Skip to main content Accessibility help
×
Home

A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics

  • J. L. Jensen (a1) (a2), A. Bienkowski (a3), A.H. Travers (a1) (a2), L.A. Calder (a4), M. Walker (a1), W. Tavares (a5) and P. Croskerry (a2)...

Abstract

Objective

Two major processes underlie human decision-making: experiential (intuitive) and rational (conscious) thinking. The predominant thinking process used by working paramedics and student paramedics to make clinical decisions is unknown.

Methods

A survey was administered to ground ambulance paramedics and to primary care paramedic students. The survey included demographic questions and the Rational Experiential Inventory-40, a validated psychometric tool involving 40 questions. Twenty questions evaluated each thinking style: 10 assessed preference and 10 assessed ability to use that style. Responses were provided on a five-point Likert scale, with higher scores indicating higher affinity for the style in question. Analysis included both descriptive statistics and t tests to evaluate differences in thinking style.

Results

The response rate was 88.4% (1172/1326). Paramedics (n=904) had a median age of 36 years (IQR 29–42) and most were male (69.5%) and primary or advanced care paramedics (PCP=55.5%; ACP=32.5%). Paramedic students (n=268) had a median age of 23 years (IQR 21–26), most were male (63.1%) and had completed high school (31.7%) or an undergraduate degree (25.4%) prior to paramedic training. Both groups scored their ability to use and favourability toward rational thinking significantly higher than experiential thinking. The mean score for rational thinking was 3.86/5 among paramedics and 3.97/5 among paramedic students (p<0.001). The mean score for experiential thinking was 3.41/5 among paramedics and 3.35/5 among paramedic students (p=0.06).

Conclusion

Working paramedics and student paramedics prefer and perceive that they have the ability to use rational over experiential thinking. This information adds to our current knowledge on paramedic decision-making and is potentially important for developing continuing education and clinical support tools.

Objectif

Deux grands processus sous-tendent les prises de décision chez l’homme : la pensée expérientielle (intuitive) et la pensée rationnelle (consciente). Toutefois, l’on ne sait pas à quel mode de pensée recourent principalement les ambulanciers paramédicaux et les étudiants en technique paramédicale dans leurs prises de décision d’ordre clinique.

Méthode

Une enquête a été menée parmi des ambulanciers paramédicaux et des étudiants en soins préhospitaliers de base. Le questionnaire se composait d’une collecte de données démographiques ainsi que d’un outil psychométrique validé de 40 questions, le Rational Experiential Inventory-40 (inventaire rationnel-expérientiel). Vingt questions portaient sur chacun des modes de pensée : dix sur le mode de prédilection et dix sur la capacité d’utiliser ce mode. Les réponses étaient cotées sur une échelle de Likert à 5 points, et les scores plus élevés indiquaient une préférence pour le mode en question. Une analyse s’appuyant sur des statistiques descriptives et des tests t a été réalisée afin de faire ressortir les différences entre les modes de pensée.

Résultats

Le taux de réponse a atteint 88,4% (1172/1326). Les ambulanciers paramédicaux (n=904), d’un âge médian de 36 ans (écart interquartile [EIQ] : 29-42), étaient pour la plupart des hommes (69,5%) et ils avaient une formation en soins préhospitaliers de base ou avancés (base=55,5%; avancés=32,5%). De leur côté, les étudiants en technique paramédicale (n=268), d’un âge médian de 23 ans (EIQ : 21-26), étaient pour la plupart des hommes (63,1%) et ils avaient terminé leurs études secondaires (31,7%) ou avaient obtenu un diplôme de premier cycle (25,4%) avant leur formation en technique paramédicale. Dans les deux groupes, les répondants ont indiqué une préférence marquée pour le mode de pensée rationnelle comparativement au mode de pensée expérientielle, et se sont dits capables de l’utiliser. Le score moyen pour la pensée rationnelle s’élevait à 3,86/5 chez les ambulanciers paramédicaux et à 3,97/5 chez les étudiants en technique paramédicale (p<0,001), tandis que le score moyen pour la pensée expérientielle était de 3,41/5 chez les ambulanciers paramédicaux et de 3,35/5 chez les étudiants en technique paramédicale (p=0,06).

Conclusions

Les ambulanciers paramédicaux et les étudiants en technique paramédicale préfèrent la pensée rationnelle à la pensée expérientielle, et ils se sentent capables de l’utiliser. Les résultats viennent enrichir les connaissances actuelles sur les prises de décision par les ambulanciers paramédicaux, et pourraient se montrer utiles dans l’élaboration d’outils de formation continue et d’aide clinique.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics
      Available formats
      ×

Copyright

Corresponding author

Correspondence to: Jan L. Jensen, Emergency Health Services, Performance and Development, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B2B2E; Email: Jan.Jensen@emci.ca

