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
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ISTEX:145FBB10804B123BC2C8403DFD63B363FCC4E76DLe document en format XML
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vignettes</term><term>Vignette</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><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></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>diagnostic errors</json:string><json:string>diagnostic error</json:string><json:string>cognitive bias</json:string><json:string>heuristic</json:string><json:string>qual</json:string><json:string>cognitive</json:string><json:string>educ</json:string><json:string>trainee</json:string><json:string>comparator</json:string><json:string>patient safety</json:string><json:string>programme</json:string><json:string>cognitive biases</json:string><json:string>debiasing</json:string><json:string>pract</json:string><json:string>internal medicine residents</json:string><json:string>educ theory pract</json:string><json:string>clinical reasoning</json:string><json:string>longitudinal curriculum</json:string><json:string>module</json:string><json:string>video 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accuracy</json:string><json:string>substantial revisions</json:string><json:string>systematic review</json:string><json:string>novel assessment tool</json:string><json:string>clinical practice</json:string><json:string>resident</json:string><json:string>curriculum</json:string></teeft></keywords><author><json:item><name>James B Reilly</name><affiliations><json:string>Division of Nephrology, Department of Medicine, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA</json:string></affiliations></json:item><json:item><name>Alexis R Ogdie</name><affiliations><json:string>Division of Rheumatology, Department of Medicine, Center for Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</json:string></affiliations></json:item><json:item><name>Joan M Von Feldt</name><affiliations><json:string>Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</json:string></affiliations></json:item><json:item><name>Jennifer S Myers</name><affiliations><json:string>Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Cognitive biases</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Continuing education, continuing professional development</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Diagnostic errors</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Graduate medical education</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Medical education</value></json:item></subject><articleId><json:string>bmjqs-2013-001987</json:string></articleId><arkIstex>ark:/67375/NVC-KR2DWWT5-H</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><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><qualityIndicators><score>8.989</score><pdfWordCount>4253</pdfWordCount><pdfCharCount>28481</pdfCharCount><pdfVersion>1.6</pdfVersion><pdfPageCount>7</pdfPageCount><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>228</abstractWordCount><abstractCharCount>1645</abstractCharCount><keywordCount>5</keywordCount></qualityIndicators><title>Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents</title><pmid><json:string>23955466</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>BMJ Quality & Safety</title><language><json:string>unknown</json:string></language><issn><json:string>2044-5415</json:string></issn><eissn><json:string>2044-5423</json:string></eissn><publisherId><json:string>bmjqs</json:string></publisherId><volume>22</volume><issue>12</issue><pages><first>1044</first></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>2013-08-16</json:string><json:string>2010</json:string></date><geogName></geogName><orgName><json:string>Department of Medicine, Perelman School of Medicine</json:string><json:string>American College of Rheumatology Research and Education</json:string><json:string>Institute of Medicine</json:string><json:string>Division of Rheumatology</json:string><json:string>Division of General Internal Medicine</json:string><json:string>Department of Medicine, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA</json:string><json:string>University of Pennsylvania</json:string><json:string>Foundation</json:string><json:string>Institutional Review Board of the University of Pennsylvania</json:string><json:string>Department of Medicine, Center for Epidemiology and Biostatistics</json:string><json:string>Sam Martin Education Pilot Award</json:string><json:string>Josiah Macy Jr</json:string><json:string>Institutional Training Grant T32</json:string></orgName><orgName_funder><json:string>Sam Martin Education Pilot Award</json:string><json:string>Josiah Macy Jr</json:string><json:string>Institutional Training Grant