Park Christine S, Stojiljkovic Ljuba, Milicic Biljana, Lin Brian F, Dror Itiel E
From the Department of Anesthesiology (C.S.P., L.S., B.F.L.), and Simulation Technology and Immersive Learning (C.S.P., L.S.), Center for Education in Medicine, Northwestern University-Feinberg School of Medicine, Chicago, IL; Department of Statistics (B.M.), School of Dentistry, University of Belgrade; and Department of Anesthesiology Clinical Center of Serbia (B.M.), Belgrade, Serbia; and Institute of Cognitive Neuroscience (I.E.D.), University College London (UCL), and Cognitive Consultants International (CCI), London, UK.
Simul Healthc. 2014 Apr;9(2):85-93. doi: 10.1097/SIH.0b013e3182a90304.
Training-induced cognitive bias may affect performance. Using a simulation-based emergency airway curriculum, we tested the hypothesis that curriculum design would induce bias and affect decision making.
Twenty-three novice anesthesiology residents were randomized into 2 groups. The primary outcome measure was the initiation of supraglottic airway and cricothyroidotomy techniques in a simulated cannot-ventilate, cannot-intubate scenario during 3 evaluation sessions. Secondary outcomes were response times for device initiation. After a baseline evaluation and didactic lecture, residents received an initial practical training in either surgical cricothyroidotomy (CRIC group) or supraglottic airway (SGA group). After the midtest, the groups switched to receive the alternate training.
From baseline to midtest, the SGA group increased initiation of supraglottic airway but not cricothyroidotomy. The CRIC group increased initiation of cricothyroidotomy but not supraglottic airway. After completion of training in both techniques, the SGA group increased initiation of both supraglottic airway and cricothyroidotomy. In contrast, the CRIC group increased initiation of cricothyroidotomy but failed to change practice in supraglottic airway. Final test response times showed that the CRIC group was slower to initiate supraglottic airway and faster to initiate cricothyroidotomy.
Practical training in only 1 technique caused bias in both groups despite a preceding didactic lecture. The chief finding was an asymmetrical effect of training sequence even after training in both techniques. Initial training in cricothyroidotomy caused bias that did not correct despite subsequent supraglottic airway training. Educators must be alert to the risk of inducing cognitive bias when designing curricula.
训练引起的认知偏差可能会影响表现。我们使用基于模拟的紧急气道课程，检验了课程设计会引发偏差并影响决策的假设。
23名麻醉学新手住院医师被随机分为两组。主要结局指标是在3次评估课程期间，模拟无法通气、无法插管的场景中声门上气道和环甲膜切开术技术的启动情况。次要结局是设备启动的反应时间。在进行基线评估和理论讲座后，住院医师在手术环甲膜切开术（CRIC组）或声门上气道（SGA组）中接受初始实践培训。在中期测试后，两组互换接受另一种培训。
从基线到中期测试，SGA组增加了声门上气道的启动，但未增加环甲膜切开术的启动。CRIC组增加了环甲膜切开术的启动，但未增加声门上气道的启动。在完成两种技术的培训后，SGA组增加了声门上气道和环甲膜切开术的启动。相比之下，CRIC组增加了环甲膜切开术的启动，但在声门上气道方面未能改变操作。最终测试反应时间显示，CRIC组启动声门上气道较慢，启动环甲膜切开术较快。
尽管之前有理论讲座，但仅对一种技术进行实践培训在两组中均导致了偏差。主要发现是即使在两种技术都经过培训后，训练顺序仍有不对称效应。最初的环甲膜切开术培训导致了偏差，尽管随后进行了声门上气道培训，该偏差仍未得到纠正。教育工作者在设计课程时必须警惕引发认知偏差的风险。
