Experimental study on Fuzzy Trace Theory and paramedic clinical reasoning

Background: Observational studies have found paramedics form rapid intuitive impressions on first meeting a patient and these impressions subsequently affected their clinical reasoning with the most experienced paramedics more likely to rely upon their intuition, than on deliberate reasoning. We report an experiment where theory-based interventions are used to alter clinical reasoning by paramedics and paramedic students in simulated patients. Method: Australian paramedics (n = 213; 49% female) and paramedicine students (n = 83; 55% female) attending paramedic conferences completed a 2x2 fully between-participants experiment. They saw a written clinical vignette in which key clinical information was precise or degraded (stimulus), they then either chose the single most likely diagnosis from a list, or ranked competing diagnoses (response). Outcome variables were diagnostic rate and response time. Results: There were no differences in diagnosis rate across the four stimulus-response conditions (0.75 [0.65, 0.84] vs 0.79 [0.68, 0.87] vs 0.78 [0.65, 0.87] vs 0.72 [0.59, 0.82], p = 0.42), and no effect of experience. Conclusion: This is the first study attempting to experimentally alter clinical reasoning in paramedics. Neither of the interventions tested succeeded in altering measures of clinical reasoning. Similar to previous research on physicians, paramedic reasoning is robust to manipulation.

研究背景：现有观察性研究表明，院前急救医护人员（paramedics）在首次接诊患者时会快速形成直觉性印象，此类印象会后续影响其临床推理过程；且经验最为丰富的院前急救医护人员更倾向于依赖直觉，而非审慎推理。本研究报告一项实验，通过基于理论的干预措施，在模拟患者情境下改变院前急救医护人员与急救医学专业学生（paramedicine students）的临床推理行为。
研究方法：参与院前急救学术会议的澳大利亚籍院前急救医护人员（n=213；女性占比49%）及急救医学专业学生（n=83；女性占比55%）完成了一项2×2完全被试间实验。受试者首先阅读一份书面临床情景（vignette），其中关键临床信息为精确或模糊形式（刺激材料，stimulus）；随后受试者需从诊断列表中选择单一最可能的诊断，或对备选诊断进行排序（反应范式，response）。本研究的结局变量为诊断正确率与反应时。
研究结果：四种刺激-反应范式下的诊断正确率无显著差异（0.75 [0.65, 0.84] vs 0.79 [0.68, 0.87] vs 0.78 [0.65, 0.87] vs 0.72 [0.59, 0.82], p=0.42），且从业经验未对结果产生显著影响。
研究结论：本研究是首次尝试通过实验手段改变院前急救医护人员临床推理过程的研究。本次测试的两项干预措施均未能有效改变临床推理相关测量指标。与既往针对内科医师的研究结果一致，院前急救医护人员的临床推理过程对干预操作具有较强的抗扰动性。