Summary
Objectives:
Medical residents engage in formal and informal education interactions with fellow
residents during the working day, and can choose whether to spend time and effort
on such interactions. Time and effort spent on such interactions can bring learning
and personal satisfaction to residents, but may also delay completion of clinical
work.
Methods:
Using hypothetical cases, we assessed the values and strategies of internal medicine
residents at one hospital for both cooperative and non-cooperative education interactions
with fellow residents. We then used these data and cellular automata models of two-person
games to simulate repeated interactions between residents, and to determine which
strategies resulted in greatest accrued value. We conducted sensitivity analyses on
several model parameters, to test the robustness of dominant strategies to model assumptions.
Results:
Twenty-nine of the 57 residents (50.9%) valued cooperation more than non-cooperation
no matter what the other resident did during the current interaction. Similarly, thirty-six
residents (63.2%) endorsed an unconditional always-cooperate strategy no matter what
the other resident had done during their previous interaction. In simulations, an
always-cooperate strategy accrued more value (776.42 value units) than an aggregate
of strategies containing non-cooperation components (675.0 value units, p = 0.052).
Only when the probability of strategy errors reached 50%, or when values were re-ordered
to match those of a Prisoner's Dilemma, did non-cooperation-based strategies accrue
the most value.
Conclusions:
Cooperation-based values and strategies were most frequent among our residents, and
dominated in simulations of repeated education interactions between them.
Keywords
Medical education - simulation - cellular automata - game theory - Prisoner‘s Dilemma
