Altabbaa Ghazwan, Raven Amanda D, Laberge Jason
Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Rockyview General Hospital, 7007 14th St. S.W. Calgary, Alberta T2V1P9, Canada.
Department of Human Factors, Alberta Health Services, Calgary AB, Canada.
Diagnosis (Berl). 2019 Jun 26;6(2):91-99. doi: 10.1515/dx-2018-0084.
Background Cognitive biases may negatively impact clinical decision-making. The dynamic nature of a simulation environment can facilitate heuristic decision-making which can serve as a teaching opportunity. Methods Momentum bias, confirmation bias, playing-the-odds bias, and order-effect bias were integrated into four simulation scenarios. Clinical simulation educators and human factors specialists designed a script of events during scenarios to trigger heuristic decision-making. Debriefing included the exploration of frames (mental models) resulting in the observed actions, as well as a discussion of specific bias-prone frames and bias-resistant frames. Simulation sessions and debriefings were coded to measure the occurrence of bias, recovery from biased decision-making, and effectiveness of debriefings. Results Twenty medical residents and 18 medical students participated in the study. Twenty pairs (of one medical student and one resident) and two individuals (medical residents alone) completed a simulation session. Evidence of bias was observed in 11 of 20 (55%) sessions. While most participant pairs were able to avoid or recover from the anticipated bias, there were three sessions with no recovery. Evaluation of debriefings showed exploration of frames in all the participant pairs. Establishing new bias-resistant frames occurred more often when the learners experienced the bias. Conclusions Instructional design using experiential learning can focus learner attention on the specific elements of diagnostic decision-making. Using scenario design and debriefing enabled trainees to experience and analyze their own cognitive biases.
背景 认知偏差可能对临床决策产生负面影响。模拟环境的动态特性有助于启发式决策，这可成为一个教学契机。方法 将动量偏差、确认偏差、概率偏差和顺序效应偏差融入四个模拟场景中。临床模拟教育工作者和人为因素专家设计了场景中的事件脚本，以触发启发式决策。总结汇报包括对导致所观察到行为的思维框架（心智模式）的探究，以及对特定的易产生偏差的思维框架和抗偏差思维框架的讨论。对模拟课程和总结汇报进行编码，以衡量偏差的发生情况、从偏差决策中恢复的情况以及总结汇报的有效性。结果 20名住院医师和18名医学生参与了该研究。20对（一名医学生和一名住院医师）和2名个体（仅住院医师）完成了一次模拟课程。在20次课程中的11次（55%）观察到了偏差证据。虽然大多数参与者对能够避免或从预期偏差中恢复过来，但有3次课程未实现恢复。对总结汇报的评估显示，所有参与者对都对思维框架进行了探究。当学习者经历偏差时，更常出现建立新的抗偏差思维框架的情况。结论 使用体验式学习的教学设计可将学习者的注意力集中在诊断决策的具体要素上。通过场景设计和总结汇报，使受训者能够体验和分析自己的认知偏差。
