Department of Medical Education, Melbourne Medical School, University of Melbourne, Carlton, Victoria, Australia.
Melbourne Business School, University of Melbourne, Carlton, Victoria, Australia.
Med Educ. 2019 Dec;53(12):1178-1186. doi: 10.1111/medu.13938. Epub 2019 Aug 8.
When errors occur in clinical settings, it is important that they are recognised without defensiveness so that prompt corrective action can be taken and learning can occur. Cognitive dissonance - the uncomfortable tension we experience when we hold two or more inconsistent beliefs - can hinder our ability to respond optimally to error.
The aim of this paper is to describe the effects of cognitive dissonance, a construct developed and tested in social psychology. We discuss the circumstances under which dissonance is most likely to occur, provide examples of how it may influence clinical practice, discuss potential remedies and suggest future research to test these remedies in the clinical context.
We apply research on cognitive dissonance from social psychology to clinical settings. We examine the factors that make dissonance most likely to occur. We illustrate the power of cognitive dissonance through two medical examples: one from history and one that is ongoing. Finally, we explore moderators at various stages of the dissonance process to identify potential remedies.
We show that there is great opportunity for cognitive dissonance to distort judgements, delay optimal responses and hinder learning in clinical settings. We present a model of the phases of cognitive dissonance, and suggestions for preventing dissonance, reducing the distortions that can arise from dissonance and inhibiting dissonance-induced escalation of commitment.
Cognitive dissonance has been studied for decades in social psychology but has not had much influence on medical education research. We argue that the construct of cognitive dissonance is very relevant to the clinical context and to medical education. Dissonance has the potential to interfere with learning, to hinder the process of coping effectively with error, and to make the accepting of change difficult. Fortunately, there is the potential to reduce the negative impact of cognitive dissonance in clinical practice.
在临床环境中出现错误时，重要的是要毫不防卫地认识到这些错误，以便能够及时采取纠正措施并进行学习。认知失调——当我们持有两个或更多不一致的信念时，我们会感到的不舒服的紧张感——会阻碍我们对错误做出最佳反应的能力。
本文旨在描述认知失调的影响，认知失调是在社会心理学中发展和测试的一种建构。我们讨论了最有可能发生失调的情况，举例说明了它如何影响临床实践，讨论了潜在的补救措施，并建议未来在临床环境中进行研究来测试这些补救措施。
我们将社会心理学中的认知失调研究应用于临床环境。我们考察了使失调最有可能发生的因素。我们通过两个医学实例来说明认知失调的力量：一个来自历史，一个正在发生。最后，我们探讨了失调过程各个阶段的调节因素，以确定潜在的补救措施。
我们表明，在临床环境中，认知失调有很大的机会扭曲判断、延迟最佳反应并阻碍学习。我们提出了认知失调的阶段模型，并提出了一些预防失调、减少失调引起的扭曲以及抑制失调引起的承诺升级的建议。
认知失调在社会心理学中已经研究了几十年，但对医学教育研究的影响不大。我们认为，认知失调的建构与临床环境和医学教育密切相关。失调有可能干扰学习，阻碍有效应对错误的过程，并使接受变革变得困难。幸运的是，有可能减少认知失调在临床实践中的负面影响。
