Cognitive Preference and Skill Acquisition: The Relationship Between Student Nurse Anesthetists and Certified Registered Nurse Anesthetists Thinking Styles

Decision-making in healthcare is a complex and, at times, uncertain process. In the United States Certified Registered Nurse Anesthetists (CRNA) administer the majority of anesthesia. Nurse Anesthetists must draw on their educational background, clinical experience, and cognitive processes to make sound clinical judgments. To avoid errors understanding the relationship between cognitive preference and skill acquisition is critical. This study was designed to describe the cognitive preferences of Student Nurse Anesthetists (SRNAs) and CRNAs in the United States. The 2 cognitive preferences explored are rational (analytical) and experiential (intuitive) decision-making. The researcher used a quantitative, cross-sectional, descriptive correlational design. The researcher administered the Rational Experiential Inventory (REI-40) via electronic survey to enrolled SRNAs and practicing CRNAs. The REI-40 is a validated psychometric tool involving 40 questions. Twenty questions evaluate each decision-making style. Ten questions assess engagement (e.g., enjoyment and reliance), and 10 questions assess the ability (e.g., capability and use) of each style. The demographics (e.g., age, gender, clinical experience, setting, and education) were collected and compared with the cognitive preference. This study revealed that SRNAs’ and CRNAs’ dominant cognitive preference was rational thinking and experiential thinking was greater than mid-scale. There was no statistical difference in how SRNAs and CRNAs scored on the REI-40 Inventory. Furthermore, there were no strong correlations between years of experience and cognitive preferences. However, there was a statistically significant difference in experiential cognitive ability and engagement when compared by gender identity. Ideally how one feels, and thinks should be aligned when making clinical decisions. This is the art and science of the profession. Research has revealed that human factors such as cognitive biases, heuristics, personal experience, and emotions play a role in decision-making. The development and integration of experiential decision-making is essential to aligning clinical judgment and safe patient care. This study describes SRNAs’ and CRNAs’ cognitive preferences and the relationship to the level of skill acquisition. This knowledge contributes to the understanding of CRNAs’ decision-making processes. Furthermore, there are ramifications for developing continuing education and clinical support tools for the profession

Judgment and Choice in Personnel Selection

[Excerpt] Imagine that you have set out to buy a used car. You examine eight cars before making your choice, test driving some of them and rejecting others at first glance (due for example to excessive rust). A researcher asks you to rate each of the eight cars in terms of overall quality. The researcher proceeds to sharply criticize you for carrying out an unsystematic search process. Your failure to test-drive every car and to ask the same questions to the dealers about each car has caused you to do a poor job of rank-ordering the cars. You respond that, since you could only afford one car, you had no interest in rank-ordering or in assigning ratings to the entire set of cars. It seems unfair to be criticized for poor performance of a task which was unrelated to your original mission of buying the best used car available. This paper explores the possibility that a similar misspecification of the goals of employee selection has caused researchers to criticize selectors for behavior which may not adversely affect the goal of hiring the best individual from among a group of candidates

Information acquisition and decision making in committees: a survey

JEL Classification: D71, E52Committees, costly information acquisition, monetary policy committees, strategic voting

Opinion as Incentives

We study a model where a decision maker (DM) must select an adviser to advise her about an unknown state of the world. There is a pool of available advisers who all have the same underlying preferences as the DM; they differ, however, in their prior beliefs about the state, which we interpret as differences of opinion. We derive atradeoff faced by the DM: an adviser with a greater difference of opinion has greater incentives to acquire information, but reveals less of any information she acquires, via strategic disclosure. Nevertheless, it is optimal to choose an adviser with at least some difference of opinion. The analysis reveals two novel incentives for an agent to acquire information: a ``persuasion'' motive and a motive to ``avoid prejudice.'' Delegation is costly for the DM because it eliminates both of these incentives. We also study the relationship between difference of opinion and difference of preference.

