Clinical intuition versus statistics: different modes of tacit knowledge in clinical epidemiology and evidence-based medicine

Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine.

Mutual influences between the implicit and explicit self-concepts: The role of memory activation and motivated reasoning

Whereas previous research has predominantly focused on dissociations between the explicit and implicit self-concepts, the current research investigates how these aspects of self-representation come into correspondence through the activation of information about the self in memory. Experiment 1 provides evidence for a “bottom-up” process of self-construal in which information activated in the implicit self-concept produces congruent changes in the explicit self-concept. Experiment 2 provides evidence for a “top-down” process of self-construal in which the motivated assertion of a propositional belief in the explicit self-concept leads, via a process of confirmatory hypothesis testing, to the activation of substantiating information in the implicit self-concept. These two processes of self-concept change are integrated within a framework that specifies how the explicit and implicit self-concepts are related within an overall, dynamic self-system. Possibilities for expanding the framework to account for self-concept dissociations are discussed.     

The reasoning skills and thinking dispositions of problem gamblers: a dual‐process taxonomy

We present a taxonomy that categorizes the types of cognitive failure that might result in persistent gambling. The taxonomy subsumes most previous theories of gambling behavior, and it defines three categories of cognitive difficulties that might lead to gambling problems: The autonomous set of systems (TASS) override failure, missing TASS output, and mindware problems. TASS refers to the autonomous set of systems in the brain (which are executed rapidly and without volition, are not under conscious control, and are not dependent on analytic system output). Mindware consists of rules, procedures, and strategies available for explicit retrieval. Seven of the eight tasks administered to pathological gamblers, gamblers with subclinical symptoms, and control participants were associated with problem gambling, and five of the eight were significant predictors in analyses that statistically controlled for age and cognitive competence. In a commonality analysis, an indicator from each of the three categories of cognitive difficulties explained significant unique variance in problem gambling, indicating that each of the categories had some degree of predictive specificity. Copyright © 2006 John Wiley & Sons, Ltd.     

Motivated reasoning and verbal vs. numerical probability assessment: Evidence from an accounting context

A perplexing yet persistent empirical finding is that individuals assess probabilities in words and in numbers nearly equivalently, and theorists have called for future research to search for factors that cause differences. This study uses an accounting context in which individuals are commonly motivated to reach preferred (rather than accurate) conclusions. Within this context, I predict new differences between verbal and numerical probability assessments, as follows: first, individuals will justify an optimistic verbal assessment (e.g., somewhat possible) by retaining the option of re-defining it, in case of negative outcomes, as though the phrase really means something different, and, for that matter, means more things. This re-definition will maintain some connection to the original meaning of the phrase, but de-emphasized relative to the new meaning. Second, based on this behavior, I also predict individuals’ verbal probability assessments to be (1) more biased and yet (2) perceived as more justifiable than their numerical assessments. I find supportive evidence in an experiment designed to test the hypotheses. This study contributes to motivated reasoning and probability assessment theories (1) with new evidence of how individuals can word-smith in multiple attributes of a phrase to justify reaching a preferred conclusion, and (2) with new, reliable differences between verbal and numerical probability assessments. This study has important theoretical and practical implications relevant to organizational contexts in which people assess the likelihoods of uncertainties in words or numbers, and with motivations to reach a preferred conclusion.     

Developmental changes in probabilistic reasoning: The role of cognitive capacity,instructions, thinking styles,and relevant knowledge

In three experiments we explored developmental changes in probabilistic reasoning, taking into account the effects of cognitive capacity, thinking styles, and instructions. Normative responding increased with grade levels and cognitive capacity in all experiments, and it showed a negative relationship with superstitious thinking. The effect of instructions (in Experiments 2 and 3) was moderated by level of education and cognitive capacity. Specifically, only higher-grade students with higher cognitive capacity benefited from instructions to reason on the basis of logic. The implications of these findings for research on the development of probabilistic reasoning are also discussed.     

The single greatest life challenge: How late-midlife adults construct narratives of significant personal challenges

This study introduces the concept of the single greatest life challenge—the most subjectively-significant challenge a person has ever faced—and explores its implications for narrative identity. Through content coding of 157 late-midlife community adults’ life challenge narratives, we catalogued the distribution of 18 life challenge topics. Through exploratory factor analysis of narrative features, we found a four-factor structure (identity processing, agency/emotion, verbosity/specificity, and scope) largely consistent with the “big three” narrative identity metastructure. The agency/emotion factor was most closely tied to traits and functioning: it correlated negatively with neuroticism and depression, correlated positively with psychological well-being and life satisfaction, and provided incremental validity in predicting depression. The stories adults tell of their greatest challenges are informative about personality and psychological functioning.     

Development of rules and strategies: balancing the old and the new

The experiments described in the lead articles replicate findings from previous studies of development of knowledge about balance scales, add several new findings, and raise four key questions: (a) How can rule use best be assessed? (b) How can we reconcile systematic use of rules with variable use of strategies? (c) When do children begin to use rules? and (d) How do children generate new rules? In this Reflection, we summarize current understanding of development of knowledge about balance scales and consider each of the four questions.