Cognitive Debiasing Strategies to Reduce Diagnostic Error1
Extracted from http://scholar.google.com/scholar? hl=en&lr=&q=cache:zL9uwLaa3t0J:www.med.uth.tmc.edu/edprog/facdev/august.pdf+
accessed September 9, 2006
Develop insight/
awareness
Provide detailed descriptions and thorough
characterizations of known cognitive
biases, together with multiple clinical
examples illustrating their adverse effects
on decision-making and diagnosis
formulation.
Consider
alternatives
Establish forced consideration of alternative
possibilities e.g., the generation and
working through of a differential
diagnosis. Encourage routinely asking the
question: What else might this be?
Metacognition
Train for a reflective approach to problem
solving: stepping back from the immediate
problem to examine and reflect on the
thinking process.
Decrease reliance
on memory
Improve the accuracy of judgments through
cognitive aids: mnemonics, clinical
practice guidelines, algorithms, hand-held
computers.
Specific training
Identify specific flaws and biases in thinking
and provide directed training to overcome
them: e.g., instruction in fundamental
rules of probability, distinguishing
correlation from causation, basic Bayesian
probability theory.
Simulation
Develop mental rehearsal, ‘‘cognitive
walkthrough’’ strategies for specific
clinical scenarios to allow cognitive biases
to be made and their consequences to be
observed. Construct clinical training
videos contrasting incorrect (biased)
approaches with the correct (debiased)
approach.
Cognitive forcing
strategies
Develop generic and specific strategies to
avoid predictable bias in particular clinical
situations.
Make task easier
Provide more information about the specific
problem to reduce task difficulty and
ambiguity. Make available rapid access
to concise, clear, well-organized
information.
Minimize time
pressures
Provide adequate time for quality decision-
making.
Accountability
Establish clear accountability and follow-up
for decisions made.
Feedback
Provide as rapid and reliable feedback as
possible to decision makers so that errors
are immediately appreciated, understood,
and corrected, resulting in better
calibration of decision makers.