The difficulty with experience: Does practice increase susceptibility to premature closure?

Eva, Kevin W.; Cunnington, J. P. W.

doi:10.1002/chp.69

Cited by 65 publications

(58 citation statements)

References 17 publications

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“…For example, Eva and colleagues showed that experienced physicians were prone to the primacy effect, a cognitive bias describing the tendency to choose an incorrect diagnosis when its features are presented earlier in the case, 26 in comparison with features of the correct diagnosis that are presented later. 28 This suggests the intriguing possibility that the primary beneficiaries of CFS may be experts and not novices, in contrast to the arguments suggested in diagnostic reasoning editorials. Future research should explore this hypothesis.…”

Section: Discussionmentioning

confidence: 96%

Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial

Sherbino

Kulasegaram

Howey

et al. 2014

CJEM

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Objectives: Cognitive forcing strategies (CFS)may reduce error arising from cognitive biases. This is the first experimental test to determine the effect of CFS training in medical students. Methods: Students were allocated to CFS training or control during a 4-week emergency medicine rotation (n = 191). At the end of the rotation examination, students were tested using computer-based cases. Application of CFS could enable reduction of diagnostic error, as evidenced by identifying multiple correct diagnoses for the two cases prone to search satisficing bias (SSB) and uncommon diagnoses for the two cases prone to availability bias (AB). Two “false positive” cases were included to test for possible “oversearching.” Results: There were 145 students in the intervention and 46 in the control group. For the SSB cases, 52% of students with CFS training and 48% in the control group initiated a search for the second diagnosis (χ2 = 0.13, df = 1, p = 0.91). More than half (54%) correctly identified the second diagnosis in the CFS group, and 48% identified it in the control group. The difference was not significant (χ2 = 2.25, df = 1, p = 0.13). For the second diagnosis in the false positive cases, 64% of the CFS group and 77% of the control group incorrectly identified it. There were no significant differences between groups (χ2 = 2.38, df = 1, p = 0.12). In the AB cases, only 45% in each group identified the uncommon correct diagnosis (χ2 = 0.001, df = 1, p = 0.98). Conclusions: The educational interventions suggested by experts in clinical reasoning and employed in our study to teach CFS failed to show any reduction in diagnostic error by novices.

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Section: Discussionmentioning

confidence: 96%

Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial

Sherbino

Kulasegaram

Howey

et al. 2014

CJEM

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“…Overestimating the posterior probability after a negative test can also lead to refusing to stop testing a patient, potentially leading to false positives and side-effects from testing. In fact, premature closure and misjudging the usefulness of a finding are two of the most common cognitive errors believed to cause diagnostic mistakes (Croskerry, 2002;Croskerry, Singhal, & Mamede, 2013;Eva & Cunnington, 2006;Graber, Franklin, & Gordon, 2005;Graber et al, 2012;Reilly, Ogdie, Von Feldt, & Myers, 2013;Voytovich, Rippey, & Suffredini, 1985). Consequently, it is important to understand more broadly how well physicians and other experts perform Bayesian reasoning in more realistic situations with their own beliefs.…”

Section: Discussionmentioning

confidence: 99%

Physician Bayesian updating from personal beliefs about the base rate and likelihood ratio

Rottman

2016

Mem Cogn

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Whether humans can accurately make decisions in line with Bayes' rule has been one of the most important yet contentious topics in cognitive psychology. Though a number of paradigms have been used for studying Bayesian updating, rarely have subjects been allowed to use their own preexisting beliefs about the prior and the likelihood. A study is reported in which physicians judged the posttest probability of a diagnosis for a patient vignette after receiving a test result, and the physicians' posttest judgments were compared to the normative posttest calculated from their own beliefs in the sensitivity and false positive rate of the test (likelihood ratio) and prior probability of the diagnosis. On the one hand, the posttest judgments were strongly related to the physicians' beliefs about both the prior probability as well as the likelihood ratio, and the priors were used considerably more strongly than in previous research. On the other hand, both the prior and the likelihoods were still not used quite as much as they should have been, and there was evidence of other nonnormative aspects to the updating, such as updating independent of the likelihood beliefs. By focusing on how physicians use their own prior beliefs for Bayesian updating, this study provides insight into how well experts perform probabilistic inference in settings in which they rely upon their own prior beliefs rather than experimenter-provided cues. It suggests that there is reason to be optimistic about experts' abilities, but that there is still considerable need for improvement.

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“…However, while System 1 reasoning is a hallmark of the experienced physician, errors may result from an overreliance on automatic reasoning. 40 Most clinical scenarios require both systems. This combined approach, often referred to as "dual processing," likely offers the best chance at diagnostic success, even for novices.…”

Section: Introductionmentioning

confidence: 99%

Assessing Diagnostic Reasoning: A Consensus Statement Summarizing Theory, Practice, and Future Needs

Ilgen

Humbert

Kuhn

et al. 2012

Academic Emergency Medicine

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Assessment of an emergency physician (EP)'s diagnostic reasoning skills is essential for effective training and patient safety. This article summarizes the findings of the diagnostic reasoning assessment track of the 2012 Academic Emergency Medicine consensus conference "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success." Existing theories of diagnostic reasoning, as they relate to emergency medicine (EM), are outlined. Existing strategies for the assessment of diagnostic reasoning are described. Based on a review of the literature, expert thematic analysis, and iterative consensus agreement during the conference, this article summarizes current assessment gaps and prioritizes future research questions concerning the assessment of diagnostic reasoning in EM.

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The difficulty with experience: Does practice increase susceptibility to premature closure?

Abstract: Physicians with greater experience appear to weigh their first impressions more heavily than those with less experience. Educators should design instructional activities that account for experience-specific cognitive tendencies.

Cited by 65 publications

References 17 publications

Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial

Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial

Physician Bayesian updating from personal beliefs about the base rate and likelihood ratio

Assessing Diagnostic Reasoning: A Consensus Statement Summarizing Theory, Practice, and Future Needs

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