References

Hide All
1. Kohn, LT, Corrigan, JM, Molla, S. To Err Is Human: Building a Safer Health System. Committee on Quality of Health Care in America. Washington DC: Institute of Medicine National Academy Press; 1999.
2. Baker, GR, Norton, PG, Flintoft, V, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004;170(11):1678-1686.
3. Graber, ML, Franklin, N, Gordon, R. Diagnostic error in internal medicine. Arch Intern Med 2005;165(13):1493-1499.
4. Calder, L, Tierney, S, Jiang, Y, et al. Patient safety analysis of the ED care of patients with heart failure and COPD exacerbations: a multicenter prospective cohort study. Am J Emerg Med 2014;32(1):29-35.
5. Calder, LA, Forster, A, Nelson, M, et al. Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study. CJEM 2010;12(5):421-430.
6. Norman, G. Dual processing and diagnostic errors. Adv Health Sci Educ Theory Pract 2009;14(Suppl 1):37-49.
7. Croskerry, P. A universal model of diagnostic reasoning. Acad Med 2009;84(8):1022-1028.
8. Pacini, R, Epstein, S. The relation of rational and experiential information processing styles to personality, basic beliefs, and the ratio-bias phenomenon. J Pers Soc Psychol 1999;76(6):972-987.
9. Sladek, RM, Bond, MJ, Huynh, LT, et al. Thinking styles and doctors’ knowledge and behaviours relating to acute coronary syndromes guidelines. Implement Sci 2008;3:23.
10. Calder, LA, Forster, AJ, Stiell, IG, et al. Experiential and rational decision making: a survey to determine how emergency physicians make clinical decisions. Emerg Med J 2012;29(10):811-816.
11. Bigham, BL, Maher, J, Brooks, SC, et al. Patient safety in emergency medical services: advancing and aligning the culture of patient safety in EMS. Edmonton, AB: Canadian Patient Safety Institute; 2010.
12. Paramedic Association of Canada. National Occupational Competency Profile, Area 1: Professional Responsibilities. Available at: http://paramedic.ca/nocp/nocp_professionalresponsibilities/ (accessed September 26, 2012).
13. Jensen, JL, Travers, AH, Bardua, DJ, et al. Transport outcomes and dispatch determinants in a paramedic long-term care program: a pilot study. CJEM 2013;15(4):206-213.
14. Björklund, F, Bäckström, M. Individual differences in processing styles: validity of the Rational-Experiential Inventory. Scand J Psychol 2008;49(5):439-446.
15. Witteman, C, van den Bercken, J, Claes, L, et al. Assessing rational and intuitive thinking styles. Eur J Psychol Assess 2009;25(1):39-47.
16. Shiloh, S, Salton, E, Sharabi, D. Individual differences in rational and intuitive thinking styles as predictors of heuristics responses and framing effects. Pers Individ Dif 2002;32(3):415e29.
17. Carper, B. Fundamental patterns of knowing in nursing. ANS Adv Nurs Sci 1978;1(1):13-23.
18. Benner, P. From Novice to Expert: Excellence and Power in Clinical Nursing practice. Menlo Park, CA: Addison-Wesley; 1984.
19. White, J. Patterns of knowing: review, critique and update. ANS Adv Nurs Sci 1995;17(4):73-86.
20. Paley, J, Cheyne, H, Dalgleish, L, et al. Nursing’s ways of knowing and dual process theories of cognition. J Adv Nurs 2007;60(6):692-701.
21. Graber, ML. Educational strategies to reduce diagnostic error: Can you teach this stuff? Adv Health Sci Educ Theory Pract 2009;14(Suppl 1):63-69.
22. Ericsson, KA, Nandagopal, K, Roring, RW. Toward a science of exceptional achievement: Attaining superior performance through deliberate practice. Ann N Y Acad Sci 2009;1172:199-217.
23. Hagiwara, MA, Suserud, BO, Andersson-Gare, B, et al. The effect of a computerized decision support system (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study. BMC Med Inform Decis Mak 2014;14:70.
24. Paramedic Association of Canada. National Occupational Competency Profile. Available at: http://www.paramedic.ca/site/nocp?nav=02 (accessed November 2, 2015).
25. Croskerry, P. Diagnostic failure: a cognitive and affective approach. In: Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology) (eds. Henriksen K, Battles JB, Marks ES, et al.). Rockville: Agency for Healthcare Research and Quality; 2005, 241–52. Available from: http://www.ahrq.gov/qual/advances/ (accessed October 7, 2014).
26. McGregor, CA, Paton, C, Thomson, C, et al. Preparing medical students for clinical decision making: a pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention. Med Teach 2012;34(7):e508-e517.
27. Skånér, Y, Backlund, L, Montgomery, H, et al. General practitioners’ reasoning when considering the diagnosis heart failure: a think-aloud study. BMC Fam Prac 2005;6(1):4.
28. Jensen, JL, Dobson, T. Towards National Evidence-Informed Practice Guidelines for Canadian EMS: Future Directions. Healthc Policy 2011;7(1):22-31.
29. Province of Nova Scotia. Emergency Health Services. Available at: http://novascotia.ca/dhw/ehs/ (accessed October 2, 2012).
30. International Roundtable on Community Paramedicine. Future of EMS. Available at: http://ircp.info/Future-of-EMS (accessed October 2, 2012).
31. Prehospital Evidence Based Protocols Project. Canadian Prehospital Evidence Based Protocols. Available at: https://emspep.cdha.nshealth.ca/ (accessed October 2, 2012).
32. Ericsson, KA. An expert-performance perspective of research on medical expertise: the study of clinical performance. Med Educ 2007;41(12):1124-1130.

Keywords

Type Description Title
WORD
Supplementary materials

Jensen supplementary material
Jensen supplementary material 1

 Word (157 KB)
157 KB

A Survey to Determine Decision-Making Styles of Working Paramedics and Student Paramedics

  • J. L. Jensen (a1) (a2), A. Bienkowski (a3), A.H. Travers (a1) (a2), L.A. Calder (a4), M. Walker (a1), W. Tavares (a5) and P. Croskerry (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed