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    S. Elqayam

    Introduction Everyday assertions are not always simply true or false. They may refer to future events; they may refer to imaginary, mythological or fictional creatures or personae; they may be enigmatic or even paradoxical. In all these... more
    Introduction Everyday assertions are not always simply true or false. They may refer to future events; they may refer to imaginary, mythological or fictional creatures or personae; they may be enigmatic or even paradoxical. In all these cases, we encounter indeterminate ...
    18 Grounded rationality A relativist framework for normative rationality Shira Elqayam De Montfort University An old Jewish story tells about two litigants appearing before the town's rabbi. The first litigant having presented his... more
    18 Grounded rationality A relativist framework for normative rationality Shira Elqayam De Montfort University An old Jewish story tells about two litigants appearing before the town's rabbi. The first litigant having presented his case, the rabbi tells him: You are right. Then the second ...
    Chapter 8 Conditionals and non-constructive reasoning David E. Over, Jonathan St. BT Evans, and Shira Elqayam Introduction A key feature of human intelligence is the facility for hypothetical thinking. By this we mean the ability to run... more
    Chapter 8 Conditionals and non-constructive reasoning David E. Over, Jonathan St. BT Evans, and Shira Elqayam Introduction A key feature of human intelligence is the facility for hypothetical thinking. By this we mean the ability to run mental simulations by making suppositions ...
    Faced with extreme demands, hypothetical thinking runs the danger of total failure. Paradoxical propositions such as the Liar... more
    Faced with extreme demands, hypothetical thinking runs the danger of total failure. Paradoxical propositions such as the Liar ("I am lying") provide an opportunity to test it to its limits, while the Liar's nonparadoxical counterpart, the Truthteller ("I am telling the truth"), provides a useful comparison. Two experiments are reported, one with abstract materials ("If I am a knave then I live in Emerald City") and one with belief-laden materials (a judge says: "If I am a knave then I enjoy pop music"). In both experiments, conditionals with Truthteller-type antecedents were…
    We present a suppositional theory of disjunctive reasoning that proposes that 'either-or', like 'if', triggers hypothetical thinking. However, disjunctions are more complex as they require the reasoner to consider two... more
    We present a suppositional theory of disjunctive reasoning that proposes that 'either-or', like 'if', triggers hypothetical thinking. However, disjunctions are more complex as they require the reasoner to consider two hypotheses, violating the singularity principle. Hence one of the ...
    According to the threshold model, when faced with a decision under diagnostic uncertainty, physicians should administer treatment if the probability of disease is above a specified threshold and withhold treatment otherwise. The... more
    According to the threshold model, when faced with a decision under diagnostic uncertainty, physicians should administer treatment if the probability of disease is above a specified threshold and withhold treatment otherwise. The objectives of the present study are to a) evaluate if physicians act according to a threshold model, b) examine which of the existing threshold models [expected utility theory model (EUT), regret-based threshold model, or dual-processing theory] explains the physicians' decision-making best. A survey employing realistic clinical treatment vignettes for patients with pulmonary embolism and acute myeloid leukemia was administered to forty-one practicing physicians across different medical specialties. Participants were randomly assigned to the order of presentation of the case vignettes and re-randomized to the order of "high" versus "low" threshold case. The main outcome measure was the proportion of physicians who would or would not prescribe treatment in relation to perceived changes in threshold probability. Fewer physicians choose to treat as the benefit/harms ratio decreased (i.e. the threshold increased) and more physicians administered treatment as the benefit/harms ratio increased (and the threshold decreased). When compared to the actual treatment recommendations, we found that the regret model was marginally superior to the EUT model [Odds ratio (OR) = 1.49; 95% confidence interval (CI) 1.00 to 2.23; p = 0.056]. The dual-processing model was statistically significantly superior to both EUT model [OR = 1.75, 95% CI 1.67 to 4.08; p < 0.001] and regret model [OR = 2.61, 95% CI 1.11 to 2.77; p = 0.018]. We provide the first empirical evidence that physicians' decision-making can be explained by the threshold model. Of the threshold models tested, the dual-processing theory of decision-making provides the best explanation for the observed empirical results.
    Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies) heavily influence analytical processes, while affective processes are often dependent on regret. The... more
    Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies) heavily influence analytical processes, while affective processes are often dependent on regret. The relationship between regret and cognitive reasoning styles has not been well studied in physicians, and is the focus of this paper. A regret questionnaire and 6 scales measuring individual differences in cognitive styles (maximizing-satisficing tendencies; analytical vs. intuitive reasoning; need for cognition; intolerance toward ambiguity; objectivism; and cognitive reflection) were administered through a web-based survey to physicians of the University of South Florida. Bonferroni's adjustment was applied to the overall correlation analysis. The correlation analysis was also performed without Bonferroni's correction, given the strong theoretical rationale indicating the need for a separate hypothesis. We also conducted a multivariate regression analysis to identify the unique influence of predictors on regret. 165 trainees and 56 attending physicians (age range 25 to 69) participated in the survey. After bivariate analysis we found that maximizing tendency positively correlated with regret with respect to both decision difficulty (r=0.673; p<0.001) and alternate search strategy (r=0.239; p=0.002). When Bonferroni's correction was not applied, we also found a negative relationship between satisficing tendency and regret (r=-0.156; p=0.021). In trainees, but not faculty, regret negatively correlated with rational-analytical thinking (r=-0.422; p<0.001), need for cognition (r=-0.340; p<0.001), and objectivism (r=-0.309; p=0.003) and positively correlated with ambiguity intolerance (r=0.285; p=0.012). However, after conducting a multivariate regression analysis, we found that regret was positively associated with maximizing only with respect to decision difficulty (r=0.791; p<0.001), while it was negatively associated with satisficing (r=-0.257; p=0.020) and objectivism (r=-0.267; p=0.034). We found no statistically significant relationship between regret and overall accuracy on conditional inferential tasks. Regret in physicians is strongly associated with their tendency to maximize; i.e. the tendency to consider more choices among abundant options leads to more regret. However, physicians who exhibit satisficing tendency - the inclination to accept a "good enough" solution - feel less regret. Our observation that objectivism is a negative predictor of regret indicates that the tendency to seek and use empirical data in decision-making leads to less regret. Therefore, promotion of evidence-based reasoning may lead to lower regret.
    Patient outcomes critically depend on accuracy of physicians'... more
    Patient outcomes critically depend on accuracy of physicians' judgment, yet little is known about individual differences in cognitive styles that underlie physicians' judgments. The objective of this study was to assess physicians' individual differences in cognitive styles relative to age, experience, and degree and type of training. Physicians at different levels of training and career completed a web-based survey of 6 scales measuring individual differences in cognitive styles (maximizing v. satisficing, analytical v. intuitive reasoning, need for cognition, intolerance toward ambiguity, objectivism, and cognitive reflection). We measured psychometric properties (Cronbach's α) of scales; relationship of age, experience, degree, and type of training; responses to scales; and accuracy on conditional inference task. The study included 165 trainees and 56 attending physicians (median age 31 years; range 25-69 years). All 6 constructs showed acceptable psychometric properties. Surprisingly, we found significant negative correlation between age and satisficing (r = -0.239; P = 0.017). Maximizing (willingness to engage in alternative search strategy) also decreased with age (r = -0.220; P = 0.047). Number of incorrect inferences negatively correlated with satisficing (r = -0.246; P = 0.014). Disposition to suppress intuitive responses was associated with correct responses on 3 of 4 inferential tasks. Trainees showed a tendency to engage in analytical thinking (r = 0.265; P = 0.025), while attendings displayed inclination toward intuitive-experiential thinking (r = 0.427; P = 0.046). However, trainees performed worse on conditional inference task. Physicians capable of suppressing an immediate intuitive response to questions and those scoring higher on rational thinking made fewer inferential mistakes. We found a negative correlation between age and maximizing: Physicians who were more advanced in their careers were less willing to spend time and effort in an exhaustive search for solutions. However, they appeared to have maintained their "mindware" for effective problem solving.