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Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study
Shivesh Prakash1,2, Shailesh Bihari3, Penelope Need4
1Prideaux Centre for Research in Health Professions Education, Flinders University, Bedford Park, South Australia, 5042, Australia. shivesh.prakash@health.sa.gov.au.
BMC Medical Education
|February 10, 2017
Summary
Cognitive errors like anchoring and premature closure are common in first-year doctors and impact performance. Simulation reveals these biases persist throughout internship, affecting diagnostic accuracy.
Area of Science:
- Medical Education
- Cognitive Psychology
- Patient Safety
Background:
- Human errors in healthcare often stem from cognitive biases.
- Limited evidence exists on the prevalence of specific cognitive errors among junior doctors.
- This study utilized high-fidelity simulation to investigate cognitive errors in first-year postgraduate doctors.
Purpose of the Study:
- To assess the relative occurrence of specific cognitive errors in first-year postgraduate doctors.
- To evaluate the impact of cognitive errors on clinical performance.
- To determine if the prevalence of cognitive errors changes during the internship year.
Main Methods:
- High-fidelity clinical simulation sessions involving interns managing acute clinical problems were reviewed.
- Two independent critical care experts identified cognitive errors using a Likert scale questionnaire and think-aloud technique.
- Teamwork and leadership skills were assessed using the Ottawa Global Rating Scale.
Main Results:
- The most frequent cognitive errors were search satisfying (90%), premature closure (78.6%), and anchoring (75.7%).
- Cognitive error prevalence did not change over the internship, unlike teamwork and leadership skills.
- Anchoring was linked to diagnostic delays and premature closure; confirmation bias negatively correlated with accurate diagnosis.
Conclusions:
- High-fidelity simulation identified a high prevalence of anchoring, premature closure, and search satisfying in first-year doctors.
- These cognitive errors negatively impacted clinical performance.
- The prevalence of these cognitive errors remained consistent throughout the internship year.
