How Can We Define “ Simple ” or “ Complex ” ? Does a “ Complex ” Problem Necessarily Result in Analysis or a “ Simple ” One in Use of Heuristics ?

The past decade has seen a considerable increase in interest in understanding the cognitive underpinnings of medical decision making in dynamic acute care arenas. Errors caused by faulty thought processes more than faulty knowledge are called “cognitive errors” and may be caused by bias, heuristic, emotion, and other nonrational cognitive elements. Although a few groups (including both authors of this article) have been studying cognition and problem solving in dynamic arenas such as emergency medicine, intensive care, or anesthesiology—including some going backmore than 20 years—these concepts are not yet well-known tomany clinicians and simulation educators. Moreover, the literature on these topics exists inmany different kinds of journals and indices and under a variety of key words, which may make finding salient information more challenging. Murray et al deserve congratulations for their work described in this issue of Simulation in Healthcare that uses simulation to understandmore fully such decision making by individuals and teams. “Decision Making in Trauma Settings: Simulation to Improve Diagnostic Skills” highlights critical questions about clinical decision making in a dynamic arena. The study design, assumptions, and conclusions can serve as the basis for an important discussion about many facets of this complex process. One issue highlighted in the article ofMurray et al is whether people are, in general, prone to certain kinds of foibles in decision making when a situation has some elements consistent with a simple explanation, along the lines of what they expect, but is actually more complex. Another is the interplay between individual decision and group decision making because health care quality and safety are known to be properties of teams rather than just of individuals. At issue as well is the contribution of clinical experience to “expertise” and to “performance.” Are experts and novices prone to different kinds of decision error in their application of knowledge (even when their “book knowledge” is equal)?Wemust also consider how accurately inferences can be made about thought process from observing surface behaviors. If making accurate inferences is difficult, how else might we better assess thought processes? Ultimately, one of the key goals in answering such questions is to determine how best to train new clinicians in these arenas of complex decision making to implement optimal decision-making strategies.