“Think about it. 7-Elevens. 7 dwarves. 7, man, that’s the number. 7 chipmunks twirlin’ on a branch, eatin’ lots of sunflowers on my uncle’s ranch. You know that old children’s tale from the sea. It’s like you’re dreamin’ about Gorgonzola cheese when it’s clearly Brie time, baby.”

I spend way too much time on EMS social media. I am fascinated by some of the comments that are posted – the dismissal of science and rational thought, the flawed logic, and the ignorant certainty that abound in the comments section provides a window into the flawed inner workings of the human brain.

 I recently stumbled onto the reflective judgment model by King and Kitchener. It seems to be a decent tool for exploring and identifying the behaviors in EMS social media commentary and EMS in general. Reflective judgment is the process of thinking about how you know what you know and how true those facts are. There are seven levels of reflective judgment proposed by King and Kitchener in their 1994 work, Developing reflective judgment: Understanding and promoting intellectual growth and critical thinking in adolescents and adults.

Level 1: “I’ve seen it work.”
This is the land where anecdote is king and correlation is causation. At this level there is no self-reflection about the validity of  ideas, concepts and beliefs they hold. There is no openness to exploring ideas, in fact contrary views are often met with hostility (see image below). The person at this level never considers that they could be wrong about something, it just isn’t viewed as a possibility.

A justification of “I’ve seen it work” is almost always nothing more than ignorant certainty but it is worth a word of caution here – every once in a great while it may be the well thought out opinion of an true expert who, after careful reflection has realized something works, but this is a rather rare thing in this day and age.

hitler 2
Arguing on the internet, level 1.

Level 2: “I was taught…”
Knowledge obtained from an authority figure like a doctor, instructor or FTO is accepted as the truth without any further reflection. Someone saying what they were taught isn’t the issue, the relationship between the teachings and how they are viewed can be the problem – are they a fluid thing capable of being updated or are the war stories taught in EMT class twenty years ago by the tow-truck driver/volunteer EMT instructor viewed as rigid doctrine and the absolute truth? Trust, but verify, should be the adage used when gaining new knowledge from an authority figure.


Level 3:  “You can make a study say anything.”
If a study can be made to say anything then all studies are worthless and can be summarily dismissed without updating beliefs.

While it is true that there are lies, damn lies and statistics and many studies are bullshit, choosing the carte-blanche dismissal of updating beliefs when new evidence becomes available is actively choosing ignorance. Studies may be flawed in both methodology and in their conclusions and influenced by financial interests but this doesn’t mean we should ignore all science, it just means we should tread carefully with an open mind.

Level 4: “This week they say amiodarone is good, next week it will be bad.”
Because it appears that the “experts” cannot make up their mind and the data is conflicting, all opinions are equally valid and thus equally worthless. Rather than allow the discomfort from holding two or more conflicting views on an idea to enter their mind and having to undergo the process of evaluating beliefs, the whole concept is  dismissed as unknowable and nothing more than opinion.

Level 5: “I’ve done my research…”
Unless the person is an actual researcher, you can be assured that anytime you encounter someone saying this it is almost always guaranteed to be bullshit. Reading a blog written by FreedomEagle67 is not really research.

 A strong confirmation bias exists here; when presented with two different interpretations of the same issue they strongly choose one side, their side, rather than being able to see the merits or faults of both stances. While data and evidence are used at this level, they are used incorrectly.

Level 6: “It depends…”
Beliefs are evaluated based on the weight of available evidence and the individual arrives at point that they are sure enough for a personal stance on the topic or idea. “I would not want epinephrine if I arrested as numerous studies have shown either no beneficial effects or negative effects when given.” The biggest issue that may arise here is the tendency to view a simple solution as an answer to a complex problem or to not consider second order effects of a proposed solution. Ideas at level six are often well supported by available evidence but the evidence that is not there is often not considered.

For example, I recently learned about second order effects (again) the hard way when I replaced my roof on my house. It was a forty year old cedar shingle roof that was in bad shape- rotting and missing some shingles, it looked like shit. Frankly, I am surprised that my HOA did not create a task force about it. We deliberated about spending the money to replace it for a while but it seemed like a no brainer to replace it and last summer we pulled the trigger on it. For the first few months I thought it I had made a great decision with no down side to it. Only after it snowed did I realize that I forgot about second order effects. The new roof melted snow and shed moisture so well that the snow melt ran down the roof and formed an ice pile in front of my garage and then began flowing into my garage and warping a door. My old rotting roof had acted like a sponge absorbing (shit – adsorbing?) the water and allowing for a majority of it to evaporate slowly, the new asphalt shingles really heat up in the sun and melt the snow in an afternoon or two. Now I have to spend $500 this weekend to put gutters up on my garage in addition to the costs of the new roof. This really isn’t a blog about my roof, but thanks for listening.

Level 7: “The best answer I can give you at this time is…”
An understanding that knowledge is fluid and new evidence may change what is the current most-correct answer. Ideas are viewed as probabilities and the likelihood that something is correct rather than black or white dichotomies and there is openness to changing ideas as new evidence emerges.

There is some reflection of the reasoning process behind why the individual holds the idea that they do.

To be completely honest here, I struggle a bit with the delineation between level six and level seven in the original model proposed by King and Kitchener. It might be that I do not understand the nuances between level six and level seven, or it might be that seven is just a better number than six.

This is not a static paradigm; it is not necessarily something where a person progresses from level one to level seven as they get older and  wiser, although that is possible. It is dynamic and can change from day to day – some days I am at level one on some ideas and level seven on others, especially if I get sucked into an argument on Facebook. Actually I might propose that as the argument drags on and comments fly back and forth you can watch a person regress down the levels.

  What is important is developing the skills for introspection found in level six and seven so they can be applied when you catch yourself operating in the lower levels. No one operates at level seven all the time on all issues and beliefs.

Then again, this whole concept could be nothing more than nonsense and I am using level 2 judgment by believing it.

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