Medical Healthcare

 

Providing good and safe patient care requires highly skilled and dedicated medical staff. Correctly diagnosing and treating patients involves complex cognitive operations. These are often carried out under time pressure, distributed cognition, and within financial constraints. Cognitive issues (such as perception, interpretation, judgment, and decision making) underpin patient care and safety, therefore, a cognitive perspective can provide important insights and ways to effectively contribute to healthcare. 

Understanding cognitive processes can improve quality of decisions, for example, how to manage risk, especially under time pressure when our ability to examine and compare choice alternatives is challenged. Under such conditions the decision making process is modified, and can result in ignoring some choice alternatives, selectively examining information, change of threshold for responding and more (for details, see time pressure). A cognitive approach also enables innovative strategies to reduce error, for example, how 'error recovery' training can be designed and implemented to construct most effective and salient mental representations (see, e.g., A novel approach to minimize error in the medical domain: Cognitive neuroscientific insights into training). 

The cognitive perspective provides the details of how to construct effective medical training (e.g., if, when & how fidelity is important, what examples are best to use, how to control for cognitive load, ways to maximize cognitive mechanisms, etc.; for details see A cognitive perspective on technology enhanced learning in medical training), and also innovative overall approaches to providing healthcare education. When the learning fits the cognitive architecture, then not only information is effectively acquired, but it is remembered in the long term, and most importantly, it is used in clinical practice and thus has an impact. 
 


Cognitive Consultants International (CCI-HQ) provides research, workshops and consultancy to improve medical healthcare see, for example, Northwestern University Medical School and Montreal General Hospital). CCI-HQ's work is aimed at enhancing decision making, reducing error and providing cost effective and efficient medical training. 


Dr. Itiel Dror has received the 2014 ABP (Association for Business Psychology) Annual Award for 'Excellence in Training', see publications.

Healthcare education and medical training is critical for providing good patient care. Understanding expertise, learning, memory, cognitive skills (e.g., anatomists), and other cognitive issues can greatly benefit the use of e-learning and technology enhanced learning. For example, how best to use virtual patients, interactive videos and simulation depends on how effectively they work with the cognitive system. Making them effective gives not only value in terms of investment, but provides better outcomes in terms of patient care and safety.

Selected publications and presentations on these issues:

