Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: A scoping review

Ten misconceptions regarding decision-making in critical care

Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system. Patient complexity, illness severity, and the urgency in initiating proper treatment all contribute to decision-making errors. Clinician-related factors such as fatigue, cognitive overload, and inexperience further interfere with effective decision-making. Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error. This evidence-based review discusses ten common misconceptions regarding critical care decision-making. By understanding how practitioners make clinical decisions and examining how errors occur, strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.

Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured Reflection in Simulation: A Mixed-Methods Experiment

AIM

The aim of this study was to examine the effect of structured reflection used during a simulated patient's diagnostic workup on diagnostic reasoning competency and accuracy and explore participants' cognitive bias experience and perceived utility of structured reflection.

BACKGROUND

Reasoning flaws may lead to diagnostic errors. Medical learners who used structured reflection demonstrated improved diagnosis accuracy.

METHOD

Embedded mixed-methods experiment examined diagnostic reasoning competency and accuracy of nurse practitioner students who did and did not use structured reflection. Cognitive bias experience and perceptions of structured reflection's utility were explored.

RESULTS

Diagnostic Reasoning Assessment mean competency scores and categories were not changed. Accuracy trended toward improvement with structured reflection. The theme, diagnostic verification, prompted diagnosis change by both structured reflection users and control participants.

CONCLUSION

Despite no changes in quantitative outcomes, explicit users of structured reflection believed that this strategy is helpful to their reasoning, and control participants used the strategy's components with the same noted benefits.

Cognitive biases in internal medicine: a scoping review

BACKGROUND

Medical errors account for up to 440,000 deaths annually, and cognitive errors outpace knowledge deficits as causes of error. Cognitive biases are predispositions to respond in predictable ways, and they don't always result in error. We conducted a scoping review exploring which biases are most prevalent in Internal Medicine (IM), if and how they influence patient outcomes, and what, if any, debiasing strategies are effective.

CONTENT

We searched PubMed, OVID, ERIC, SCOPUS, PsychINFO, and CINAHL. Search terms included variations of "bias", "clinical reasoning", and IM subspecialties. Inclusion criteria were: discussing bias, clinical reasoning, and physician participants.

SUMMARY

Fifteen of 334 identified papers were included. Two papers looked beyond general IM: one each in Infectious Diseases and Critical Care. Nine papers distinguished bias from error, whereas four referenced error in their definition of bias. The most commonly studied outcomes were diagnosis, treatment, and physician impact in 47 % (7), 33 % (5), and 27 % (4) of studies, respectively. Three studies directly assessed patient outcomes. The most commonly cited biases were availability bias (60 %, 9), confirmation bias (40 %, 6), anchoring (40 %, 6), and premature closure (33 %, 5). Proposed contributing features were years of practice, stressors, and practice setting. One study found that years of practice negatively correlated with susceptibility to bias. Ten studies discussed debiasing; all reported weak or equivocal efficacy.

OUTLOOK

We found 41 biases in IM and 22 features that may predispose physicians to bias. We found little evidence directly linking biases to error, which could account for the weak evidence of bias countermeasure efficacy. Future study clearly delineating bias from error and directly assessing clinical outcomes would be insightful.

The World Stroke Academy: A World Stroke Organization global pathway to improve knowledge in stroke care

BACKGROUND

The World Stroke Academy (WSA) (www.world-stroke-academy.org) is the educational platform of the World Stroke Organization (WSO). It facilitates educational activities (e.g. webinars and eLearning modules) and supports the WSO mission by providing high-quality stroke education to healthcare professionals. It provides evidence-based educational materials in a variety of formats to meet the needs of the WSO membership.

AIM

This article introduces the WSA, its core activities, and outlines how to access the many educational resources it offers.

RESULTS

The WSA offers high-quality peer reviewed stroke education material and uses outcome metrics to assess and improve the quality of medical training of healthcare professionals. This article also highlights the importance of identifying knowledge and knowledge-to-action gaps through the creation of special projects and initiatives. It describes three areas in which the WSA has carried out recent educational initiatives, namely: life after stroke, women in stroke, and stroke checklist/pre-printed stroke orders.

CONCLUSION

WSA material is freely available, and we would encourage the global stroke community to use, and contribute to, its resources.

Exploring the Competencies of Japanese Expert Nurse Practitioners: A Thematic Analysis

Nurse practitioners (NPs) provide medical care equivalent to that of physicians and facilitate access to healthcare. Although Japan’s first NP graduated in 2010, how Japanese expert NPs work effectively in clinical contexts is yet to be investigated. We aimed to identify the competencies that make expert NPs in Japan effective. Twelve Japanese expert NPs were purposely selected. The average age of the participants was 44.8 years, average NP experience was 7.5 years, and eight participants were women. Semi-structured interviews were conducted online from March to May 2021. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Thematic analysis revealed five themes: working in physicians’ contexts, interprofessional collaboration, involvement in nurses’ work, contribution to healthcare, and personal qualities for effective working. Japanese expert NPs can function effectively in clinical settings by flexibly and humbly collaborating with other medical professionals who have autonomous positions. They can improve the quality of healthcare by proposing practical solutions to problems faced by patients and medical organizations. These explored competencies can be applied to other aging and more complex societal contexts, and in updating the required competencies of Japanese NPs.