Academic journal article American Journal of Pharmaceutical Education

Rational and Experiential Decision-Making Preferences of Third-Year Student Pharmacists

Academic journal article American Journal of Pharmaceutical Education

Rational and Experiential Decision-Making Preferences of Third-Year Student Pharmacists

Article excerpt


Pharmacists are challenged with processing information and making decisions amid growing amounts of accessible medical information, increasingly complex healthcare systems, mounting legal pressures, and ongoing demands for patient autonomy. In addition, pharmacists' decision making responsibilities have increased as their roles in team-based models of care and collaborative drug therapy management have expanded. Heuristics ("rules of thumb") and biases can significantly influence clinical decision making, but the resulting systematic errors have prompted a shift towards objective, rational, and informed decision making through the use of evidence-based medicine (EBM). (1-3) Understanding the underlying preferences for decision making in pharmacy is critical for informing pharmacy education and developing educational approaches that promote good decisions. (3,4)

Decision making is a complex process that can be explained, in part, by dual-process theories of cognitive psychology. (5-7) Models of decision making derived from Cognitive-Experiential Self-Theory (CEST) propose that there are 2 primary modes of information processing operating simultaneously and sequentially. Rational processing incorporates the use of conscious, deliberate, analytical, rule-based criteria. (8) It involves critical evaluation of evidence and a structured decision-making process. In contrast, experiential processing is considered automatic, fast, recognition-primed, and intuitive; it can be influenced by context, personal dispositions, and emotional arousal. (8,9)

Individuals tend to prefer one mode over another (10) and are relatively consistent in using that mode; however, decision-making styles can be influenced by the way information is presented. (3,11) Further, preferences in decision-making and thinking styles may differ by a specific population (ie, undergraduate students) or profession (ie, doctors). (6,12,13) As such, careful consideration should be given to the design and implementation of strategies that inform and influence decision making, particularly as they relate to context-specific populations. (14)

For healthcare professionals making clinical decisions, there is a need to balance rational and experiential thought processes to make correct decisions in a time-efficient manner. While cognitive psychology has extensively explored issues underlying the decision-making process, the extent to which pharmacists rely on rational and experiential modes of information processing is not known. Decision making by pharmacists and student pharmacists may differ distinctly from other populations and professions because of context, resources, responsibilities, and general personality characteristics. The purpose of this study was to examine student pharmacists' preferences towards experiential and rational thinking, and to compare these preferences to the preferences of other health professionals and student populations. Understanding the underlying constructs that drive decision making in future pharmacists can provide insight into teaching and learning strategies that promote safe decision making, especially as it relates to the efficacy of direct patient care and mitigation of medication errors.


In spring 2013, all P3 students (n=150) enrolled in the doctor of pharmacy (PharmD) program at the University of North Carolina (UNC) at Chapel Hill Eshelman School of Pharmacy were invited to participate in the study. Participation was voluntary and no incentives (eg, course credit, compensation) were provided. Consent to participate was implied by completion of the survey instrument described below. This study was approved by the UNC Institutional Review Board.

To collect data about student pharmacist decision-making styles, all participants were asked to complete an electronic survey instrument consisting of demographic questions (gender, race/ethnicity, age, and prior degree completion) followed by the Rational Experiential Inventory (REI-40). …

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