Bias mitigation skills in diagnostic reasoning: utilizing a situated cognition approach

Diagnostic errors are common in healthcare and often stem from a failure to consider the social and contextual factors that influence clinician decision-making. Systemic inequities and clinician bias disproportionately contribute to diagnostic inaccuracies among marginalized communities. Medical schools are well-positioned to address this challenge by providing curricula that explore the impact of social context on diagnostic reasoning and equip students with strategies to mitigate harms associated with clinician bias.

The authors developed a novel curriculum grounded in situated cognition theory and evidence-based bias mitigation strategies to enhance diagnostic reasoning among medical students. Third-year medical students on their Internal Medicine clerkship explored key cognitive concepts, engaged in case-based discussions to explore the impact of social context on the diagnostic process, and learned bias mitigation strategies. Instructors prompted students to apply these skills in clinical settings through a written assignment, and authors analyzed responses using qualitative methods.

Thirty students participated between January 2023 and June 2024. Students demonstrated a clear understanding of how patient identity, clinician bias, and systemic barriers influence diagnostic processes. Students identified how language, substance use disorders, mental health, and health literacy impacted the diagnostic process of patients they had cared for. Students applied strategies such as individuation, promoting positive emotions, and enhancing motivation to mitigate bias. They also engaged in patient advocacy and highlighted opportunities for system-level improvements.

This curriculum is the first to combine the framework of situated cognition theory with practical bias mitigation strategies to teach diagnostic reasoning. Next steps include expanding educator training, introducing the curriculum earlier in medical education, and longitudinal integration across clerkships and clinical sites. Repeated exposure to these concepts throughout training can help solidify the importance of recognizing social contexts and utilizing bias mitigation strategies as a fundamental component of diagnostic reasoning and patient care.