Nicole A. Yoskowitz

Methodological Review: Translational cognition for decision support in critical care environments: A review

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real-world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers.

Methodological Review: Cognitive and learning sciences in biomedical and health instructional design: A review with lessons for biomedical informatics education

Theoretical and methodological advances in the cognitive and learning sciences can greatly inform curriculum and instruction in biomedicine and also educational programs in biomedical informatics. It does so by addressing issues such as the processes related to comprehension of medical information, clinical problem-solving and decision-making, and the role of technology. This paper reviews these theories and methods from the cognitive and learning sciences and their role in addressing current and future needs in designing curricula, largely using illustrative examples drawn from medical education. The lessons of this past work are also applicable, however, to biomedical and health professional curricula in general, and to biomedical informatics training, in particular. We summarize empirical studies conducted over two decades on the role of memory, knowledge organization and reasoning as well as studies of problem-solving and decision-making in medical areas that inform curricular design. The results of this research contribute to the design of more informed curricula based on empirical findings about how people learn and think, and more specifically, how expertise is developed. Similarly, the study of practice can also help to shape theories of human performance, technology-based learning, and scientific and professional collaboration that extend beyond the domain of medicine. Just as biomedical science has revolutionized health care practice, research in the cognitive and learning sciences provides a scientific foundation for education in biomedicine, the health professions, and biomedical informatics.

Towards effective evaluation and reform in medical education: a cognitive and learning sciences perspective

Health professions education is dealing with major transformations in light of the changing nature of the health care delivery system, including the use of technology for “just in time” delivery of care, evidence-based practice, personalized medical care and learning, as health professionals strive to integrate biomedical advances and clinical practice. This has forced the medical education community to reassess the current teaching and learning practices and more importantly, the evaluation of the medical education process. There have been recent advances in cognitive and learning sciences theories, some of which can inform medical educators about best teaching and learning practices and their impact on the evaluation process. An understanding of these theories provides a sound rationale for choosing specific instructional strategies and choosing evaluation measures that assess the curricular objectives. The review begins with an overview of evaluation and assessment in education, followed by an overview of major theories from the cognitive and learning sciences. Next, the role of cognitive and learning sciences theories in informing the process of medical education evaluation is discussed, including its impact on student learning, performance and professional competence, as well as recommendations for reform of medical curricula based on such theories. The paper continues with the elaboration of current trends in health sciences education, particularly medical education, and available evidence for the impact on student learning and performance as well as areas where more research is needed.

Patterns of reasoning and decision making about condom use by urban college students

Abstract HIV infection rates are rapidly increasing among young heterosexuals, making it increasingly important to understand how these individuals make decisions regarding risk in sexual encounters. Our objective in this study was to characterize young adults’ safer sex behaviour and associate this behaviour with patterns of reasoning, using cognitive, information processing methods to understand the process of sexual risk taking. Sixty urban college students from NYC maintained diaries for two weeks and then were interviewed regarding lifetime condom use and sexual history. Using cognitive analysis, we characterized four patterns of condom use behaviour: consistent condom use (35.0%), inconsistent condom use (16.7%), shifting from consistent to inconsistent condom use (35.0%), and shifting from inconsistent to consistent condom use (13.3%). Directionality of reasoning (i.e. data-driven and hypothesis-driven reasoning) was analysed in the explanations provided for condom use decisions. The consistent and inconsistent patterns of condom use were associated with data-driven heuristic reasoning, where behaviour becomes automated and is associated with a high level of confidence in ones judgment. In the other two patterns, the shift in behaviour was due to a significant event that caused a change in type of reasoning to explanation-based reasoning, reflecting feelings of uncertainty and willingness to evaluate their decisions. We discuss these results within the framework of identifying potentially high-risk groups (e.g. heterosexual young adults) as well as intervention strategies for risk reduction. Further, our findings not only identify different patterns of condom use behaviour, but our investigation of the cognitive process of decision-making characterizes the conditions under which such behaviour and reasoning change.

Comprehension of sexual situations and its relationship to risky decisions by young adults

Abstract This research examines the nature of the relationship between comprehension of sexual situations and decisions about risky sexual behaviour by young adults. Participants were 56 heterosexual students from Brooklyn College, NY, located in a community with a relatively high prevalence of HIV/AIDS. They read a sexual encounter scenario and verbally responded to open-ended questions and made decisions about condom use. The responses were recorded, transcribed and analysed. Prior beliefs were evaluated based on participants’ initial responses to the scenario. High and low risk individuals showed a specific set of beliefs about safer sex practices, and they processed information differently during comprehension of the sexual situation. Low-risk individuals focused on cues that show “risks of unprotected sex”, with the goal of not taking any risks. High-risk individuals processed given information as emotionally related, with the goal of ‘immediate pleasure’ in the situation. These processing variables influenced the young adults’ decisions to practice (or not) safer sex behaviour. Educational interventions need to be tailored for different patterns of behaviour. The goal of a customization approach is to intervene at appropriate weak links in the decision-making process, including any contradictory or unjustified beliefs, to promote safer sex behaviour.

The Slippery Slope of Sexual Decision-Making in Young Adults: The Role of Social and Cognitive Factors

Sexual decision-making in young adults continues to present challenges for public health and social science researchers more than three decades after the first HIV epidemic. The objective of this chapter is to identify relevant social and cognitive factors that may influence decision-making about risky sexual behavior in young adults. More specifically, the chapter focuses on our research on sexual decision-making among heterosexual urban college students in a high-risk HIV/AIDS community. Participants completed two weeks of daily sexual encounter diaries, followed by in-depth interviews. Both quantitative and qualitative methods were used to analyze the data. Results showed that participants’ decisions about the use of condoms varied by particular social factors, such as partner influence and condom use attitudes; and cognitive factors, such as perceptions of relationship status and HIV/STD risk assessment. Participants’ justification of their behavior differentiated higher- from lower- risk individuals. The findings suggest that in order to intervene effectively with higher-risk individuals, it is important to understand the nature of the evidence used to make decisions and the conditions under which these decisions change. Risky decision-making in the context of education, the role of technology, and adequate interventions are discussed.