – if simple linear rules work then more likely that intuition will be used if a more complicated way of combining information works then more likely to be analytical (but only if you know about it) Ambiguity of its content if organising principle is available then more likely to use it. unfamiliarity of decision task induces intuition (no organising principles exist for combining information cues) possibility of accuracy: if the possibility exists that it is possible to be highly accurate using a procedure then people will use it and be more analytical Task presentation task decomposition: if decisions are structured in ways that guide nurses towards a sequence of subtasks then that will induce analysis cue definition: quantitative cues induce analysis; images and qualitative cues induce intuition response time: short time – intuition; longer time = analysis Other factors that can induce shifts along the continuum include social factors (such as expected behaviour), institutional factors (such as access to information on ways of combining cues and vitally, what the decision maker actually knows more knowledge of principles available generally means more analysis. Dr Carl Thompson, University of York intuition Analysis

Dr Carl Thompson, University of York INTUITION Quality Of Analysis Quality Of intuition ANALYSIS Least Precise/ explicit Definition of concepts Specification of relationships Measurement of magnitudes most Precise/ explicit MODE “7” 6 5 4 3 2 1 KNOWLEDGE non- clinical expert descriptive case randomised scientific GENERATION cognitive judgement consensus (positive) control controlled experiment “judgement” judgement model study trial DECISION non-cognitive clinical expert decision MAKING “decision” judgement consensus (normative) decision model Dr Carl Thompson, University of York © dowie2002

Dr Carl Thompson, University of York 5 premises Cognition moves on an intuitive-analytical continuum Quasi-rationality is the middle ground in a cognitive continuum Cognitive (judgement and decision) tasks move along a continuum parallel to cognition itself Cognition moves along the intuitive-analytical continuum as a function of time Cognition is selectively capable of relying on pattern recognition and on the use of functional relations conditional upon task characteristics 5 premises of cognitive continuum theory Lets explore each of these assumptions in turn Dr Carl Thompson, University of York

Dr Carl Thompson, University of York INTUITION QUASI RATIONALITY ANALYSIS CHARACTERISTICS RAPID INFO PROCESSING SIMULTANEOUS CUE USE JUDGEMENT PROCESS NOT RETRACEABLE HIGH CONFIDENCE IN OUCOIME LOW CONFIDENCE IN PROCESS ERRORS NORMALLY DISTRIBUTED INCONSISTENT (LOW COGNITIVE CONTROL) LOW COGNITIVE EFFORT NEEDED LEADS TO INTERPERSONAL CONFLICT RELIANCE ON PICTORIAL/NON VERBAL CUES RAW CUE DATA/EVENTS STORED IN MEMORY RESISTANT TO NEW CUES CUES EVALUATED AT PERCEPTUAL LEVEL WEIGHTED AVERAGE ORGANISING PRINCIPLE SLOW INFO PROCESS SEQUENTIAL CUE USE JUDGEMNENT PROCESS RETRACEABLE LOGICAL RULES AVAILABLE AND USED LOW CONFIDENCE IN OUTCOME HIGH CONFIDENCE IN PROCESS ERRORS FEW, BUT LARGE WHEN THEY OCCUR CONSITENT (HIGH COGNITIVE CONTROL) LEADS TO RESOLVABLE CONFLICT RELIANCE ON QUANTITATIVE CUES COMPLEX ORGAINSING PRINCIPLES STORED IN MEMORY RESPONSIVE TO NEW CUES CUES EVALUATED AT MEASUREMENT LEVEL TASK SPECIFIC ORGAINSING PRINCIPLE INVOLVES ASPECTS OF BOTH POLES OF THE CONTINUUM – A BLEND. WE TEND TO OPERATE IN THIS REGION OF THE CONTINUUM IN DAILY LIFE. QUASI RATIONALITY MAY BE MORE OR LESS ANALYTICAL OR INTUIIVE DEPENDING ON THE RELATIVE MIX OF INTUITIVE AND ANALYTICAL CHARACTERISTICS DEMANDED BY THE INFORMATION ENVIRONMENT PREMISE 1 Dr Carl Thompson, University of York

