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Assessing the association between thinking dispositions and clinical error
  1. John Kinnear1,2,
  2. Nick Wilson1,3
  1. 1 Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
  2. 2 Department of Anaesthetics, Southend University Hospital NHS Foundation Trust, Southend, UK
  3. 3 Department of Anaesthetics, Mid Essex Hospital Trust, Chelmsford, UK
  1. Correspondence to Professor John Kinnear, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford CM1 1SQ, UK; John.Kinnear{at}


Background Dual-process theory suggests that type 1 thinking results in a propensity to make ‘intuitive’ decisions based on limited information. Type 2 processes, on the other hand, are able to analyse these initial responses and replace them with rationalised decisions. Individuals may have a preference for different modes of rationalisation, on a continuum from careful to cursory. These ‘dispositions’ of thinking reside in type 2 processes and may result in error when the preference is for ‘quick and casual’ decision-making.

Methods We asked clinicians to answer a cognitive puzzle to which there was an obvious, but incorrect, answer, to measure their propensity for ‘quick and casual’ decision-making. The same clinicians were also asked to report the number of clinical errors they had committed in the previous two weeks. We hypothesised an association between committing error and settling for an incorrect answer, and that the cognitive puzzle would have predictive capability.

Results 90 of 153 (59%) clinicians reported that they had committed error, while 103 (67%) gave the incorrect ‘intuitive’ answer to the cognitive puzzle. There was no statistically significant difference between clinicians who committed error and answered incorrectly, and those who did not and answered correctly (χ2(1, n=1153)=0.021, p=0.885).

Conclusions The prevalence of clinical error in our study was higher than previously reported in the literature, and the propensity for accepting intuitive solutions was high. Although the cognitive puzzle was unable to predict who was more likely to commit error, the study offers insights into developing other predictive models for error.

  • medical education and training
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  • Contributors JK designed the study, wrote the study proposal, carried out the data analysis and wrote the first draft of the manuscript. He is responsible for the overall content as guarantor. NW reviewed the study proposal, administered the questionnaire, collected the data and reviewed the manuscript.

  • Competing interests None declared.

  • Ethics approval Faculty Research Ethics Committee of Anglia Ruskin University (FREP 16/17083).

  • Provenance and peer review Not commissioned; internally peer reviewed.

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