Ng Mingwei, Wong Evelyn, Sim Guek Gwee, Heng Pek Jen, Terry Gareth, Yann Foo Yang
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
Accident and Emergency Department, Changi General Hospital, Singapore, Singapore.
PLoS One. 2025 Jan 2;20(1):e0316361. doi: 10.1371/journal.pone.0316361. eCollection 2025.
Clinical medicine is becoming more complex and increasingly requires a team-based approach to deliver healthcare needs. This dispersion of cognitive reasoning across individuals, teams and systems (termed "distributed cognition") means that our understanding of cognitive biases and errors must expand beyond traditional "in-the-head" individual mental models and focus on a broader "out-in-the-world" context instead. To our knowledge, no qualitative studies thus far have examined cognitive biases in clinical settings from a team-based sociocultural perspective. Our study therefore seeks to explore how cognitive biases and errors among emergency physicians (EPs) arise due to sociocultural influences and lapses in team cognition.
Our study team comprised four EPs of different seniorities from three different institutions and local and international academics who provided qualitative methodological guidance. We adopted a constructivist paradigm and employed a reflexive thematic analysis approach which acknowledged our researcher reflexivity. We conducted seven focus group discussions with 25 EPs who were purposively sampled for maximum variation. Our research question was: How do sociocultural factors lead to cognitive biases and medical errors among EPs?
Our themes coalesce around sociocultural pressures related to team psychology. In theme one, the EP is compelled by sociocultural pressures to blindly trust colleagues. In the second, the EP is obliged by cultural norms to be "nice" and neatly summarise cases into illness scripts during handovers. In the last, the EP is under immense pressure to follow conventional wisdom, comply with clinical protocols and not challenge inpatient specialists.
Cognitive biases and errors in clinical decision-making can arise due to lapses in distributed team cognition. Although this study focuses on emergency medicine, these pitfalls in team-based cognition are relevant across the entire continuum of care and across all specialties of medicine. The hyperacute nature of emergency medicine merely exacerbates and condenses these into a compressed timeframe. Indeed, similar relays are run every day in every discipline of medicine, with the same unified goal of doing the best for our patients while not committing cognitive errors and dropping the baton.
临床医学正变得日益复杂，越来越需要采用团队协作的方式来满足医疗保健需求。认知推理在个体、团队和系统之间的这种分散（称为“分布式认知”）意味着，我们对认知偏差和错误的理解必须超越传统的“头脑中”个体心理模型，而应关注更广泛的“现实世界”背景。据我们所知，目前尚无定性研究从基于团队的社会文化视角审视临床环境中的认知偏差。因此，我们的研究旨在探讨急诊医生（EP）中的认知偏差和错误是如何因社会文化影响和团队认知失误而产生的。
我们的研究团队由来自三个不同机构的四名不同资历的急诊医生以及提供定性方法指导的本地和国际学者组成。我们采用建构主义范式，并运用了反思性主题分析方法，承认我们研究者的反思性。我们与25名经过目的抽样以实现最大程度多样性的急诊医生进行了七次焦点小组讨论。我们的研究问题是：社会文化因素如何导致急诊医生出现认知偏差和医疗错误？
我们的主题围绕与团队心理相关的社会文化压力展开。在主题一中，急诊医生受到社会文化压力的驱使而盲目信任同事。在主题二中，急诊医生受文化规范约束，在交接班时要“和善”并将病例简洁地归纳为疾病脚本。在最后一个主题中，急诊医生面临着巨大压力，要遵循传统观念、遵守临床方案且不挑战住院专科医生。
临床决策中的认知偏差和错误可能因分布式团队认知失误而产生。尽管本研究聚焦于急诊医学，但基于团队认知的这些陷阱在整个护理连续体以及所有医学专科中都具有相关性。急诊医学的超急性性质只是将这些情况加剧并浓缩到一个紧凑的时间框架内。事实上，医学的各个学科每天都在进行类似的接力，有着相同的统一目标，即尽力为患者提供最佳治疗，同时不犯认知错误并避免交接失误。
