Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents
Identifieur interne : 000487 ( Istex/Corpus ); précédent : 000486; suivant : 000488Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents
Auteurs : James B. Reilly ; Alexis R. Ogdie ; Joan M. Von Feldt ; Jennifer S. MyersSource :
- BMJ Quality & Safety [ 2044-5415 ] ; 2013-12.
English descriptors
- KwdEn :
- Academic year, Additional degrees, Assessment tools, Bias, Clinical experience, Clinical practice, Clinical reasoning, Clinical scenarios, Cognitive, Cognitive bias, Cognitive biases, Cognitive errors, Cognitive interventions, Cognitive psychology, Comparator, Comparator group, Complete part, Critical reflection, Curriculum, Debiasing, Debiasing strategies, Diagnostic, Diagnostic accuracy, Diagnostic decisions, Diagnostic error, Diagnostic error knowledge assessment test, Diagnostic errors, Diagnostic momentum, Diagnostic skills, Educ, Educ theory pract, Educational strategies, Entire curriculum, Final component, Heuristic, Institutional review board, Internal consistency, Internal medicine residents, Knowledge test, Longitudinal, Longitudinal curricula, Longitudinal curriculum, Medical education, Medical students, Medicine residents, Module, Novel assessment tool, Online module, Patient safety, Patient safety movement, Perelman school, Pract, Primary care programme, Programme, Psychometric properties, Qual, Reasoning strategies, Reilly, Resident, Second year, Sensitive nature, Small group discussions, Small group facilitators, Substantial revisions, Systematic review, Systems errors, Trainee, Video, Video vignettes, Vignette.
- Teeft :
- Academic year, Additional degrees, Assessment tools, Bias, Clinical experience, Clinical practice, Clinical reasoning, Clinical scenarios, Cognitive, Cognitive bias, Cognitive biases, Cognitive errors, Cognitive interventions, Cognitive psychology, Comparator, Comparator group, Complete part, Critical reflection, Curriculum, Debiasing, Debiasing strategies, Diagnostic, Diagnostic accuracy, Diagnostic decisions, Diagnostic error, Diagnostic error knowledge assessment test, Diagnostic errors, Diagnostic momentum, Diagnostic skills, Educ, Educ theory pract, Educational strategies, Entire curriculum, Final component, Heuristic, Institutional review board, Internal consistency, Internal medicine residents, Knowledge test, Longitudinal, Longitudinal curricula, Longitudinal curriculum, Medical education, Medical students, Medicine residents, Module, Novel assessment tool, Online module, Patient safety, Patient safety movement, Perelman school, Pract, Primary care programme, Programme, Psychometric properties, Qual, Reasoning strategies, Reilly, Resident, Second year, Sensitive nature, Small group discussions, Small group facilitators, Substantial revisions, Systematic review, Systems errors, Trainee, Video, Video vignettes, Vignette.
Abstract
Background 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. Methods 48 PGY-2 internal medicine residents participated in a three-part, 1-year curriculum in cognitive bias and diagnostic error. Residents completed a multiple-choice test designed to assess the recognition and knowledge of common heuristics and biases both before and after the curriculum. Results were compared with PGY-3 residents who did not receive the curriculum. An additional assessment in which residents reviewed video vignettes of clinical scenarios with cognitive bias and debiasing techniques was embedded into the curriculum. Results 38 residents completed all three parts of the curriculum and completed all assessments. Performance on the 13-item multiple-choice knowledge test improved post-curriculum when compared to both pre-curriculum performance (9.26 vs 8.26, p=0.002) and the PGY-3 comparator group (9.26 vs 7.69, p<0.001). All residents correctly identified at least one cognitive bias and proposed at least one debiasing strategy in response to the videos. Conclusions 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.