T32</json:string></orgName_funder><orgName_provider></orgName_provider><persName><json:string>David Aizenberg</json:string><json:string>Lisa Bellini</json:string><json:string>Seven</json:string><json:string>Stephen Kim</json:string><json:string>Todd Barton</json:string><json:string>Von Feldt</json:string><json:string>Jodi Lenko</json:string><json:string>Jennifer Kogan</json:string><json:string>Matt Rusk</json:string><json:string>Medicine</json:string><json:string>Karen Warburton</json:string><json:string>Safety</json:string><json:string>Steve Gluckman</json:string><json:string>Judy Shea</json:string><json:string>James</json:string><json:string>Eleven</json:string></persName><placeName><json:string>PA</json:string></placeName><ref_url><json:string>http://dx.doi.org/</json:string></ref_url><ref_bibl><json:string>Merriam et al</json:string><json:string>Graber et al</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/NVC-KR2DWWT5-H</json:string></ark><categories><wos><json:string>1 - social science</json:string><json:string>2 - health policy & services</json:string><json:string>1 - science</json:string><json:string>2 - health care sciences & services</json:string></wos><scienceMetrix></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Health Policy</json:string></scopus><inist><json:string>1 - sciences humaines et sociales</json:string></inist></categories><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1136/bmjqs-2013-001987</json:string></doi><id>145FBB10804B123BC2C8403DFD63B363FCC4E76D</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/145FBB10804B123BC2C8403DFD63B363FCC4E76D/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/145FBB10804B123BC2C8403DFD63B363FCC4E76D/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/145FBB10804B123BC2C8403DFD63B363FCC4E76D/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">BMJ Publishing Group Ltd</publisher><availability><licence><p>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</p></availability><date>2013-08-16</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents</title><author xml:id="author-0000"><persName><forename type="first">James B</forename><surname>Reilly</surname></persName><affiliation>Division of Nephrology, Department of Medicine, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Alexis R</forename><surname>Ogdie</surname></persName><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></author><author xml:id="author-0002"><persName><forename type="first">Joan M</forename><surname>Von Feldt</surname></persName><affiliation>Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Jennifer S</forename><surname>Myers</surname></persName><affiliation>Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation></author><idno type="istex">145FBB10804B123BC2C8403DFD63B363FCC4E76D</idno><idno type="ark">ark:/67375/NVC-KR2DWWT5-H</idno><idno type="DOI">10.1136/bmjqs-2013-001987</idno><idno type="href">qhc-22-1044.pdf</idno><idno type="article-id">bmjqs-2013-001987</idno><idno type="PMID">23955466</idno><idno type="local">qhc;22/12/1044</idno></analytic><monogr><title level="j">BMJ Quality & Safety</title><title level="j" type="abbrev">BMJ Qual Saf</title><idno type="pISSN">2044-5415</idno><idno type="eISSN">2044-5423</idno><idno type="publisher-id">bmjqs</idno><idno type="PublisherID-hwp">qhc</idno><idno type="PublisherID-nlm-ta">BMJ Qual Saf</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-12"></date><biblScope unit="volume">22</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1044">1044</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013-08-16</date></creation><langUsage><language ident="en">en</language></langUsage><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></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>Cognitive biases</term></item><item><term>Continuing education, continuing professional development</term></item><item><term>Diagnostic errors</term></item><item><term>Graduate medical education</term></item><item><term>Medical education</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2013-08-16">Created</change><change when="2013-12">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/145FBB10804B123BC2C8403DFD63B363FCC4E76D/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">qhc</journal-id><journal-id journal-id-type="nlm-ta">BMJ Qual Saf</journal-id><journal-id journal-id-type="publisher-id">bmjqs</journal-id><journal-title>BMJ Quality & Safety</journal-title><abbrev-journal-title abbrev-type="publisher">BMJ Qual Saf</abbrev-journal-title><abbrev-journal-title>BMJ Qual Saf</abbrev-journal-title><issn pub-type="ppub">2044-5415</issn><issn pub-type="epub">2044-5423</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">bmjqs-2013-001987</article-id><article-id pub-id-type="doi">10.1136/bmjqs-2013-001987</article-id><article-id pub-id-type="other">qhc;22/12/1044</article-id><article-id