are we willing to change our impression of first impressions?

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COMMENTARY Are we willing to change our impression of first impressions? Kevin McLaughlin Received: 22 November 2013 / Accepted: 5 December 2013 Ó Springer Science+Business Media Dordrecht 2014 As humans we are all obligate raters of each other. We rate even when we find ourselves unable to define precisely the construct that we are being asked to rate, and often do so with surprising confidence (Dunning et al. 1990). From more than 60 years of research on impression formation we know that when we first encounter baristas, hairdressers, financial advisors, or medical trainees in a social setting we immediately begin to form an impression of them, their personality traits, motivations and abilities (Asch 1946; Asch and Zukier 1984; Reeder et al. 2004). Theories on how we form social impressions have evolved since Asch initially proposed that we simply create a Gestalt impression from all of the available data (Asch 1946; Asch and Zukier 1984) to more recent theories sug- gesting that we consider two separate categories of data: stereotypes and individuating information (Brewer 1988; Fiske and Neuberg 1990). Stereotypes shape a priori expec- tations of an individual’s behaviour based upon their age, gender, ethnicity, and occupa- tion, while individuating information refers to observed behaviours. As to how these data are integrated, Brewer proposes a dual process model whereby we default to stereotypes unless we have personal knowledge of this individual or their observed behaviour is inconsistent with the stereotype (Brewer 1988). In their continuum model Fiske and Neuberg propose a variation on dual processing such that we form and initial impression from stereotypes and then—depending upon our motivation—we may attend to individ- uating information and recategorize the individual based upon these data (Fiske and Neuberg 1990). Dual processing is not unique to impression formation, and while the terminology may differ between domains, there are many examples of this in sociology, psychology, and medicine (Croskerry 2009; Kahneman 2011; Reyna 2004, 2008; Sloman 1996; Smith and DeCoster 2000). This ubiquity is partly explained by the existence of two types of memory, This comment refers to the article available at doi:10.1007/s10459-013-9453-9. K. McLaughlin (&) Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada e-mail: [email protected] 123 Adv in Health Sci Educ DOI 10.1007/s10459-013-9490-4

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COMMENTARY

Are we willing to change our impression of firstimpressions?

Kevin McLaughlin

Received: 22 November 2013 / Accepted: 5 December 2013� Springer Science+Business Media Dordrecht 2014

As humans we are all obligate raters of each other. We rate even when we find ourselves

unable to define precisely the construct that we are being asked to rate, and often do so with

surprising confidence (Dunning et al. 1990). From more than 60 years of research on

impression formation we know that when we first encounter baristas, hairdressers, financial

advisors, or medical trainees in a social setting we immediately begin to form an

impression of them, their personality traits, motivations and abilities (Asch 1946; Asch and

Zukier 1984; Reeder et al. 2004). Theories on how we form social impressions have

evolved since Asch initially proposed that we simply create a Gestalt impression from all

of the available data (Asch 1946; Asch and Zukier 1984) to more recent theories sug-

gesting that we consider two separate categories of data: stereotypes and individuating

information (Brewer 1988; Fiske and Neuberg 1990). Stereotypes shape a priori expec-

tations of an individual’s behaviour based upon their age, gender, ethnicity, and occupa-

tion, while individuating information refers to observed behaviours. As to how these data

are integrated, Brewer proposes a dual process model whereby we default to stereotypes

unless we have personal knowledge of this individual or their observed behaviour is

inconsistent with the stereotype (Brewer 1988). In their continuum model Fiske and

Neuberg propose a variation on dual processing such that we form and initial impression

from stereotypes and then—depending upon our motivation—we may attend to individ-

uating information and recategorize the individual based upon these data (Fiske and

Neuberg 1990).

Dual processing is not unique to impression formation, and while the terminology may

differ between domains, there are many examples of this in sociology, psychology, and

medicine (Croskerry 2009; Kahneman 2011; Reyna 2004, 2008; Sloman 1996; Smith and

DeCoster 2000). This ubiquity is partly explained by the existence of two types of memory,

This comment refers to the article available at doi:10.1007/s10459-013-9453-9.

K. McLaughlin (&)Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, 3330Hospital Drive NW, Calgary, AB T2N 4N1, Canadae-mail: [email protected]

123

Adv in Health Sci EducDOI 10.1007/s10459-013-9490-4

implicit and explicit (Sherry and Schacter, 1987; Smith and DeCoster 2000). In implicit

memory we store a large sample of our prior experiences, which allows us to form average

expectations of any given situation (i.e., stereotypes). These expectations can be accessed

rapidly and subconsciously (System 1 processing) and, as they predict the most probable

outcome, implicit expectations have a high likelihood of being correct. In explicit memory

we store symbolic representations of knowledge, typically in the form of rules, which we

can then apply consciously (System 2 processing) when analyzing case-specific data (i.e.,

individuating information). There are cognitive advantages to having two systems of

information processing rather than one. For example, we can make decisions based upon

System 1 processing alone if data or time limitations do not allow for effective System 2

processing. Alternatively, if additional data and time are available, we can use System 2

processing to validate or revise our System 1-based decision. With experience, the

application of explicit rules may shape implicit expectations. For example, if we have

learned an explicit rule that female residents are better at communicating than male res-

idents, with repeated application this rule may develop into an implicit expectation (Roese

1994).

