Cognitive Task Analyses emerged from the field of Macrocognition and are designed to evaluate real-world decisions. We hope to triangulate findings using real-time ethnographic approaches. Clinical vignettes and other controlled approaches struggle to approximate decision making in dynamic contexts.

Relatedly, solutions to help clinicians/trainees apply accurate heuristics and avoid cognitive biases should raise contextual awareness and be context-specific.

My take away point when it comes to clinical decision making is that context matters. The dynamic contexts we practice in make studying how clinicians make decisions difficult, but the closer we can get towards examining real world (such as with CTAs) and real time decision making, the better.

Great question! Certainly fatigue and lack of sleep predispose to cognitive errors. Although there wasn’t a clear theme, we occasionally heard from the residents we interviewed that being tired, stressed, or busy with other patient care needs contributed to their decision making.