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.