' Immunising' physicians against availability bias in diagnostic reasoning: a randomised controlled experiment.

Autor:	Mamede S; Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands s.mamede@erasmusmc.nl.; Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands., de Carvalho-Filho MA; Internal Medicine, State University of Campinas, Campinas, Brazil.; Center for Education Development and Research in the Health Professions, University of Groningen, Groningen, The Netherlands., de Faria RMD; Propeudeutics, Federal University of Minas Gerais, Belo Horizonte, Brazil.; Education and Research Center, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil., Franci D; Internal Medicine, State University of Campinas, Campinas, Brazil., Nunes MDPT; Internal Medicine, Universidade de São Paulo, Sao Paulo, Brazil., Ribeiro LMC; Department of Medical Education Development, UNIFENAS Medical School, Belo Horizonte, Brazil., Biegelmeyer J; Internal Medicine, Universidade de São Paulo, Sao Paulo, Brazil., Zwaan L; Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands., Schmidt HG; Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.; Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2020 Jul; Vol. 29 (7), pp. 550-559. Date of Electronic Publication: 2020 Jan 27.
DOI:	10.1136/bmjqs-2019-010079
Abstrakt:	Background: Diagnostic errors have often been attributed to biases in physicians' reasoning. Interventions to 'immunise' physicians against bias have focused on improving reasoning processes and have largely failed. Objective: To investigate the effect of increasing physicians' relevant knowledge on their susceptibility to availability bias. Design, Settings and Participants: Three-phase multicentre randomised experiment with second-year internal medicine residents from eight teaching hospitals in Brazil. Interventions: Immunisation: Physicians diagnosed one of two sets of vignettes (either diseases associated with chronic diarrhoea or with jaundice) and compared/contrasted alternative diagnoses with feedback. Biasing phase (1 week later): Physicians were biased towards either inflammatory bowel disease or viral hepatitis. Diagnostic performance test: All physicians diagnosed three vignettes resembling inflammatory bowel disease, three resembling hepatitis (however, all with different diagnoses). Physicians who increased their knowledge of either chronic diarrhoea or jaundice 1 week earlier were expected to resist the bias attempt. Main Outcome Measurements: Diagnostic accuracy, measured by test score (range 0-1), computed for subjected-to-bias and not-subjected-to-bias vignettes diagnosed by immunised and not-immunised physicians. Results: Ninety-one residents participated in the experiment. Diagnostic accuracy differed on subjected-to-bias vignettes, with immunised physicians performing better than non-immunised physicians (0.40 vs 0.24; difference in accuracy 0.16 (95% CI 0.05 to 0.27); p=0.004), but not on not-subjected-to-bias vignettes (0.36 vs 0.41; difference -0.05 (95% CI -0.17 to 0.08); p=0.45). Bias only hampered non-immunised physicians, who performed worse on subjected-to-bias than not-subjected-to-bias vignettes (difference -0.17 (95% CI -0.28 to -0.05); p=0.005); immunised physicians' accuracy did not differ (p=0.56). Conclusions: An intervention directed at increasing knowledge of clinical findings that discriminate between similar-looking diseases decreased physicians' susceptibility to availability bias, reducing diagnostic errors, in a simulated setting. Future research needs to examine the degree to which the intervention benefits other disease clusters and performance in clinical practice. Trial Registration Number: 68745917.1.1001.0068. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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