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A cognitive forcing tool to mitigate cognitive bias - a randomised control trial.
Eoin D O'Sullivan1, Susie J Schofield2
1Department of Renal Medicine, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, UK. eoindosullivan@gmail.com.
BMC Medical Education
|January 10, 2019
Summary
A cognitive forcing tool did not reduce diagnostic errors in a randomized trial, despite positive user feedback. Further research is needed to validate its clinical utility for reducing cognitive bias in medical decision-making.
Area of Science:
- Medical Education
- Clinical Decision Making
- Cognitive Psychology
Background:
- Cognitive bias is a significant factor contributing to diagnostic errors, presenting challenges in education and clinical practice.
- Understanding the impact of cognitive bias is crucial for improving patient safety and healthcare outcomes.
- Diagnostic errors remain a persistent issue in medicine, necessitating innovative solutions.
Purpose of the Study:
- To evaluate the effectiveness of a cognitive forcing tool in reducing diagnostic errors.
- To explore the mechanisms through which a cognitive forcing tool might influence clinical decision-making.
- To assess the perceived impact and usability of the cognitive forcing tool among medical professionals.
Main Methods:
- A single-blinded, randomized clinical trial was conducted using an online, case-based approach from January 2017 to September 2018.
- Participants included medical professionals of varying seniority across the UK, Republic of Ireland, and North America.
- Qualitative "think aloud" interviews were conducted with 20 doctors to understand their experience with the tool.
Main Results:
- No statistically significant difference in diagnostic error rates was observed between the intervention and control groups (mean 2.8 vs 3.1 cases correct, P=0.49).
- Doctors across all grades demonstrated errors related to cognitive bias.
- Qualitative data indicated the cognitive forcing strategy was well-received, with users reporting a subjectively positive impact on accuracy and thoughtfulness.
Conclusions:
- The quantitative results did not support the use of the cognitive forcing tool to improve diagnostic accuracy in clinical practice.
- Despite the lack of statistical significance, the positive qualitative feedback suggests the tool has potential merit and face validity.
- Further investigation is warranted to determine the clinical utility and optimal implementation of cognitive forcing strategies.
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