Heuristics Deficit

What is a Heuristics Deficit?

In clinical teaching, when dealing with a learner who is struggling, we sometimes find that they demonstrate a deficiency in their ability to apply heuristics in their problem solving and decision-making. When this is profound, we now apply the term ‘Heuristics Deficit’.

What are Heuristics?

Here is a short simple video describing heuristics:

The most well-known work in this area comes from Kahneman & Tversky. Their first paper on this can be found here: Judgement under uncertainty. The concept is more fully described in their recent book, Thinking Fast, Thinking Slow where heuristics form the basis for System 1 Thinking.

How do learners with HD present?

Heuristics are widely used in our problem solving.  They should not be applied all the time but they are a central part of clinical decision-making. Our preceptors model practical heuristics to their learners but our programs rarely assess heuristic thinking.  Learners with HD present in several ways:

  • Vague, unprioritized differential diagnoses
  • Very slow when seeing patients
  • Difficulty with undifferentiated presentations
  • Sometimes have very odd first choice when pinned to make a diagnostic decision
  • Tend to over investigate
  • Verbose, over-inclusive notes or emails or documentation

Note that for all of these learner presentations, other causes may be present.