There is an ‘interesting’ exchange in Academic Medicine over a paper published by Geoff Norman and colleagues. Some daggers drawn methinks. Norman and colleagues state:
‘Errors in diagnosis are more likely to be rectified by conscientious acquisition of relevant knowledge (i.e., clinical experience) than by any attempt to extinguish general cognitive biases and thinking failures.’ I agree.
Croskerry (from the ‘Critical Thinking Program, Division of Medical Education’) and colleagues seem to disagree with this formulation of the issue. I will stick my head above the parapet. The attempt to formalise self-examination of error outwith of multiple contextual examples will fail. It is an academic growth area, but it assumes we not only understand error, but that we have a formal mechanical model of thinking: I suggest we don’t have any such meaningful computational model. Yes, yes, I know the Kahneman and Tversky work, and have feasted on the Simple Heuristics School. Time will tell. But if I see an address like ‘Critical Thinking Program’, I am reminded of the quote attributed to that great physicist: “Whoever undertakes to set himself up as judge in the field of truth and knowledge is shipwrecked by the laughter of the Gods.”
Final point: there needs to be a tax raised every time the word ‘reflection’ is used in the context of medical education. Just think of all the dermatological misery mirrors have caused mankind.