The effect of cognitive debiasing training among family medicine residents

Abstract

Background: Debiasing education has been recommended for physicians in training. We report on the efficacy of a workshop designed to aid family medicine residents recognize and respond to their risk of misdiagnosis due to cognitive biases during patient care. Methods: Residents participated in a debiasing workshop in which they were taught to recognize and respond to cognitive biases likely to contribute to misdiagnosis. Metacognition was introduced and cognitive forcing strategies were demonstrated and practiced. While precepting clinic visits, attendings evaluated residents in the following areas: 1) diagnostic concordance between resident and attending, 2) ability of the resident to perceive their risk of cognitive bias, 3) the quality of the resident's plan to mitigate this risk, and 4) the presence of an unrecognized cognitive bias. Pre and post workshop data were compared. Results: Preceptor concurrence with the residents' diagnoses was unchanged - 74% (63 of 85) vs. 78% (45 of 58, p=0.64). Residents' ability to recognize their risk of cognitive bias was unchanged - 51% (43 of 85) vs. 57% (33 of 58, p=0.46). Residents' formulation of an acceptable plan to mitigate the effect of cognitive bias increased from 84% (36 of 43) to 100% (33 of 33, p=0.02). Preceptors' perception of an unrecognized cognitive bias in the residents' presentation was unchanged - 12% (10 of 85) vs. 9% (5 of 58, p=0.55). Conclusions: A debiasing workshop for family medicine residents demonstrated improvement in one of four studied outcomes.