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Cognitive biases in Mohs micrographic surgery
Faisal Dubash1, Andrew Affleck1, Marese O'Reilly1
1Department of Dermatology Ninewells Hospital and Medical School Dundee UK.
Abstract:
Mohs surgeons' fallibility is an important topic to explore. There are no studies on the role of cognitive biases in heuristic decision-making within Mohs micrographic surgery (MMS) as a contributing factor in mistakes or errors of clinical judgement. We reviewed established cognitive biases applied to heuristics during the pre-operative, intraoperative and reconstruction stages of MMS, and recommend conscious cognitive bias mitigating strategies for Mohs surgeons. Clinical errors/incidents may be reframed as opportunities to learn and develop, rather than evidence of competency or status. These experiences offer the opportunity to sharpen skills within metacognition and allow for more cognizant Mohs surgeons. We highly recommend all Mohs surgeons develop in-depth knowledge and maintain awareness of cognitive biases throughout clinical practice, to enhance clinical performance.
Insights
Cognitive biases can influence Mohs micrographic surgery (MMS) decision-making. Awareness and mitigation strategies for these biases can enhance surgeon performance and reduce clinical errors.
Area of Science:
- Dermatology
- Cognitive Psychology
- Surgical Education
Background:
- Mohs micrographic surgery (MMS) relies on precise decision-making.
- Surgeon fallibility in MMS can lead to clinical errors.
- The role of cognitive biases in MMS errors is understudied.
Purpose of the Study:
- To explore the influence of cognitive biases on heuristic decision-making in MMS.
- To identify specific cognitive biases affecting pre-operative, intraoperative, and reconstruction phases.
- To propose strategies for mitigating cognitive biases in Mohs surgeons.
Main Methods:
- Literature review of established cognitive biases.
- Application of bias concepts to MMS decision-making stages.
- Analysis of potential impact on clinical judgment and errors.
Main Results:
- Cognitive biases are relevant to heuristic decision-making in MMS.
- Biases can contribute to errors in clinical judgment during MMS.
- Metacognitive strategies can help mitigate bias.
Conclusions:
- Mohs surgeons should be aware of cognitive biases.
- Implementing bias mitigation strategies can enhance surgical performance.
- Reframing errors as learning opportunities promotes metacognition.
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