BACKGROUND: Systematic biases in group decision making (i.e., group biases) may result in suboptimal decisions and potentially harm patients. It is not well known how impaired group decision making in patient care may affect medical training. This study aimed to explore medical residents\' experiences and perspectives regarding impaired group decision making and the role of group biases in medical decision making.
METHODS: This study used a qualitative approach with thematic analysis underpinned by a social constructionist epistemology. Semi-structured interviews of medical residents were conducted at a single internal medicine residency program. Residents were initially asked about their experiences with suboptimal medical decision making as a group or team. Then, questions were targeted to several group biases (groupthink, social loafing, escalation of commitment). Interviews were transcribed and transferred to a qualitative data analysis software. Thematic analysis was conducted to generate major themes within the dataset.
RESULTS: Sixteen interviews with residents revealed five major themes: (1) hierarchical influence on group decision making; (2) group decision making under pressure; (3) post-call challenges in decision making; (4) interactions between teamwork and decision making; and (5) personal and cultural influences in group decision making. Subthemes were also identified for each major theme. Most residents were able to recognize groupthink in their past experiences working with medical teams. Residents perceived social loafing or escalation of commitment as less relevant for medical team decision making.
CONCLUSIONS: Our findings provide unique insights into the complexities of group decision making processes in teaching hospitals. Team hierarchy significantly influenced residents\' experiences with group decision making-most group decisions were attributed to consultants or senior team members, while lower ranking team members contributed less and perceived fewer opportunities to engage in group decisions. Other factors such as time constraints on decision making, perceived pressures from other staff members, and challenges associated with post-call days were identified as important barriers to optimal group decision making in patient care. Future studies may build upon these findings to enhance our understanding of medical team decision making and develop strategies to improve group decisions, ultimately leading to higher quality patient care and training.

Groups often outperform individuals in problem-solving. Nevertheless, failure to critically evaluate ideas risks suboptimal outcomes through so-called groupthink. Prior studies have shown that people who hold shared goals, perspectives, or understanding of the environment show similar patterns of brain activity, which itself can be enhanced by consensus-building discussions. Whether shared arousal alone can predict collective decision-making outcomes, however, remains unknown. To address this gap, we computed interpersonal heart rate synchrony, a peripheral index of shared arousal associated with joint attention, empathic accuracy, and group cohesion, in 44 groups (n = 204) performing a collective decision-making task. The task required critical examination of all available information to override inferior, default options and make the right choice. Using multidimensional recurrence quantification analysis (MdRQA) and machine learning, we found that heart rate synchrony predicted the probability of groups reaching the correct consensus decision with >70% cross-validation accuracy-significantly higher than that predicted by the duration of discussions, subjective assessment of team function or baseline heart rates alone. We propose that heart rate synchrony during group discussion provides a biomarker of interpersonal engagement that facilitates adaptive learning and effective information sharing during collective decision-making.

This paper explores how the allure of magical thinking and groupthink contrasts with intuition of emotional truth. Since truth can terrify, the author suggests that a longer learning curve is needed to apprehend what Bion (1970a) called the \"evolving O\" of the analytic session. Traumatized patients are described as dream weavers who spin webs of partial truths and lies around their true selves. For the analyst, untangling these webs involves what Bion (1970b) calls an \"act of faith.\" Clinical material is presented to show how groupthink and other concretions of thought can, under favorable circumstances, be transformed on the wings of psychic truth. Alternatively, uncontained violent emotions can become calcified, creating a carapace over the chrysalis of the patient\'s true self. The author concludes that the analyst\'s desire for a particular treatment outcome can unwittingly lead to the formation of an adhesive web where healthy analytic culture becomes a cult. Paradoxically, it is only when there is equal attention to emotional truth and lies that a trajectory of growth is likely to evolve.

To educate nurse managers on territorialism and groupthink as being factors within workplace bullying among nurses within the clinical and academic settings that can psychologically and physically harm affected persons.
Territorialism and groupthink are explored as being factors within workplace bullying used by a bully or bullies to target others for personal gain and power. Workplace bullying has become habitual practice in nursing and nursing academia. Workplace bullying is identified not only as unethical behaviour but also as a dangerous practice that can lead to depression, anxiety, stress, and posttraumatic distress syndrome. Persons affected are subjected to emotional abuse that can lead to isolation, low self-esteem, and self-doubt.
Methods by which persons in the workplace can identify bullying that involves territorialism and groupthink are examined. Nurse managers are identified as being instrumental in the identification of workplace bullying involving territorialism and groupthink, and in working with the affected person(s) and bully or bullies to seek mediation through a human resource representative. For nursing managers, it is imperative that workplace bullying is immediately addressed. Workplace bullying creates a hostile and intimidating working environment that affects the physical and mental health of affected persons.
Early identification and resolution of workplace bullying could alleviate the development of physiological and psychological health problems by affected persons. After workplace bullying has been reported, the affected persons should focus on the healing of mind, spirit, and body. New circumstances (e.g., a new place of employment or a promotion) may trigger feelings of anger, intimidation or fear; therefore, it\' is important for persons who have experienced bullying in the workplace to understand the abusive environment itself was not directly associated with any wrongdoing by them.
Workplace bullying is disruptive to the workplace and affects productivity, absenteeism from work and turnover intentions. Persons impacted by territorialism and groupthink within the context of workplace bullying can develop psychological and physiological health problems.

