Premature closure? Not so fast.

To cite: Dhaliwal G. BMJ Qual Saf 2017;26:87–89. Dual process theory (DPT) and the intertwined concepts of heuristics and biases, popularised by Kahneman’s book Thinking Fast and Slow, are widely discussed models for analysing decision-making processes inside and outside medicine. The basic premise of DPT is that the brain has a fast, intuitive, but occasionally error-prone system (system 1) and a slower, energy-intensive but more accurate analytical system (system 2). Inexorably tied up with the DPT model is the idea that the errors made in system 1 are a result of shortcuts (heuristics) and predispositions (biases) and the hope that if we spent more time in system 2, cognitive errors could be mitigated. Insights from this model have driven quality improvement and medical education efforts. Learning about how our brain succeeds and fails is interesting, humbling and motivating—but is it effective? My instinct has always been that it is, but as I have tried to answer key questions that my own DPT-based teaching inevitably brings up, I have become less certain.