Ginsburg Joshua
University of Texas Southwestern, Department of Emergency Medicine, Dallas, Tx.
J Educ Teach Emerg Med. 2025 Jul 31;10(3):L1-L6. doi: 10.21980/J84W96. eCollection 2025 Jul.
Although this lecture was given to first-year residents, it is also appropriate for upper-level residents, medical students, fellows, and faculty.
Medical errors are largely due to errors of cognition rather than lack of knowledge.1 The cognitive processes that underlie these errors are often explained using Dual Process Theory, which posits that we engage in either fast, intuitive, low-effort System 1 thinking or slow, analytical, high-effort System 2 thinking. Although System 1 thinking is crucial for efficient emergency medicine practice, it is susceptible to the biases that cause cognitive errors. Research to date is mixed regarding the effect of educational interventions aimed at reducing cognitive bias but tends to show a benefit to cognitive bias training over a variety of outcome measures.2 Many experts therefore believe that physicians should be taught about cognitive biases and debiasing strategies in an effort to reduce medical errors.3,4.
By the end of this lecture, learners should be able to, 1) Define dual process theory, 2) identify common cognitive biases, 3) recognize high-risk situations for cognitive errors, and 3) discuss debiasing strategies and integrate one strategy into your workflow.
This interactive lecture was created in PowerPoint and delivered in-person to 14 first-year residents during their "Intern Curriculum," a monthly meeting separate from the residency-wide conference. The lecture took 30 minutes to deliver.
Residents responded to pre- and post-lecture Likert scale surveys regarding their knowledge of cognitive biases and debiasing strategies, as well as a post-lecture survey regarding the quality of the lecture, the relevance of the content, and the likelihood of making changes to their practice based on the lecture.
A total of 14 residents responded to the survey, and all residents completed both the pre-lecture and post-lecture questions. In the pre-lecture survey, 35.7% (5) of participants reported that they had good or extensive knowledge of cognitive biases, and 7.1% (1) of participants reported that they had good or extensive knowledge of debiasing strategies. In the post-lecture survey, 85.7% (12) of participants reported that they had good or extensive knowledge of cognitive biases, and 78.6% (11) of participants reported that they had good or extensive knowledge of debiasing strategies. All (14) participants felt the lecture was of good or excellent quality, 92.9% (13) felt it was very or extremely relevant to them as emergency medicine physicians, and 100% (14) reported they were likely to make changes to their practice based on this lecture.
The results of the survey show that residents perceived increased knowledge of both cognitive errors and debiasing strategies after attending this lecture. The lecture was rated highly, was found to be relevant to practice, and was likely to change practice going forward for most learners. These results suggest that an interactive lecture may have an important role in introducing residents to the concepts of cognitive errors and debiasing.
Cognitive bias, bias, debiasing, errors.
尽管本次讲座是面向一年级住院医师的，但对高年级住院医师、医学生、研究员和教员也同样适用。
医疗差错很大程度上是由于认知错误而非知识不足。1 构成这些错误基础的认知过程通常用双加工理论来解释，该理论假定我们要么进行快速、直观、低努力的系统1思维，要么进行缓慢、分析性、高努力的系统2思维。尽管系统1思维对于高效的急诊医学实践至关重要，但它容易受到导致认知错误的偏差影响。迄今为止，关于旨在减少认知偏差的教育干预效果的研究结果不一，但在各种结果指标上，认知偏差训练往往显示出益处。2 因此，许多专家认为应该教导医生认知偏差和去偏差策略，以减少医疗差错。3,4
在本次讲座结束时，学习者应能够：1）定义双加工理论；2）识别常见的认知偏差；3）识别认知错误的高风险情况；4）讨论去偏差策略并将一种策略融入自己的工作流程。
本次互动讲座以PowerPoint形式制作，并在“实习课程”期间亲自向14名一年级住院医师进行了讲授，“实习课程”是每月一次的会议，与全院范围的会议分开。讲座用时30分钟。
住院医师在讲座前和讲座后对关于认知偏差和去偏差策略知识的李克特量表调查做出回应，以及在讲座后对关于讲座质量、内容相关性以及基于讲座改变其实践可能性的调查做出回应。
共有14名住院医师对调查做出回应，所有住院医师都完成了讲座前和讲座后的问题。在讲座前的调查中，35.7%（5名）参与者报告他们对认知偏差有良好或广泛的了解，7.1%（1名）参与者报告他们对去偏差策略有良好或广泛的了解。在讲座后的调查中，85.7%（12名）参与者报告他们对认知偏差有良好或广泛的了解，78.6%（11名）参与者报告他们对去偏差策略有良好或广泛的了解。所有（14名）参与者都认为讲座质量良好或优秀，92.9%（13名）认为它对他们作为急诊医学医生非常或极其相关，100%（14名）报告他们可能会基于本次讲座改变其实践。
调查结果表明，住院医师在参加本次讲座后认为对认知错误和去偏差策略的了解有所增加。讲座得到了高度评价，被认为与实践相关，并且很可能会改变大多数学习者未来的实践。这些结果表明，互动讲座在向住院医师介绍认知错误和去偏差概念方面可能具有重要作用。
认知偏差、偏差、去偏差、错误。