pub-id-type="other">qhc;bmjqs-2013-001987</article-id><article-id pub-id-type="pmid">23955466</article-id><article-id pub-id-type="other">1044</article-id><article-id pub-id-type="other">bmjqs-2013-001987</article-id><article-categories><subj-group subj-group-type="heading"><subject>Innovations in education</subject></subj-group></article-categories><title-group><article-title>Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Reilly</surname><given-names>James B</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Ogdie</surname><given-names>Alexis R</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Von Feldt</surname><given-names>Joan M</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Myers</surname><given-names>Jennifer S</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Division of Nephrology, Department of Medicine</addr-line>, <institution>Allegheny General Hospital, West Penn Allegheny Health System</institution>, <addr-line>Pittsburgh, Pennsylvania</addr-line>, <country>USA</country></aff><aff id="af2"><label>2</label><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></aff><aff id="af3"><label>3</label><addr-line>Division of Rheumatology, 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></aff><aff id="af4"><label>4</label><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></aff><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></corresp></author-notes><pub-date pub-type="ppub"><month>12</month><year>2013</year></pub-date><pub-date pub-type="epub-original"><day>16</day><month>8</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>16</day><month>8</month><year>2013</year></pub-date><volume>22</volume><volume-id pub-id-type="other">22</volume-id><volume-id pub-id-type="other">22</volume-id><issue>12</issue><issue-id pub-id-type="other">qhc;22/12</issue-id><issue-id pub-id-type="other">12</issue-id><issue-id pub-id-type="other">22/12</issue-id><fpage>1044</fpage><history><date date-type="received"><day>11</day><month>3</month><year>2013</year></date><date date-type="rev-recd"><day>16</day><month>7</month><year>2013</year></date><date date-type="accepted"><day>26</day><month>7</month><year>2013</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="qhc-22-1044.pdf"></self-uri><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></abstract><kwd-group><kwd>Cognitive biases</kwd><kwd>Continuing education, continuing professional development</kwd><kwd>Diagnostic errors</kwd><kwd>Graduate medical education</kwd><kwd>Medical education</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents</title></titleInfo><name type="personal"><namePart type="given">James B</namePart><namePart type="family">Reilly</namePart><affiliation>Division of Nephrology, Department of Medicine, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alexis R</namePart><namePart type="family">Ogdie</namePart><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><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Joan M</namePart><namePart type="family">Von Feldt</namePart><affiliation>Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jennifer S</namePart><namePart type="family">Myers</namePart><affiliation>Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2013-12</dateIssued><dateCreated encoding="w3cdtf">2013-08-16</dateCreated><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><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><subject><genre>keywords</genre><topic>Cognitive biases</topic><topic>Continuing education, continuing professional development</topic><topic>Diagnostic errors</topic><topic>Graduate medical education</topic><topic>Medical education</topic></subject><relatedItem type="host"><titleInfo><title>BMJ Quality & Safety</title></titleInfo><titleInfo type="abbreviated"><title>BMJ Qual Saf</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">2044-5415</identifier><identifier type="eISSN">2044-5423</identifier><identifier type="PublisherID">bmjqs</identifier><identifier type="PublisherID-hwp">qhc</identifier><identifier type="PublisherID-nlm-ta">BMJ Qual Saf</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>22</number></detail><detail type="issue"><caption>no.</caption><number>12</number></detail><extent unit="pages"><start>1044</start></extent></part></relatedItem><identifier type="istex">145FBB10804B123BC2C8403DFD63B363FCC4E76D</identifier><identifier type="ark">ark:/67375/NVC-KR2DWWT5-H</identifier><identifier type="DOI">10.1136/bmjqs-2013-001987</identifier><identifier type="href">qhc-22-1044.pdf</identifier><identifier type="ArticleID">bmjqs-2013-001987</identifier><identifier type="PMID">23955466</identifier><identifier type="local">qhc;22/12/1044</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by the BMJ Publishing Group Limited. 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