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Academic Medicine:
doi: 10.1097/ACM.0000000000000063
Letters to the Editor

Teaching Based on Thinking Fast and Slow

van Merriënboer, Jeroen J.G. PhD

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Professor of learning and instruction, Maastricht University, Maastricht, The Netherlands; j.vanmerrienboer@maastrichtuniversity.nl.

Disclosures: None reported.

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To the Editor:

I read Custers’1 criticism on dual processing theory (DPT) with interest. Yet, his conclusion that “a description of clinical problem solving as the result of two interacting systems […] gives few clues to […] what the best approach to teaching clinical problem solving will be”1(p5) is disputable and seems to rest on an oversimplification of DPT. In fact, real-life tasks such as medical diagnosis can never be classified as System 1 or System 2 because they contain both consistent aspects (System 1) and variable aspects (System 2). The great advantage of DPT is not that it creates a dichotomous classification for cognitive tasks but, rather, that it acknowledges that System 1 and System 2 processes occur and can be developed in parallel; expertise development is thus more than a sole transition from System 2 to System 1 processing on a cognitive continuum.2 Combined with a process of cognitive task analysis,3 in which real-life diagnostic task performance is analyzed in its consistent and variable aspects, DPT provides a particularly strong basis for teaching.

Four-component instructional design,4 for example, is a research-based educational model related to DPT that provides highly detailed guidelines for the design of instruction and the teaching of clinical problem solving, among other topics. Learning tasks provide the backbone of learning and make an appeal on both System 1 and System 2 processing. Supportive information helps learners to perform and learn variable aspects of learning tasks and develops System 2 processing through reflection and cognitive feedback. Procedural information helps learners to perform and learn consistent aspects of learning tasks and develops System 1 processing through just-in-time provision of “how-to” information and corrective feedback. Finally, part-task practice may help to reach full automaticity of selected System 1 aspects through repetitive practice. In contrast to teaching models based on cognitive continuum theory, this approach allows for the coordinated development of System 1 and System 2 processing in a process of complex learning.

Jeroen J.G. van Merriënboer, PhD

Professor of learning and instruction, Maastricht University, Maastricht, The Netherlands;

j.vanmerrienboer@maastrichtuniversity.nl.

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References

1. Custers EJFM. Medical education and cognitive continuum theory: An alternative perspective on medical problem solving and clinical reasoning. Acad Med. 2013;88:1–7

2. Van Merriënboer JJG. Perspectives on problem solving and instruction. Comput Educ. 2013;64:153–160

3. Van Merriënboer JJG Training Complex Cognitive Skills. 1997 Englewood Cliffs, NJ Educational Technology Publications

4. Van Merriënboer JJG, Kirschner PA Ten Steps to Complex Learning. 20132nd rev ed New York, NY Routledge

© 2014 by the Association of American Medical Colleges

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