Role of knowledge and reasoning processes as predictors of resident physicians' susceptibility to anchoring bias in diagnostic reasoning: a randomised controlled experiment.

Autor:	Mamede S; Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands s.mamede@erasmusmc.nl., Zandbergen A; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands., de Carvalho-Filho MA; Wenckebach Institute (WIOO), University Medical Centre Groningen, Groningen, The Netherlands., Choi G; Department of Hematology, University Medical Centre Groningen, Groningen, The Netherlands., Goeijenbier M; Department of Intensive Care, Spaarne Gasthuis, Haarlem, The Netherlands.; Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands., van Ginkel J; Department of Psychology, Methodology and Statistics, Leiden University, Leiden, The Netherlands., Zwaan L; Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands., Paas F; Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands., Schmidt HG; Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2024 Aug 16; Vol. 33 (9), pp. 563-572. Date of Electronic Publication: 2024 Aug 16.
DOI:	10.1136/bmjqs-2023-016621
Abstrakt:	Background: Diagnostic errors have been attributed to reasoning flaws caused by cognitive biases. While experiments have shown bias to cause errors, physicians of similar expertise differed in susceptibility to bias. Resisting bias is often said to depend on engaging analytical reasoning, disregarding the influence of knowledge. We examined the role of knowledge and reasoning mode, indicated by diagnosis time and confidence, as predictors of susceptibility to anchoring bias. Anchoring bias occurs when physicians stick to an incorrect diagnosis triggered by early salient distracting features (SDF) despite subsequent conflicting information. Methods: Sixty-eight internal medicine residents from two Dutch university hospitals participated in a two-phase experiment. Phase 1: assessment of knowledge of discriminating features (ie, clinical findings that discriminate between lookalike diseases) for six diseases. Phase 2 (1 week later): diagnosis of six cases of these diseases. Each case had two versions differing exclusively in the presence/absence of SDF. Each participant diagnosed three cases with SDF (SDF+) and three without (SDF-). Participants were randomly allocated to case versions. Based on phase 1 assessment, participants were split into higher knowledge or lower knowledge groups. Main Outcome Measurements: frequency of diagnoses associated with SDF; time to diagnose; and confidence in diagnosis. Results: While both knowledge groups performed similarly on SDF- cases, higher knowledge physicians succumbed to anchoring bias less frequently than their lower knowledge counterparts on SDF+ cases (p=0.02). Overall, physicians spent more time (p<0.001) and had lower confidence (p=0.02) on SDF+ than SDF- cases (p<0.001). However, when diagnosing SDF+ cases, the groups did not differ in time (p=0.88) nor in confidence (p=0.96). Conclusions: Physicians apparently adopted a more analytical reasoning approach when presented with distracting features, indicated by increased time and lower confidence, trying to combat bias. Yet, extended deliberation alone did not explain the observed performance differences between knowledge groups. Success in mitigating anchoring bias was primarily predicted by knowledge of discriminating features of diagnoses. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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