  • Shimizu, T., and Dror I. E. (2023). A history information management strategy for minimizing biases and noise for improved medical diagnosis. BMJ Open Quality, 2, e002367. 
  • Martin, K., Ricciardelli, R., & Dror, I. E. (2020). How Forensic mental health nurses’ perspectives of their patients can bias healthcare. Journal of Clinical Nursing, 29, (13-14), 2482-2494.
  • Dror, I. E., Schmidt, P., and O'Connor, L. (2011). A Cognitive Perspective on Technology Enhanced Learning in Medical Training: Great Opportunities, Pitfalls and Challenges. Medical Teacher, 33 (4), 291-296.
  • ​Dror, I. E., Melinek, J., Arden, J. L. Kukucka, J., Hawkins, S., Carter, J. & Atherton, D. S. (in press). Cognitive Bias in Forensic Pathology Decisions. Journal of Forensic Sciences. 
  • Grand Rounds on "Cognitively Effective Ways to Reduce Errors in Medical Decision Making and Increase Patient Safety" at Massachusetts General Hospital (MGH). Boston.
  • Dror, I. E., Stevenage, S. V., & Ashworth, A. (2008). Helping the cognitive system learn: Exaggerating distinctiveness and uniqueness. Applied Cognitive Psychology, 22 (4), 573-584. 
  • Park, C.S, Stojiljkovic, L., Lin, B.F., Milicic, B., & Dror, I. E. (2014). Training Induces Cognitive Bias: The Case of a Simulation-Based Emergency Airway Curriculum. Simulation in Healthcare, 9 (2), 85-93. 
  • Dror, I.E. (2016). A Hierarchy of Expert Performance. Journal of Applied Research in Memory and Cognition.  
  • Dror, I. E. (2012). The Paradoxical Nature of Expertise: The Good, the Bad, and the Ugly. Keynote at International Meeting on Simulation in Healthcare (IMSH) Annual Conference of the Society for Simulation in Healthcare (SSiH). San Diego. 
  • Dror, I. E. (2013). Patient safety. In J. A. Dent & R. M. Harden (Eds.), A Practical Guide for Medical Teachers (pp. 276-282). Elsevier. 
  • ​Grand Rounds on "The Terror of Error: Reducing Errors in Medical Decision Making and Increase Patient Safety"  at Monash Medical Center Hospital. Melbourne, Australia. 
  • Sung, M., Johnson, J.E. & Dror, I. E. (2009). Complexity as a guide to understanding decision bias: A contribution to the favorite-longshot bias debate. Journal of Behavioral Decision Making, 22 (3), 318-337.
  • Dror, I. E. (2013). Cognitive Technology. In the 2013 Yearbook of Science & Technology (pp. 80-82). New York: McGraw-Hill. 
  • Fraser-Mackenzie, P.  & Dror, I. E. (2011). Dynamic reasoning and time pressure: Transition from analytical operations to experiential responses. Theory and Decision, 71 (2), 211-225. 
  • ​​A 1-day workshop on "A Cognitive Neuroscience Perspective n Patient Safety & How to Achieve Behaviour Change: Battling Bacteraemia and other Adversaries" at Townsville Hospital and Health Services,, Australia. 
  • Fernandez. R., Dror, I. E., Smith, C. (2011). Spatial abilities of expert clinical anatomists: Comparison of abilities between novices, intermediates, and experts in anatomy. Anatomical Sciences Education, 4 (1), 1-8. 
  • ​Dror, I. E., Kukucka, J., Kassin, S, & Zapf, P. (2018). No One is Immune To Contextual Bias—Not Even the Forensic Pathologist. Journal of Applied Research in Memory and Cognition, 7 (2). 
  • Dror, I.E. (2012). Effective Use of Virtual Patient. Institute for Innovative Technology In Medical Education (iINTIME). 
  • Dror, I. E. (ed.) (2011). Technology Enhanced Learning and Cognition. John Benjamins, Amsterdam.
  • Dror, I. E. (2011). A novel approach to minimize error in the medical domain: Cognitive neuroscientific insights into training. Medical Teacher, 33 (1), 34-38.
  • Cherrett, T., Wills, G., Price, J., Maynard,S ., & Dror, I.E. (2009). Making training more cognitively effective: Making videos interactive. British Journal of Educational Technology, 40 (6), 1124-1134.
  • Dror, I. E. (2011).  Patient care and training: Minimizing errors in medical care that result in patient harm. Medical Teacher, 33 (5), 426-427.
  • Dror, I.E. (2009). Using cognitive technology to enhance learing. International Conference on Computer Supported Education. Lisbon, Portugal. 
  • Fraser-Mackenzie, P. & Dror, I. E. (2009). Selective information sampling: Cognitive coherence in evaluation of a novel item. Judgment and Decision Making, 4 (4), 307-316. 
  • Dror, I.E. (2012). Cognitively Effective Use of Technology in Healthcare Education. Keynote at NHS Masterclass Understanding the Principles of the Department of Health's Technology-enhanced Framework.
  • Dror, I.E. (2012). Expert Performance: A Paradox in Human Cognitive Processing. University of California, Los Angeles (UCLA).
  • Dror, I. E, Makany, T., & Kemp, J. (2011). Overcoming learning barriers through knowledge management. Dyslexia, 17, 38-47.
  • Stibel, J. M., Dror, I. E., & Ben-Zeev, T. (2009). Dissociating Choice and Judgment in Decision Making:  The Collapsing Choice Theory. Theory and Decision, 66 (2), 149-179.
  • Dror, I.E. & Charlton, D. (2006). Why experts make errors.  Journal of Forensic Identification, 56 (4), 600-616.
  • Dror, I. E., Busemeyer, J.R., & Basola, B. (1999). Decision making under time pressure: An independent test of sequential sampling models.  Memory and Cognition, 27 (4), 713-725. 
  • Dror, I.E. (2012). How to Exploit the Emerging Cognitive Opportunities Arising from Medical Simulations. McGill University. 
  • Dror, I. E. (2011). Enhancing Judgements and Improving Performance in Medical Care. The British Medical Association (BMA).
  • Dror, I. E. (2011). Reducing Error in Medical Decision Making. Feinberg School of Medicine, Northwestern University. 
