Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: A scoping review

Abstract

Background: The high prevalence of diagnostic errors by health care providers has prompted medical educators to examine cognitive biases and debiasing strategies in an effort to prevent these errors. The National Academy of Medicine hypothesized that explicit diagnostic reasoning education of all health care professionals can improve diagnostic accuracy. Objectives: The purpose of this scoping review is to identify, analyze, and summarize the existing literature on student health care providers' use of cognitive debiasing strategies to reduce diagnostic error. Data sources: The review was guided by the Joanna Briggs Institute methodology for scoping reviews. A systematic search of PubMed, CINAHL, PsychINFO, and Scopus databases for debiasing strategies in student provider education yielded 33 studies. Conclusions: The 33 studies included in this review represent four categories of debiasing strategies: increased medical knowledge or experience (seven studies), guided reflection (eight studies), self-explanation of reasoning (nine studies), and checklists to expand diagnosis considerations (seven studies). The studies were inclusive of medical students and residents; no studies included nurse practitioner (NP) students. Guided reflection, the most clearly defined and implemented strategy, showed the most promise for improvement of diagnostic accuracy. Educational interventions were wide ranging in content and delivery but did yield a path for future research. Implications for practice: There are myriad debiasing strategies student providers may use to mitigate cognitive bias. Structured reflection and education initiatives demonstrated the most consistent improvements in diagnostic accuracy. Future studies on debiasing strategies must include NP students to understand their response to these initiatives.

Checklists to reduce diagnostic error: a systematic review of the literature using a human factors framework

“…After title and abstract screening, 69 articles underwent full-text review (1 of which) 40 was found in a systematic review. 41 Of these 69 articles, a total of 30 met all inclusion criteria. Five articles included more than one checklist.…”

“…The serial searches yielded 5761 citations, of which 2575 were duplicates and were removed. After title and abstract screening, 69 articles underwent full-text review (1 of which)40 was found in a systematic review 41. Of these 69 articles, a total of 30 met all inclusion criteria.…”

Exploring the Competencies of Japanese Expert Nurse Practitioners: A Thematic Analysis

“…Currently, nurses in clinical practice in Japan are faced with the anxiety of having to care for several patients with diverse diseases and different clinical situations simultaneously, while consistently updating their medical knowledge [ 31 ]. NPs can effectively mitigate nurses’ workload and understand that the anxiety may be influenced by the nurses’ cognitive load about medicine [ 32 ]. Nurses operate in a different work environment than physicians and have limited opportunities to gain a deeper understanding of various treatments and laboratory testing.…”

Identifying and addressing nonrational processes in REB ethical decision-making

“…In their scoping review of debiasing interventions among medical students, Griffith et al (2020) identified four primary debiasing strategies: gaining increased medical knowledge or experience (seven studies); guided reflection (eight studies); self-explanation of reasoning (nine studies); and checklists to increase diagnosis considerations (seven studies). Of these four, only guided reflection showed notable success.…”

“…Despite its 30-year history, debiasing research remains underdeveloped and hence far from conclusive. Most of what exists focusses on diagnostic errors among medical students (See Griffith et al, 2020 for an extensive review), with a few additional studies directed toward judicial sentencing (e.g. Lidén et al, 2019; Stein and Drouin, 2018).…”