Evidence & Research
Built on published science.
The design rests on decades of peer-reviewed work in cognition and medical education. We cite it by name, teach it in our own words, and state plainly where the literature is observational.
01 · Cognition & Workflow
Why the method works.
- Working memory is small. It holds roughly four items at once (Miller, 1956; Cowan, 2001) — far fewer than an inpatient list. Externalizing the list is the fix.
- Interruptions cost more than the time they take. Attention residue lingers after a switch (Leroy, 2009), and unfinished tasks intrude on the mind (Zeigarnik, 1927).
- Pre-deciding helps. Implementation intentions — "when X, I'll do Y" — improve follow-through (Gollwitzer, 1999). The card and the one question are exactly that.
- Expression reduces load. Writing things down frees cognitive resources (Pennebaker, 1986); salience can hijack attention (Wolfe, 1994).
02 · Reasoning & Competency
Why the platform is shaped this way.
- Expertise is structured knowledge. Illness scripts and problem representation organize expert reasoning (Bordage; Schmidt & Rikers) — the backbone of ClearShifts Reasoning.
- Two systems, two failure modes. Dual-process theory and the biases of fast thinking (Kahneman; Croskerry) motivate explicit debiasing and cognitive-forcing strategies.
- Testing and feedback build skill. Retrieval practice strengthens learning (Roediger); audit-and-feedback changes practice when well-designed (Ivers, Cochrane) — the logic of formative, documented signal.
- Entrustment is the workplace measure. Entrustable professional activities frame supervision as how much help the work required (ten Cate) — the Engine's Demonstrated stream.
03 · Stated Honestly
What we do and don't claim.
The science above supports the mechanism: making friction visible and reasoning practicable. Most of this literature is observational, and we do not claim it proves a clinical outcome. We make no outcome claims for ClearShifts.
The Pilot
A year-long feasibility pilot is underway at a Child & Adolescent PMHNP fellowship during 2026–27. Results are in preparation.