Pairing Neutral Cues with Alcohol Intoxication: New Findings in Executive and Attention Networks

Rationale: Alcohol-associated stimuli capture attention, yet drinkers differ in the precise stimuli that become paired with intoxication. Objectives: Extending our prior work to examine the influence of alcoholism risk factors, we paired abstract visual stimuli with intravenous alcohol delivered covertly and examined brain responses to these Pavlovian conditioned stimuli in fMRI when subjects were not intoxicated. Methods: Sixty healthy drinkers performed task-irrelevant alcohol conditioning that presented geometric shapes as conditioned stimuli. Shapes were paired with a rapidly rising alcohol limb (CS+) using intravenous alcohol infusion targeting a final peak breath alcohol concentration of 0.045 g/dL or saline (CS−) infusion at matched rates. On day two, subjects performed monetary delay discounting outside the scanner to assess delay tolerance and then underwent event-related fMRI while performing the same task with CS+, CS−, and an irrelevant symbol. Results: CS+ elicited stronger activation than CS− in frontoparietal executive/attention and orbitofrontal reward-associated networks. Risk factors including family history, recent drinking, sex, and age of drinking onset did not relate to the [CS+ > CS−] activation. Delay-tolerant choice and [CS+ > CS−] activation in right inferior parietal cortex were positively related. Conclusions: Networks governing executive attention and reward showed enhanced responses to stimuli experimentally paired with intoxication, with the right parietal cortex implicated in both alcohol cue pairing and intertemporal choice. While different from our previous study results in 14 men, we believe this paradigm in a large sample of male and female drinkers offers novel insights into Pavlovian processes less affected by idiosyncratic drug associations

The effects of primary and conditioned reinforcement on choice under rapid-acquisition conditions.

BACKGROUND: Studies examining preference in concurrent schedules and concurrent- chains procedures have primarily involved steady-state designs with repeated exposure to unchanging reinforcer contingencies. More recently, the acquisition of preference has been studied using rapid-acquisition designs in which reinforcer contingencies change unpredictably across sessions. Grace and colleagues have proposed the cumulative decision model (CDM; Christensen & Grace, 2010; Grace & McLean, 2006; see Grace, 2016 for review) which accounts for acquisition of choice in concurrent chains as well as at steady state. However, the effects of conditioned reinforcement (i.e., terminal-link entries) are not considered in the CDM, and few studies have examined how relative terminal-link entry rate affects acquisition of choice. AIMS: The first aim was to how preference is affected by rapidly changing reinforcer contingencies in concurrent schedules and concurrent chains. The second aim of this research was to develop a model of choice which could account for preference exhibited in concurrent schedules under rapid-acquisition conditions and use this model to extend the CDM to account for effects of conditioned reinforcement. METHODS: Experiment 1 was conducted using concurrent schedules and examined preference in terms of sensitivity to reinforcer ratio when the distribution of log reinforcer ratios was uniform or bimodal. Experiment 2 examined sensitivity to terminal-link entry ratio when left and right terminal-link durations were both short (4 s) or long (16 s). Experiment 3 examined sensitivity to terminal-link entry ratio when initial-link durations were both short (4 s) or long (16 s). Experiment 4 examined sensitivity to terminal-link immediacy ratio when terminal links signalled which initial-link alternative resulted in terminal-link entry (cued) and when they did not (uncued). Left and right terminal links were of unequal durations (4 s and 16 s) or (16 s and 4 s). Experiment 5 examined sensitivity to terminal-link entry ratio when terminal links were cued and uncued but left and right terminal-link durations were equal. RESULTS: In our concurrent schedules experiment, preference was stronger when the distribution of reinforcers was bimodal (approximate matching) and weaker when its distribution was uniform (severe under matching). In Experiment 2, short terminal-link durations resulted in approximate matching while long terminal links produced severe under matching. Bias was strong in pigeons in Experiment 3 but not systematic in terms of order or initial-link duration. Preference between short and long initial links was also approximately equal. However, there was a decrease in preference during the last 12 sessions for short initial links. In Experiment 4, preference was much stronger in cued terminal links (severe over matching) compared to uncued (matching). In Experiment 5, when left and right terminal-link durations were equal, preference was approximately equal between cued and uncued terminal links (severe under matching). However, preference was stronger when birds had prior exposure to uncued terminal links and preference was pooled across cued and uncued conditions (approximate matching). The decision model we developed was able to describe the difference in preference in Experiment 1 but was unable to explain it. This model was also able to account for observed preference in our concurrent-chains experiments, with the exception of Experiment 3. Only experiments using concurrent chains resulted in strong biases. Biases were strongest when terminal links were long and there was no prior exposure to short terminal links. Bias was weakest during short terminal links but only when there was prior exposure to long terminal links. When left and right terminal links were of equal durations, bias was stronger with prior exposure to cued terminal links and weaker with prior exposure to uncued terminal links. Bias was strongest when terminal links were uncued with no prior exposure to cued terminal links. Bias was weakest when terminal links were uncued but with prior exposure to cued terminal links. CONCLUSION: Reinforcer contingencies such as terminal-link duration and signalled terminal links have been observed in previous research. Although the effect of initial-link duration on preference was not observed, there was a decrease in preference at the end of training for short initial links. This indicates that preference under rapid-acquisition conditions could be similar to that observed in steady-state research if pigeons had repeated exposure to unchanging terminal-link entry ratios. Results indicate that preference acquisition under rapidly changing terminal-link entry and immediacy ratios is similar to that observed in steady state studies. The strong biases observed are inversely related to the strength of preference. Although we offer one plausible explanation for this, further scrutiny of this relationship is required to understand it. In terms of predictive accuracy, the decision model we developed was able to predict observed preference and accounted for an adequate amount of variance in the data, with the exception of Experiment 5. The model's accounts of preference at the individual trial level were largely successful. However, when left and right terminal-link durations were equal and did not change, there was a more noticeable effect of the preceding session's terminal-link entry rates on current responding which indicates a molar component of responding prevalent under these conditions in Experiment 5, More research is required to improve our model's ability to account for this molar component. Moreover, additional empirical work is required to allow the model to explain preference acquisition in concurrent schedules under rapid acquisition conditions while satisfying parameter invariance