BACKGROUND: Group decision-making can be placed on a continuum of group dynamics, between Groupthink and Polythink.
OBJECTIVE: To present a new assessment tool for the characterization of medical teams\' decision-making group dynamics, and test it to study the effects of exposure to rudeness on various types of group dynamics.
METHODS: Three judges who watched videotapes of critical care simulations evaluated 24 neonatal intensive care unit teams\' decision-making processes. Teams were rated using the new assessment tool, especially designed for this quantitative study, based on items adapted from symptoms of Polythink and Groupthink.
RESULTS: Measures of reliability, inter-rater agreement and internal consistency, were reasonably good. Confirmatory factor analysis refined the tool and verified that the symptoms in each category (Polythink or Groupthink) of the refined 14 items\' assessment tool were indeed measures of the construct. The average General Score was in the range of the balanced dynamic on the continuum, and without tendency towards one of the extremities (Groupthink or Polythink). No significant effect of exposure to rudeness on group dynamics was found.
CONCLUSIONS: This is a first attempt at using quantitative methods to evaluate decision-making group dynamics in medicine, by adapting symptoms of Groupthink and Polythink as items in a structured assessment tool. It suggests a new approach to understanding decision-making processes of medical teams. The assessment tool seems to be a promising, feasible and reasonably reliable research tool to be further studied in medicine and other disciplines engaged in decision-making.

暂无摘要。

There is emerging interest in understanding group decision making among a team of health professionals. Groupthink, a term coined by Irving Janis to depict premature consensus seeking in highly cohesive groups, is a theory that has been widely discussed in disciplines outside health care. However, it remains unclear how it has been conceptualized, studied, and mitigated in the context of health professionals conducting patient care. This scoping review aimed to examine the conceptualization of groupthink in health care, empirical research conducted in healthcare teams, and recommendations to avoid groupthink. Eight databases were systematically searched for articles focusing on groupthink among health professional teams using a scoping review methodology. A total of 22 articles were included-most were commentaries or narrative reviews with only four empirical research studies. This review found that focus on groupthink and group decision making in medicine is relatively new and growing in interest. Few empirical studies on groupthink in health professional teams have been performed and there is conceptual disagreement on how to interpret groupthink in the context of clinical practice. Future research should develop a theoretical framework that applies groupthink theory to clinical decision making and medical education, validate the groupthink framework in clinical settings, develop measures of groupthink, evaluate interventions that mitigate groupthink in clinical practice, and examine how groupthink may be situated amidst other emerging social cognitive theories of collaborative clinical decision making.

The effectiveness of policymakers\' decision-making in times of crisis depends largely on their ability to integrate and make sense of information. The COVID-19 crisis confronts governments with the difficult task of making decisions in the interest of public health and safety. Essentially, policymakers have to react to a threat, of which the extent is unknown, and they are making decisions under time constraints in the midst of immense uncertainty. The stakes are high, the issues involved are complex and require the careful balancing of several interests, including (mental) health, the economy, and human rights. These circumstances render policymakers\' decision-making processes vulnerable to errors and biases in the processing of information, thereby increasing the chances of faulty decision-making processes with poor outcomes. Prior research has identified three main information-processing failures that can distort group decision-making processes and can lead to negative outcomes: (1) failure to search for and share information, (2) failure to elaborate on and analyze information that is not in line with earlier information and (3) failure to revise and update conclusions and policies in the light of new information. To date, it has not yet been explored how errors and biases underlying these information-processing failures impact decision-making processes in times of crisis. In this narrative review, we outline how groupthink, a narrow focus on the problem of containing the virus, and escalation of commitment may pose real risks to decision-making processes in handling the COVID-19 crisis and may result in widespread societal damages. Hence, it is vital that policymakers take steps to maximize the quality of the decision-making process and increase the chances of positive outcomes as the crisis goes forward. We propose group reflexivity-a deliberate process of discussing team goals, processes, or outcomes-as an antidote to these biases and errors in decision-making. Specifically, we recommend several evidence-based reflexivity tools that could easily be implemented to counter these information-processing errors and improve decision-making processes in uncertain times.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population\'s movements, work, education, gatherings, and general activities in attempt to \"flatten the curve\" of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20-40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5-10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.

In this article, we aim to develop a political economy of mass hysteria. Using the background of COVID-19, we study past mass hysteria. Negative information which is spread through mass media repetitively can affect public health negatively in the form of nocebo effects and mass hysteria. We argue that mass and digital media in connection with the state may have had adverse consequences during the COVID-19 crisis. The resulting collective hysteria may have contributed to policy errors by governments not in line with health recommendations. While mass hysteria can occur in societies with a minimal state, we show that there exist certain self-corrective mechanisms and limits to the harm inflicted, such as sacrosanct private property rights. However, mass hysteria can be exacerbated and self-reinforcing when the negative information comes from an authoritative source, when the media are politicized, and social networks make the negative information omnipresent. We conclude that the negative long-term effects of mass hysteria are exacerbated by the size of the state.