Raising awareness of cognitive biases during diagnostic reasoning.

Kaylee Van Geene,Carmen Erkelens,Esther De Groot,Dorien Zwart

doi:10.1007/s40037-016-0274-4

Kaylee Van Geene, Carmen Erkelens + Show 2 more

Open Access

https://doi.org/10.1007/s40037-016-0274-4

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Abstract

IntroductionBias in diagnostic reasoning can potentially lead to severe consequences. We explored how to design an experiential learning workshop in a general practice clerkship to raise awareness on bias.MethodA group of 12 students was split into two groups. Both groups ‘diagnosed’ two patients in two case studies. Only one group, without them knowing, were given a case including salient distracting features. The whole group discussed the influence of these distractors. In the second round all students had salient distracting features in their case descriptions but only one group had a debiasing tool, a checklist to reconsider their first diagnosis, which they discussed in the final large group discussion.ResultsStudents were misled by salient distracting features and thus experienced how one small difference in a case description may lead to a different diagnosis, due to bias. The debiasing tool was regarded with scepticism. Afterwards, students indicated that, thanks to experiencing bias themselves, they felt better equipped to recognize the risk of bias.ConclusionsAn experiential learning approach with case studies containing salient distracting features seems to be a viable method to learn about bias in a general practice clerkship.

Highlights

Bias in diagnostic reasoning can potentially lead to severe consequences
Salient distracting features are findings in a case description that tend to grab the attention because they are typical for a particular disease, but are unrelated to the actual problem
Researchers advocate the need for more attention in clinical practices to ways to reduce the influence of cognitive biases during diagnostic decision-making [5]

Summary

Introduction

Bias in diagnostic reasoning can potentially lead to severe consequences. In the second round all students had salient distracting features in their case descriptions but only one group had a debiasing tool, a checklist to reconsider their first diagnosis, which they discussed in the final large group discussion. Cognitive biases in diagnostic decision-making are inclinations to use mental shortcuts to develop a diagnosis, which may lead to an inaccurate interpretation of the patient’s complaint with potentially severe consequences [3, 4]. Salient distracting features can misdirect diagnostic reasoning and lead to mistakes [1]. Researchers advocate the need for more attention in clinical practices to ways to reduce the influence of cognitive biases during diagnostic decision-making (debiasing) [5]. The process of ‘debiasing’ general practitioners (GPs), who have to make a diagnosis from a wide range of possibilities where mistakes could be made, should start early in their training [7]

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