The impact of the mode of thought in complex decisions: intuitive decisions are better

A number of recent studies have reported that decision quality is enhanced under conditions of inattention or distraction (unconscious thought; Dijksterhuis, 2004; Dijksterhuis and Nordgren, 2006; Dijksterhuis et al., 2006). These reports have generated considerable controversy, for both experimental (problems of replication) and theoretical reasons (interpretation). Here we report the results of four experiments. The first experiment replicates the unconscious thought effect, under conditions that validate and control the subjective criterion of decision quality. The second and third experiments examine the impact of a mode of thought manipulation (without distraction) on decision quality in immediate decisions. Here we find that intuitive or affective manipulations improve decision quality compared to analytic/deliberation manipulations. The fourth experiment combines the two methods (distraction and mode of thought manipulations) and demonstrates enhanced decision quality, in a situation that attempts to preserve ecological validity. The results are interpreted within a framework that is based on two interacting subsystems of decision-making: an affective/intuition based system and an analytic/deliberation system

History-based action selection bias in posterior parietal cortex.

Making decisions based on choice-outcome history is a crucial, adaptive ability in life. However, the neural circuit mechanisms underlying history-dependent decision-making are poorly understood. In particular, history-related signals have been found in many brain areas during various decision-making tasks, but the causal involvement of these signals in guiding behavior is unclear. Here we addressed this issue utilizing behavioral modeling, two-photon calcium imaging, and optogenetic inactivation in mice. We report that a subset of neurons in the posterior parietal cortex (PPC) closely reflect the choice-outcome history and history-dependent decision biases, and PPC inactivation diminishes the history dependency of choice. Specifically, many PPC neurons show history- and bias-tuning during the inter-trial intervals (ITI), and history dependency of choice is affected by PPC inactivation during ITI and not during trial. These results indicate that PPC is a critical region mediating the subjective use of history in biasing action selection