  • Smith, W., Dror, I. E., & Mander, H. (2003). The effect of training specificity on performance in novel and related tasks. XX BPS Annual Cognitive Conference. 
  • Dror, I. E., Langer, E.J., Houlette, M., & Ashworth, R.S.( 2001). Training and tasks demands that restrict and enhance performance. Psychonomic Abstracts, 6, 85.
  • Price, J., Wills, G., Dror, I. E., Cherrett, T. and Maynard, S. (2008). Risk assessment education: Utilizing interactive video for teaching health and safety. The 8th IEEE International Conference on Advanced Learning. Santander, Spain.
  • Ashworth, A.R.S., & Dror, I. E. (2001). Object Identification as a Function of Discriminability and Learning Presentations: The Effect of Stimulus Similarity and Canonical Frame Alignment on Aircraft Identification. Journal of Experimental Psychology: Applied, 6 (2),148-157.
  • Dror, I.E.  (2008). Technology’s role in learning: Possibilities and pitfalls. Rethinking the digital divide, the 15th International Conference of the Association for Learning Technology. Leeds University, Leeds.
  • Dror, I. E. (2011). The paradox of human expertise: Why experts get it wrong. In N. Kapur (Ed.) The Paradoxical Brain (pp. 177-188). Cambridge, UK: Cambridge University Press.
  • Dror, I.E.  (2008). Designing e-learning? Don't leave your brain at home! Learning Technologies conference. London.
  • Peron, A. E., Dror, I. E., & Bucks, R.  (2005). The number of choice alternatives in a decision making task: Cursed by, or spoilt for choice?  9th European Congress of Psychology. Granada, Spain.
  • Makany, T., Kemp, J., & Dror, I. E. (2009). Optimising the use of note-taking as an external cognitive aid for increasing learning. British Journal of Educational Technology, 40 (4), 619-635.
  • Dror, I. E. (2008). Technology enhanced learning: The good, the bad, and the ugly. Pragmatics & Cognition, 16 (2), 215-223.
  • Dror, I. E., Ashworth, R. S., Schreiner, C.S., Robbins, R.D., & Snooks, S. F. (1997). The primacy effect on identification: Initial presentations during training establish long lasting representations. Psychonomic Abstracts, 2, 628. Philadelphia, PA.
  • Dror, I. E. (1996). Cognitive plasticity and its implications and applications to teaching. Lilly Conferences on College Teaching (West). UCLA Conference center, CA.
  • Cherrett, T.,Maynard, S., Wills, G., Price, J., and Dror, I. E. (2008). Utilising Interactive Video for Teaching Health and Safely. European Information Systems (EUNIS) 14th congress on Visions for use of IT. Aarhus, Denmark.
  • Dror, I.E.  (2007). What do the brain and e-learning have to do with one another? The E-learning Network Annual Meeting. London.
  • Baden, D., Dror, I. E., and Warwick-Evans, L.A. (2000). The dynamics within and between decisions. Psychonomic Abstracts, 4, 81.
  • Engelbrecht, P.C.,  Makany, T., Meadmore, K., Dudley, R. & Dror, I.E. (2007). It is not worth learning if it is not remembered: designing e-learning to increase memory. INTED 2007. Valencia, Spain.
  • Dascal, M. & Dror, I. E.  (2005). The impact of cognitive technologies: Towards a pragmatic approach. Pragmatics & Cognition, 13 (3), 451-457.
  • Rafaely, V., Dror, I. E., & Remington, R. E. (2006).  Information selectivity in decision making by young and older adults. International Journal of Psychology, 41 (2), 117-131.
  • Makany, T., Engelbrecht, P.C, Meadmore, K., Dudley, R, Redhead, S., and Dror, I. E. (2007). Giving the learners control of navigation: Cognitive gains and losses. INTED 2007. Valencia, Spain.
  • Dror, I.E. & Treves, R.  (2006). Using cognition to construct technology to enhance learning. Technology Enhanced Learning ESRC Meeting, Wolverhampton, UK. 
  • Dror, I. E. (2011). Making HIT "Brain Friendly" - Optimizing Cognitive Technology and Distributed Cognition in Medicine and Healthcare. Keynote at the Greater China eHealth Forum. Hong Kong. 
  • Dror, I. E. (2011). Medical Education: Do We Know What We Are Doing? Keynote at the Simulation and Training (SiTEL) Conference. Washington. 
  • Rafaely, V., Dror, I. E., & Busemeyer, J. R. (1998). The susceptibility of young and old adults to positive and negative outcomes of recent decisions. Psychonomic Abstracts, 3, 41.
  • Dror, I. E. (2011). Brain friendly technology: What is it? And why we need it? In I. E. Dror, Technology Enhanced Learning and Cognition. John Benjamins, Amsterdam. 
  • Dror, I. E. & Harnad, S. (eds.) (2008). Cognition Distributed: How Cognitive Technology Extends Our Minds. (258 pp.) John Benjamins, Amsterdam. 
  • Dror, I. E. (2011). Building Learning with the Brain In Mind. Learning technology Conference. London. 
  • Dror, I. E. (2010). Training to Minimize Errors in Clinical Decision Making: The Challenges, Obstacles, and the Way Forward. Keynote at The annual conference of the Association for Simulated Practice in Healthcare (ASPiH).  
  • Dror, I.E.  (2007). Exploiting the opportunities and avoiding the pitfalls of games technology: The cognitive perspective. Using games technology and methodology to improve training & education - the opportunities and the issues, ETSA (European Training and Simulation Association) symposium. London. 
  • Dror, I.E.  (2008). Learning to human cognition. National Conference of Applied Learning Technologies. Coventry, UK.
  • Dror, I.E. (2010). Training to Minimize Errors in Medical Decision Making: The Challenges, Obstacles, and the Way Forward.  Keynote at the Annual Meeting of the Association for Medical Education in Europe (AMEE). Glasgow. 
  • Dror, I. E. (2011). Patient care and training: Minimizing errors in medical care that result in patient harm, Medical Teacher, 33 (5), 426-427.