Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review

Area of Science:

• Cognitive psychology in medicine
• Medical education research
• Diagnostic reasoning

Background:

• Diagnostic errors have significant human and economic impacts.
• The dual-process model explains diagnostic errors through cognitive shortcuts (heuristics).
• Interventions are needed to improve analytical and non-analytical reasoning in medical professionals.

Purpose of the Study:

• To systematically review and appraise studies on interventions enhancing reasoning in medical trainees and doctors.
• To assess the effectiveness of these interventions in improving diagnostic processes.

Main Methods:

• Conducted systematic searches across five major databases (Medline, PsycInfo, Embase, ERIC, Cochrane).
• Included studies evaluating interventions aimed at improving analytical and/or non-analytical reasoning.
• Synthesized findings from 28 included studies across various intervention categories.

Main Results:

• Twenty-eight studies evaluated interventions including educational strategies, checklists, cognitive forcing, guided reflection, and instructions.
• Guided reflection interventions were consistently successful across multiple studies.
• Cognitive forcing strategies improved diagnostic accuracy and confidence judgments.

Conclusions:

• Cognitive interventions show promising results for enhancing diagnostic reasoning in medical professionals.
• Guided reflection and cognitive forcing strategies are particularly effective.
• Further research with diverse samples and refined methodologies is needed before widespread recommendations for medical education and policy.