Url:
DOI: 10.1136/bmjqs-2013-001987
Links to Exploration step
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<front><div type="abstract">Background 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. Methods 48 PGY-2 internal medicine residents participated in a three-part, 1-year curriculum in cognitive bias and diagnostic error. Residents completed a multiple-choice test designed to assess the recognition and knowledge of common heuristics and biases both before and after the curriculum. Results were compared with PGY-3 residents who did not receive the curriculum. An additional assessment in which residents reviewed video vignettes of clinical scenarios with cognitive bias and debiasing techniques was embedded into the curriculum. Results 38 residents completed all three parts of the curriculum and completed all assessments. Performance on the 13-item multiple-choice knowledge test improved post-curriculum when compared to both pre-curriculum performance (9.26 vs 8.26, p=0.002) and the PGY-3 comparator group (9.26 vs 7.69, p<0.001). All residents correctly identified at least one cognitive bias and proposed at least one debiasing strategy in response to the videos. Conclusions 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.</div>
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<abstract>Background 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. Methods 48 PGY-2 internal medicine residents participated in a three-part, 1-year curriculum in cognitive bias and diagnostic error. Residents completed a multiple-choice test designed to assess the recognition and knowledge of common heuristics and biases both before and after the curriculum. Results were compared with PGY-3 residents who did not receive the curriculum. An additional assessment in which residents reviewed video vignettes of clinical scenarios with cognitive bias and debiasing techniques was embedded into the curriculum. Results 38 residents completed all three parts of the curriculum and completed all assessments. Performance on the 13-item multiple-choice knowledge test improved post-curriculum when compared to both pre-curriculum performance (9.26 vs 8.26, p=0.002) and the PGY-3 comparator group (9.26 vs 7.69, p>0.001). All residents correctly identified at least one cognitive bias and proposed at least one debiasing strategy in response to the videos. Conclusions 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.</abstract>
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<affiliation>Division of Nephrology, Department of Medicine, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA</affiliation>
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<author xml:id="author-0001"><persName><forename type="first">Alexis R</forename>
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<affiliation>Division of Rheumatology, Department of Medicine, Center for Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation>
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<author xml:id="author-0002"><persName><forename type="first">Joan M</forename>
<surname>Von Feldt</surname>
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<affiliation>Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation>
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<abstract><p>Background 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. Methods 48 PGY-2 internal medicine residents participated in a three-part, 1-year curriculum in cognitive bias and diagnostic error. Residents completed a multiple-choice test designed to assess the recognition and knowledge of common heuristics and biases both before and after the curriculum. Results were compared with PGY-3 residents who did not receive the curriculum. An additional assessment in which residents reviewed video vignettes of clinical scenarios with cognitive bias and debiasing techniques was embedded into the curriculum. Results 38 residents completed all three parts of the curriculum and completed all assessments. Performance on the 13-item multiple-choice knowledge test improved post-curriculum when compared to both pre-curriculum performance (9.26 vs 8.26, p=0.002) and the PGY-3 comparator group (9.26 vs 7.69, p<0.001). All residents correctly identified at least one cognitive bias and proposed at least one debiasing strategy in response to the videos. Conclusions 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.</p>
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<title-group><article-title>Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents</article-title>
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<addr-line>Division of Nephrology, Department of Medicine</addr-line>
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, <country>USA</country>
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<addr-line>Division of Rheumatology, Department of Medicine</addr-line>
, <institution>Center for Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania</institution>
, <addr-line>Philadelphia, Pennsylvania</addr-line>
, <country>USA</country>
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<addr-line>Division of Rheumatology, Department of Medicine</addr-line>
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, <addr-line>Philadelphia, Pennsylvania</addr-line>
, <country>USA</country>
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<addr-line>Division of General Internal Medicine, Department of Medicine</addr-line>
, <institution>Perelman School of Medicine at the University of Pennsylvania</institution>
, <addr-line>Philadelphia, Pennsylvania</addr-line>
, <country>USA</country>
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<author-notes><corresp><label>Correspondence to</label>
Dr James B Reilly, Allegheny General Hospital, 320 E. North Ave., 7th Floor South Tower, Pittsburgh, PA 15212, USA; <email>jreilly1@wpahs.org</email>
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<issue>12</issue>
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<fpage>1044</fpage>
<history><date date-type="received"><day>11</day>
<month>3</month>
<year>2013</year>
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<month>7</month>
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<abstract><sec><title>Background</title>
<p>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.</p>
</sec>
<sec><title>Methods</title>
<p>48 PGY-2 internal medicine residents participated in a three-part, 1-year curriculum in cognitive bias and diagnostic error. Residents completed a multiple-choice test designed to assess the recognition and knowledge of common heuristics and biases both before and after the curriculum. Results were compared with PGY-3 residents who did not receive the curriculum. An additional assessment in which residents reviewed video vignettes of clinical scenarios with cognitive bias and debiasing techniques was embedded into the curriculum.</p>
</sec>
<sec><title>Results</title>
<p>38 residents completed all three parts of the curriculum and completed all assessments. Performance on the 13-item multiple-choice knowledge test improved post-curriculum when compared to both pre-curriculum performance (9.26 vs 8.26, p=0.002) and the PGY-3 comparator group (9.26 vs 7.69, p<0.001). All residents correctly identified at least one cognitive bias and proposed at least one debiasing strategy in response to the videos.</p>
</sec>
<sec><title>Conclusions</title>
<p>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.</p>
</sec>
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