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'Immunising' physicians against availability bias in diagnostic reasoning: a randomised controlled experiment
Sílvia Mamede1,2, Marco Antonio de Carvalho-Filho3,4, Rosa Malena Delbone de Faria5,6
1Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands s.mamede@erasmusmc.nl.
BMJ Quality & Safety
|January 29, 2020
Summary
Increasing physicians' knowledge reduced susceptibility to diagnostic bias. This intervention improved diagnostic accuracy in a simulated setting, offering a potential strategy to mitigate medical errors.
Area of Science:
- Medical Education
- Cognitive Bias in Medicine
- Diagnostic Error Reduction
Background:
- Diagnostic errors are frequently linked to physician reasoning biases.
- Past interventions aimed at mitigating bias by improving reasoning processes have shown limited success.
Purpose of the Study:
- To assess if enhancing physicians' knowledge influences their vulnerability to availability bias.
- To investigate a novel approach to reduce diagnostic errors.
Main Methods:
- A three-phase randomized experiment involving internal medicine residents across eight Brazilian teaching hospitals.
- Physicians received 'immunization' through vignette diagnosis and feedback, followed by a biasing phase and a diagnostic performance test.
Main Results:
- 'Immunized' physicians demonstrated significantly better diagnostic accuracy on biased vignettes compared to non-immunized physicians (0.40 vs. 0.24, p=0.004).
- Availability bias negatively impacted non-immunized physicians' performance, while 'immunized' physicians' accuracy remained unaffected.
Conclusions:
- Increasing knowledge of discriminating clinical findings can decrease susceptibility to availability bias in simulated diagnostic scenarios.
- This intervention shows promise for reducing diagnostic errors, warranting further investigation in diverse disease contexts and clinical practice.
