Decision-Making in the Backcountry and Its Clinical Applications in Medical Education—a Pilot Experiential Learning Workshop

Abstract

Introduction—Decision-making in clinical environments is often impacted by cognitive biases and exacerbated by high stakes, time pressures, and unreliable feedback—characteristics of a “wicked learning environment,” as defined by Robin Hogarth.^1,2 Traditional medical education inadequately addresses these biases, relying primarily on passive, lecture-based instruction. Objective—To bridge this gap, we designed and piloted an experiential learning workshop for first-year medical students, integrating backcountry skiing as a parallel wicked learning environment to teach decision-making biases, fallacies, and heuristics. Methods—The study employed a qualitative questionnaire to better understand student experience and measured learning outcomes. Results—Twenty-six students participated in the classroom-based components, and of those 26, 8 participated in the experiential learning component. Qualitative questionnaire responses suggest an elevated understanding of how backcountry decision-making informs clinical decision-making and the importance of decision-making within patient care. Discussion—There is clear potential for the programming to be expanded and applied to other forms of the outdoor recreation experience. Results suggest that applying the experiential learning model provides an additional and broader understanding of how decision-making biases may intersect with practical applications in medical settings. Despite limitations, including a low response rate, the results suggest that this novel approach enhances the understanding of cognitive biases and decision-making in clinical settings. Future iterations will aim to scale participation, include quantitative assessments, and explore alternative wicked learning environments. Conclusion—This pilot program demonstrates the potential of combining outdoor experiential learning with medical education to address critical gaps in teaching decision-making biases and improve clinical practice.