In the current issue of Advances, Wood offers a narrative review of the literature on first

impressions and ponders how System 1 processing by raters might impact trainees’

evaluations as we transition to a competency-based framework of training (Holmboe et al.

2010; Wood 2013). The review is balanced in drawing from a wide variety of literature,

including that on heuristics and biases, in which System 1 processing is typically con-

sidered to be error-prone (Kahneman 2011), and naturalistic decision-making, where the

ability to make good decision quickly based upon limited data is considered the hallmark

of expertise (Klein 2009). In his review, Wood does not declare any preconceptions

regarding the accuracy of System 1-based ratings. Instead, he describes equipoise

regarding the merits of Systems 1 and 2 when rating competencies of trainees, and pro-

poses a research agenda to study the role of the two processing systems in evaluation. As

we enter a new era of evaluation in medical education, this review and the resulting

research questions are particularly well-timed. In reality, with our long tradition in medical

education of humans rating humans in a social setting—for example in the objective

structured clinical examination and in-training evaluation report—we have, perhaps

unknowingly, been incorporating System 1 processing into competency rating all along.

Ironically, Wood’s proposed research agenda challenges us to take a System 2 approach

to System 1 processing! For some in medical education this concept might represent a

challenge as the typical first impression of information processing is that System 1 leads to

bad decisions (Croskerry 2013; Graber et al. 2005). However, there is a large body of

literature on decision making to suggest that System 1 processing does not inevitably lead

to poor decisions (Gigerenzer and Gaissmaier 2011)—and even those in the heuristics and

biases camp recognize the virtues of System 1 processing (Kahneman and Klein 2009). So

perhaps it is time for us to reconsider our first impression.

References

Asch, S. E. (1946). Forming impressions of personality. The Journal of Abnormal and Social Psychology,41, 258–290.

Asch, S. E., & Zukier, H. (1984). Thinking about persons. Journal of Personality and Social Psychology, 46,1230–1240.

K. McLaughlin

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Brewer M. B. (1988). A dual process model of impression formation. In Srull T. K. & Wyer R. S. (Eds),Advances in social cognition. Hillsdale, NJ: Erlbaum.

Croskerry, P. (2009). A universal model of diagnostic reasoning. Academic Medicine, 84, 1022–1028.Croskerry, P. (2013). From mindless to mindful practice—cognitive bias and clinical decision making. New

England Journal of Medicine, 368, 2445–2448.Dunning, D., Griffin, D. W., Milojkovic, J. D., & Ross, L. (1990). The overconfidence effect in social

prediction. Journal of Personality and Social Psychology, 58, 568–581.Fiske S. T. & Neuberg S. L. (1990). A continuum of impression formation, from category-based to indi-

viduating processes: Influences of information and motivation on attention and interpretation. In ZannaM (Ed.), Advances in experimental social psychology. San Diego, CA: Academic Press.

Gigerenzer, G., & Gaissmaier, W. (2011). Heuristic decision making. Annual Review of Psychology, 62,451–482.

Graber, M. L., Franklin, N., & Gordon, R. (2005). Diagnostic error in internal medicine. Archives of InternalMedicine, 165, 1493–1499.

Holmboe, E. S., Sherbino, J., Long, D. M., Swing, S. R., & Frank, J. R. (2010). The role of assessment incompetency-based medical education. Medical Teacher, 32, 676–682.

Kahneman, D. (2011). Thinking fast and slow. Canada: Doubleday Canada.Kahneman, D., & Klein, G. (2009). Conditions for intuitive expertise: A failure to disagree. American

Psychologist, 64, 515–526.Klein, G. (2009). Streetlights and shadows: Searching for the keys to adaptive decision making. Cambridge,

MA: MIT Press.Reeder, G. D., Vonk, R., Ronk, M. J., Ham, J., & Lawrence, M. (2004). Dispositional attribution: Multiple

inferences about motive-related traits. Journal of Personality and Social Psychology, 86, 530–544.Reyna, V. F. (2004). How people make decisions that involve risk: A dual-processes approach. Current

Directions in Psychological Science, 13, 60–66.Reyna, V. F. (2008). A theory of medical decision making and health: fuzzy trace theory. Medical Decision

Making, 28, 850–865.Roese, N. J. (1994). The functional basis of counterfactual thinking. Journal of Personality and Social

Psychology, 66, 805–818.Sherry, D. F., & Schacter, D. L. (1987). The evolution of multiple memory systems. Psychological Review,

94, 439–454.Sloman, S. A. (1996). The empirical case for two systems of reasoning. Psychological Bulletin, 119, 3–22.Smith, E. R., & DeCoster, J. (2000). Dual-process models in social and cognitive psychology: conceptual

integration and links to underlying memory systems. Personality and Social Psychology Review, 4,108–131.

Wood T. J. (2013). Exploring the role of first impressions in rater-based assessments. Adv Health Sci EducTheory Pract (current issue). doi:10.1007/s10459-013-9453-9.

Are we willing to change our impression of first impressions?

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