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Experiential and rational decision making: a survey to determine how emergency physicians make clinical decisions
  1. Lisa A Calder1,3,
  2. Alan J Forster2,3,
  3. Ian G Stiell1,3,
  4. Laura K Carr3,
  5. Jamie C Brehaut3,
  6. Jeffrey J Perry1,3,
  7. Christian Vaillancourt1,3,
  8. Patrick Croskerry4
  1. 1Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to Dr Lisa A Calder, The Ottawa Hospital—Civic Campus, 1053 Carling Avenue, F654, Box 685, Ottawa, ON K1Y 4E9, Canada; lcalder{at}


Background Dual-process psychological theories argue that clinical decision making is achieved through a combination of experiential (fast and intuitive) and rational (slower and systematic) cognitive processes.

Objective To determine whether emergency physicians perceived their clinical decisions in general to be more experiential or rational and how this compared with other physicians.

Methods A validated psychometric tool, the Rational Experiential Inventory (REI-40), was sent through postal mail to all emergency physicians registered with the College of Physicians and Surgeons of Ontario, according to their website in November 2009. Forty statements were ranked on a Likert scale from 1 (Definitely False) to 5 (Definitely True). An initial survey was sent out, followed by reminder cards and a second survey to non-respondents. Analysis included descriptive statistics, Student t tests, analysis of variance and comparison of mean scores with those of cardiologists from New Zealand.

Results The response rate in this study was 46.9% (434/925). The respondents' median age was 41–50 years; they were mostly men (72.6%) and most had more than 10 years of clinical experience (66.8%). The mean REI-40 rational scores were higher than the experiential scores (3.93/5 (SD 0.35) vs 3.33/5 (SD 0.49), p<0.0001), similar to the mean scores of cardiologists from New Zealand (mean rational 3.93/5, mean experiential 3.05/5). The mean experiential scores were significantly higher for female respondents than for male respondents (3.40/5 (SD 0.49) vs 3.30/5 (SD 0.48), p=0.003).

Conclusions Overall, emergency physicians favoured rational decision making rather than experiential decision making; however, female emergency physicians had higher experiential scores than male emergency physicians. This has important implications for future knowledge translation and decision support efforts among emergency physicians.

  • Decision making
  • emergency medicine
  • questionnaires emergency services
  • hospital
  • emergency department

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  • Funding This study was funded by the Emergency Medicine Patient Safety Foundation and the Society for Academic Emergency Medicine, Des Plaines, Illinois. Fellowship funds were provided for research and training in patient safety. The funder was not involved in data analysis or in altering the manuscript.

  • Competing interests None to declare.

  • Ethics approval Ottawa Hospital Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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