Module 4, Question 2

Decision support is only as good as the data quality on which it based. As Hebda and Czar mention, from data, comes the formation of knowledge. It is extremely important to have high quailty data in order to have a sound knowledge. And in order to make good decisions, it is important to have sound knowledge. As clinicians, we are all relying on the quality of the data within the CDSS's to make good decisions. And our patients are relying on this as well. I look at decision support systems as a great way to help educate patients, and it's important to me to be giving them current and correct information.

Module 4, Question 1

I remember when I was in nursing school, the further I got into the program, the more I realized how much more there was to learn and how little I really knew. The readings helped bring up that memory for me. I think this attitude is what Thompson was referring to in discussing over-confidence and how to combat it. In this regard, and in many others, the readings greatly influenced my perception of my own clinical decision making. Where I work, the nurses are extremely independent in their decision making. And since I have been at that same place since I graduated from nursing school, it is the only way I know. It is probably true that after almost 12 years of experience in one place, that I have gotten a little "cocky" in my clinical confidence and need to re-adopt my attitude from when I was in nursing school. Don't get me wrong, I think there's a lot to be said for years of experience, but we need to realize that we can't solely depend on that when it comes to our decision making.

I can also see some of Kahneman's points in my own practice. Again, since I have been in the same place, with basically the same patient population for a long time, I have actually been quite sheltered. There are a lot of heuristics that I use, and so far, (knock on wood), I have not seen any "bad outcomes" as a result of these, but I realize now that I need to be aware of my own perceptions when I make judgements, especially in circumstances that I have never been in before.

I hate to say it, but I think heuristics is a fancy way of saying "human laziness." We get content and complacent in our own little worlds and don't make the extra effort to research and think things through all the time. Sometimes, we do things because it's the way we've always done them, or it's the only way we know how. Being back in school has really helped revitalize my way of thinking, and this module is a perfect example of that. I think heuristics are always going to be present, but I think the biggest way to combat them is to even be aware of them.

I recently got into a heated discussion with a doctor about a decision he made that I did not agree with. Granted, the final call was not mine to make, but I went home and researched the situation, and was pleased to find good evidence in support of my opinion of the situation. I think this would have been a perfect example of how a doctor (and patient) would have benefited from some evidence based research, and not relied on "the way he had always done things."

Module 3

According to the Multiple Intelligences Test, my greatest strengths were musical, spatial/visual, logical/math, and intrapersonal, in descending order. My greatest strength, by far is musical. But I don't think of myself as having extraordinary musical talent, I just think of myself as an auditory learner. My husband, in fact, has often commented on my talent of picking out actors' and actresses' voices in commercials without seeing who they are. I have really benefited from instructors that have used you-tube and other movie-like clips in my classes. That way, I can listen to information. I found a clip on you-tube that also fits into my current area of practice (maternity nursing): http://www.youtube.com/watch?v=Z6gU_V7zfrk . Even though the song might seem silly, it actually has a lot of good, factual information in it. Pretty clever, I thought. The other thing I thought about regarding music, was my brother had a friend that was trying to create songs about anatomy and putting them on cd's. I don't know if he ever succeeded, but I thought it was a great idea. How many of us have words to songs memorized? Imagine how easy it would be to memorize the components of the digestive tract, say, if it were to a familiar tune.

My other strengths were spatial/visual and logical/math. The spatial/visual also fits into my preference for video clips. I'm not only getting auditory stimulation, but also visual. Visual images tend to stick in my mind. Due to the logical/math in me, I've also liked games and puzzles my entire life. My grandma brags about how I could put jigsaw puzzles together at age two. I always loved learning in elementary school, because everything was always a game. I taught a class this last week and I included a crossword puzzle of review terms in my handouts. I don't know if this would necessarily be included in the logical department, and I don't know if other students will appreciate it, but as a student, I know I would appreciate a list of review terms that were made into a game.

Lastly, intrapersonal came in at 30 and interpersonal came in at 29. I attribute this to my feeling, emotional nature, according to the Myers-Briggs test. I am pretty aware of how I'm feeling and I realize I can be overly-sensitive to criticism (even constructive). I tend to do better with instructors that aren't overly critical and that come across as an actual person. The clip for this module showing the college students holding up signs was really effective for me because not only did it show interesting facts, but it also had an emotional aspect to it. I also enjoy the social aspect of learning. Online classes definitely have advantages, but I find myself feeling like I'm missing something without the face to face contact with the other students.