Division of Nephrology, Department of Medicine, Allegheny General Hospital, West Penn Allegheny Health System, , Pittsburgh, Pennsylvania, USA.
BMJ Qual Saf. 2013 Dec;22(12):1044-50. doi: 10.1136/bmjqs-2013-001987. Epub 2013 Aug 16.
Trends in medical education have reflected the patient safety movement's initial focus on systems. While the role of cognitive-based diagnostic errors has been increasingly recognised among safety experts, literature describing strategies to teach about this important problem is scarce.
48 PGY-2 internal medicine residents participated in a three-part, 1-year curriculum in cognitive bias and diagnostic error. Residents completed a multiple-choice test designed to assess the recognition and knowledge of common heuristics and biases both before and after the curriculum. Results were compared with PGY-3 residents who did not receive the curriculum. An additional assessment in which residents reviewed video vignettes of clinical scenarios with cognitive bias and debiasing techniques was embedded into the curriculum.
38 residents completed all three parts of the curriculum and completed all assessments. Performance on the 13-item multiple-choice knowledge test improved post-curriculum when compared to both pre-curriculum performance (9.26 vs 8.26, p=0.002) and the PGY-3 comparator group (9.26 vs 7.69, p<0.001). All residents correctly identified at least one cognitive bias and proposed at least one debiasing strategy in response to the videos.
A longitudinal curriculum in diagnostic error and cognitive bias improved internal medicine residents' knowledge and recognition of cognitive biases as measured by a novel assessment tool. Further study is needed to refine learner assessment tools and examine optimal strategies to teach clinical reasoning and cognitive bias avoidance strategies.
医学教育的趋势反映了患者安全运动最初对系统的关注。虽然认知为基础的诊断错误在安全专家中越来越受到重视，但描述教授这一重要问题的策略的文献却很少。
48 名 PGY-2 内科住院医师参加了一个为期一年、三部分的认知偏差和诊断错误课程。住院医师在课程前后都完成了一项旨在评估他们对常见启发式和偏差的识别和知识的多项选择题测试。结果与未接受课程的 PGY-3 住院医师进行了比较。在课程中还嵌入了一项额外的评估，让住院医师查看带有认知偏差和去偏差技术的临床情景视频片段。
38 名住院医师完成了课程的所有三个部分，并完成了所有评估。与课程前的表现（9.26 对 8.26，p=0.002）和 PGY-3 对照组（9.26 对 7.69，p<0.001）相比，在完成课程后的多项选择题知识测试中的表现有所提高。所有住院医师都正确识别出至少一种认知偏差，并针对视频提出了至少一种去偏差策略。
一个关于诊断错误和认知偏差的纵向课程提高了内科住院医师对认知偏差的知识和识别能力，这是通过一种新的评估工具来衡量的。需要进一步研究来完善学习者的评估工具，并研究教授临床推理和认知偏差避免策略的最佳策略。