Dr Carl Thompson, University of York PREMISE 2:Quasi rationality is the middle ground in the cognitive continuum Six points of diversity within ‘quasi rationality’: Cognitive method – from intuition to analysis Feasibility – of using each mode of cognition Degree of control – from intervention to representation Potential for interpersonal conflict – low (analysis) high (intuition) Covertness – more intuition more covertness Correspondence vs. coherence – intuition emphasises correspondence, analysis emphasises coherence Dr Carl Thompson, University of York

Dr Carl Thompson, University of York INDUCING INTUITION INDUCING QUASI RATIONALITY INDUCING ANALYSIS CHARACTERISTICS COMPLEXITY OF TASK STRUCTURE JUDGEMENT SCALE HAS MANY ALTERNATIVES/STEPS TO SOLUTION LARGE N (>5) CUES DISPLAYED SIMULTANEOUSLY JIGH REDUNDANCY AMONGST CUES CONITUOS HIGHLY VARIABLE CUE VALUE DISTRIBUTIONS EQUAL WEIGHTING OF CUES IN ECOLOGY LINEAR RELATIONS BETWEEN CUES AND CRITERION AMBIGUITY OF TASK CONTENT ORGANISING PRINCIPLE UNAVAILABLE TASK OUTCOME NOT AVAILABLE UNFAMILAR TASK CONTENT NO FEEDFORWARD/MINIMAL FEEDBACK HIGH ACCURACY UNLIKELY FORM OF TASK PRESENTATION A POSTERIORI TASK AND COGNITIVE DECOMPOSITION CONTINUOUS CUE DATA PICTORIAL CUE DEFINITIONS, PERCEPTUALLY MEASURED BRIEF TIME AVAILABLE FOR JUDGEMENT OR DECISION COMPLEXITY OF TASK STRUCTURE JUDGEMENT SCALE HAS FEW ALTERNATIVES/STEPS TO SOLUTION SMALL N (2-4) CUES DISPLAYED SIMULTANEOUSLY LOW REDUNDANCY AMONGST CUES DICHOTOMOUS OR DISCRETE CUES DISTRIBUTIONS UNKNOWN UNEQUAL WEIGHTING OF CUES IN ECOLOGY NON LINEAR RELATIONS BETWEEN CUES AND CRITERION AMBIGUITY OF TASK CONTENT ORGANISING PRINCIPLEREADILY UNAVAILABLE TASK OUTCOME READILY AVAILABLE FAMILAR TASK CONTENT FEEDFORWARD AND FEEDBACK HIGH ACCURACY LIKELY FORM OF TASK PRESENTATION A PRIORI TASK AND COGNITIVE DECOMPOSITION DICHOTOMOUS OR DISCRETE CUE DATA QUANTITATVE CUE DEFINITIONS, OBJECTIVELY MEASURED LONG TIME AVAILABLE FOR JUDGEMENT OR DECISION TASKS WHICH INDUCE QUASI RATIONALITY WILL SHOW A MIXTURE OF INTUITION-INDUCING ELEMENTS AS WELL AS ANALYSIS INDUCING ELEMENTS. RELATIVE BALANCE IN THE MIXTURE WILL PREDICT THE POLE TOWARD WHICH COGNITION WOULD MOVE PREMISE 3 Dr Carl Thompson, University of York

Dr Carl Thompson, University of York Premise 4:Cognition moves along the intuitive-analytical continuum as a function of time Cognitive activities may move along the intuitive-analytic continuum over time; as they do, the relative contributions of intuitive and analytical components to quasi-rationality will change. Successful cognition inhibits movement, failure stimulates it. (Hammond 1980 p72) Premise 4 Dr Carl Thompson, University of York

Dr Carl Thompson, University of York activity Think of two ‘very different’ (qualitatively I.e. they feel different) but common decisions you face in clinical practice Try and describe (for each, on paper) the: Complexity of task structure (number of cues; if they are redundant; any organising principle?) Ambiguity of task content (availability of organising principle; familiarity of what task content; possibility of accuracy) Form of task presentation (task decomposition; cue definition; permitted or implied response time). Think about which mode of cognition you SHOULD use for the problem and which you ACTUALLY use in practice – what’s the impact of social factors? Dr Carl Thompson, University of York