入手可能性のバイアスと反射的な推論が,内科のレジデントの診断の正確性に与える影響
Sílvia Mamede1, Tamara van Gog, Kees van den Berge
1Department of Psychology, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands. mamede@fsw.eur.nl
JAMA
|September 16, 2010
まとめ
最近の同様のケースは,2年目の住人の可用性バイアスを誘発し,診断エラーにつながります. しかし,構造化された反射は,すべての住民の診断精度を向上させ,このバイアスを軽減しました.
科学分野:
- 医学における認知心理学
- 医療教育 医療教育について
- 臨床的意思決定 臨床的意思決定
背景:
- 診断誤差は,臨床推論における認知バイアスと関連しています.
- バイアスの認知メカニズムと効果的な教育介入に関する経験的データは限られている.
研究 の 目的:
- 最近の臨床経験が可用性バイアスを誘発し,診断エラーを引き起こすかどうかを判断する.
- 構造化された反射が,この可用性バイアスに対抗できるかどうかを評価する.
主な方法:
- 36人の内科内科医 (1年目と2年目) を対象とした実験研究.
- 第1段階: 6人の症例の初期診断.
- 第2段階:非分析的推論を用いて8件の新規症例を診断し,4件の症例は第1段階の症例と同様の結果を示した.
- 第3段階:反省的推論を用いて4つの類似した症例を再診断.
主要な成果:
- 2年生は,第1年生と比較して,同様の症例で可用性バイアスを示した (正確度が低い,P=.03).
- 2年生は,同様の症例の以前の診断を頻繁に思い出した (P=.04).
- 反射的推論は,両方の居住者グループで診断の正確性を大幅に改善しました (P=.006).
結論:
- 2年生は,同様のケースで非分析的な推論を使用する際,可用性バイアスを示した.
- 診断反射は,このバイアスに効果的に抵抗し,第1年生と第2年生の両方で精度を向上させた.
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