Diversion and Deviation: How Distracting Contextual Factors Amplify Cognitive Biases in Clinical Reasoning

Area of Science:

• Medical Education
• Cognitive Psychology
• Clinical Decision Making

Background:

• Clinical reasoning errors are common, with cognitive biases identified as a significant contributing factor.
• Over 100 cognitive biases exist, with more than 40 documented in clinical reasoning literature.
• Understanding contextual factors influencing clinical reasoning is crucial for error reduction.

Purpose of the Study:

• To investigate the interplay between cognitive biases and distracting contextual factors (DCFs).
• To determine the impact of these interactions on the accuracy of clinical reasoning.

Main Methods:

• A simulation study involving participants watching video encounters with or without DCFs.
• Participants completed post-encounter forms and think-aloud exercises.
• Latent thematic analysis and MANOVA/ANOVA were used to assess reasoning accuracy and identify bias associations.

Main Results:

• Thirteen cognitive biases were identified; anchoring, availability, and confirmation bias were most prevalent.
• Diagnostic reasoning accuracy was lower in cases with DCFs (72% vs. 80%).
• The number of biases and their co-occurrence with DCFs significantly reduced diagnostic accuracy.

Conclusions:

• Cognitive biases significantly impact clinical reasoning, particularly diagnostic accuracy.
• Distracting contextual factors can exacerbate the negative effects of cognitive biases.
• Further research into bias-DCF interactions is needed to improve clinical reasoning and reduce errors.