Created September 14, 2019, last updated about 1 year ago.
Collection: 112, Score: 144, Trend score: 0, Read count: 145, Articles count: 8, Created: 2019-09-14 06:43:20 UTC. Updated: 2019-09-14 06:54:41 UTC.
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Errors in clinical reasoning, known as cognitive biases, are implicated in a significant proportion of diagnostic errors. Despite this knowledge, little emphasis is currently placed on teaching cognitive psychology in the undergraduate medical curriculum. ⋯ Medical educators should nurture healthy skepticism among medical students by raising awareness of cognitive biases and equipping them with robust tools to circumvent such biases. This will enable tomorrow's doctors to improve the quality of care delivered, thus optimizing patient outcomes.
People diagnose themselves or receive advice about their illnesses from a variety of sources ranging from their family or friends, alternate medicine, or through conventional medicine. In all cases, the diagnosing mechanism is the human brain which normally operates under the influence of a variety of biases. Most, but not all biases, reside in intuitive decision making, and no individual or group is immune from them. ⋯ Exploring and cultivating such debiasing initiatives should be seen as the next major research area in clinical decision making. Awareness of bias and strategies for debiasing are important aspects of the critical thinker's armamentarium. Promoting critical thinking in undergraduate, postgraduate and continuing medical education will lead to better calibrated diagnosticians.
When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. ⋯ We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making.
In a companion paper, we proposed that cognitive debiasing is a skill essential in developing sound clinical reasoning to mitigate the incidence of diagnostic failure. We reviewed the origins of cognitive biases and some proposed mechanisms for how debiasing processes might work. In this paper, we first outline a general schema of how cognitive change occurs and the constraints that may apply. ⋯ We outline three groups of suggested interventions going forward: educational strategies, workplace strategies and forcing functions. We stress the importance of ambient and contextual influences on the quality of individual decision making and the need to address factors known to impair calibration of the decision maker. We also emphasise the importance of introducing these concepts and corollary development of training in critical thinking in the undergraduate level in medical education.
Trends in medical education have reflected the patient safety movement's initial focus on systems. While the role of cognitive-based diagnostic errors has been increasingly recognised among safety experts, literature describing strategies to teach about this important problem is scarce. ⋯ A longitudinal curriculum in diagnostic error and cognitive bias improved internal medicine residents' knowledge and recognition of cognitive biases as measured by a novel assessment tool. Further study is needed to refine learner assessment tools and examine optimal strategies to teach clinical reasoning and cognitive bias avoidance strategies.
Diagnostic errors account for more than 8% of adverse events in medicine and up to 30% of malpractice claims. Mechanisms of errors may be related to the working environment but cognitive issues are involved in about 75% of the cases, either alone or in association with system failures. The majority of cognitive errors are not related to knowledge deficiency but to flaws in data collection, data integration, and data verification that may lead to premature diagnostic closure. ⋯ It reviews the strategies described to prevent cognitive diagnostic errors. Many approaches propose awareness and reflective practice during daily activities, but the improvement of the quality of training at the pre-graduate, postgraduate and continuous levels, by using evidence-based education, should also be considered. Several conditions must be fulfilled to increase the understanding, the prevention, and the correction of diagnostic errors related to clinical reasoning: physicians must be willing to understand their own reasoning and decision processes; training efforts should be provided during the whole continuum of a clinician's career; and the involvement of medical schools, teaching hospitals, and medical societies in medical education research should be increased to improve evidence about error prevention.
Diagnostic errors contribute to as many as 70% of medical errors. Prevention of diagnostic errors is more complex than building safety checks into health care systems; it requires an understanding of critical thinking, of clinical reasoning, and of the cognitive processes through which diagnoses are made. When a diagnostic error is recognized, it is imperative to identify where and how the mistake in clinical reasoning occurred. ⋯ Recent literature questioning whether teaching critical thinking skills increases diagnostic accuracy is critically examined, as are studies suggesting that metacognitive practices result in better patient care and outcomes. Instruction in metacognition, reflective practice, and cognitive bias awareness may help learners move toward adaptive expertise and help clinicians improve diagnostic accuracy. The authors argue that explicit instruction in metacognition in medical education, including awareness of cognitive biases, has the potential to reduce diagnostic errors and thus improve patient safety.
In this article we investigate the functional effects of ambivalence on decision-making processes. We build on the misattribution literature and recent work on ambivalence to propose that individuals who properly identify the causes of their ambivalence (i.e., identified ambivalence) can systematically process relevant situational cues to make more effective decisions. ⋯ We then investigate the role of trait self-control as a specific contingency in our model; our results indicate that identified ambivalence leads to effective decisions when individuals are low in trait self-control. Taken together, we advance theory and offer robust, consistent empirical evidence that explains why and how ambivalence can result in functional outcomes. (PsycINFO Database Record
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