A cognitive bias in diagnostic reasoning and its remediation by the “2-Dimensional Approach”
Background Misdiagnoses are associated with various cognitive biases, which are difficult to reduce even if physicians think about clinical cases deliberately. We propose a new "2-Dimensional Approach" that combines two perspectives in diagnostic reasoning: organs (brain, heart, lung, i...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
F1000 Research Ltd
2020-06-01
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| Series: | MedEdPublish |
| Subjects: | |
| Online Access: | https://www.mededpublish.org/Manuscripts/2906 |
| _version_ | 1811271414086369280 |
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| author | Hisashi Shimozono Nobutoshi Nawa Makoto Takahashi Makoto Tomita Yujiro Tanaka |
| author_facet | Hisashi Shimozono Nobutoshi Nawa Makoto Takahashi Makoto Tomita Yujiro Tanaka |
| author_sort | Hisashi Shimozono |
| collection | DOAJ |
| description | Background
Misdiagnoses are associated with various cognitive biases, which are difficult to reduce even if physicians think about clinical cases deliberately. We propose a new "2-Dimensional Approach" that combines two perspectives in diagnostic reasoning: organs (brain, heart, lung, intestine/liver, kidney) and systems (metabolic, endocrine, blood/tumor, infection, immune, circulatory, nervous systems). Systems involve throughout the whole body and can be pathogenesis of diseases. As a result of diseases, organs show abnormal vital signs and symptoms. We investigated: (1) whether each individual resident has a bias for either organs or systems when they diagnose clinical cases, and (2) whether the 2D Approach can reduce such a bias.
Methods
We randomly assigned PGY1 residents (n=105) to either the 2D Approach group (n=45) or a control group (n=60). After attending either a lecture on the 2D Approach or a non-related lecture, residents were asked to diagnose two clinical cases. We divided each diagnosis into one of the two categories, either "organs" or "systems". We investigated whether each resident would diagnose the two cases into the same category, either organs or systems (i.e., a bias for either organs or systems).
Results
The participants in the control group tended to diagnose the two cases into the same category, either organs or systems (OR: 5.63, 95% CI: 1.62-21.7, p=0.0030, Fisher's exact test). In the 2D Approach group, the category of diagnoses for the two cases were not related to each other (OR: 2.14, 95% CI: 0.50-9.81, p=0.33).
Conclusion
There is a bias for either organs or systems when residents diagnose clinical cases, suggesting that organs and systems are different perspectives in diagnostic reasoning. By combining these 2 different perspectives in a 2-dimensional matrix, the 2D Approach reduces this bias. |
| first_indexed | 2024-04-12T22:20:38Z |
| format | Article |
| id | doaj.art-5a27ae691f4344768ea587756925085a |
| institution | Directory Open Access Journal |
| issn | 2312-7996 |
| language | English |
| last_indexed | 2024-04-12T22:20:38Z |
| publishDate | 2020-06-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | MedEdPublish |
| spelling | doaj.art-5a27ae691f4344768ea587756925085a2022-12-22T03:14:23ZengF1000 Research LtdMedEdPublish2312-79962020-06-0191A cognitive bias in diagnostic reasoning and its remediation by the “2-Dimensional Approach”Hisashi Shimozono0Nobutoshi Nawa1Makoto Takahashi2Makoto Tomita3Yujiro Tanaka4Department of Medical Education Research and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityDepartment of Medical Education Research and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityDepartment of Medical Education Research and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityClinical Research Center, Tokyo Medical and Dental University Hospital of MedicineDepartment of Medical Education Research and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental UniversityBackground Misdiagnoses are associated with various cognitive biases, which are difficult to reduce even if physicians think about clinical cases deliberately. We propose a new "2-Dimensional Approach" that combines two perspectives in diagnostic reasoning: organs (brain, heart, lung, intestine/liver, kidney) and systems (metabolic, endocrine, blood/tumor, infection, immune, circulatory, nervous systems). Systems involve throughout the whole body and can be pathogenesis of diseases. As a result of diseases, organs show abnormal vital signs and symptoms. We investigated: (1) whether each individual resident has a bias for either organs or systems when they diagnose clinical cases, and (2) whether the 2D Approach can reduce such a bias. Methods We randomly assigned PGY1 residents (n=105) to either the 2D Approach group (n=45) or a control group (n=60). After attending either a lecture on the 2D Approach or a non-related lecture, residents were asked to diagnose two clinical cases. We divided each diagnosis into one of the two categories, either "organs" or "systems". We investigated whether each resident would diagnose the two cases into the same category, either organs or systems (i.e., a bias for either organs or systems). Results The participants in the control group tended to diagnose the two cases into the same category, either organs or systems (OR: 5.63, 95% CI: 1.62-21.7, p=0.0030, Fisher's exact test). In the 2D Approach group, the category of diagnoses for the two cases were not related to each other (OR: 2.14, 95% CI: 0.50-9.81, p=0.33). Conclusion There is a bias for either organs or systems when residents diagnose clinical cases, suggesting that organs and systems are different perspectives in diagnostic reasoning. By combining these 2 different perspectives in a 2-dimensional matrix, the 2D Approach reduces this bias.https://www.mededpublish.org/Manuscripts/2906the 2D Approacha bias for either organs or systemscognitive biasclinical reasoningdiagnosis. |
| spellingShingle | Hisashi Shimozono Nobutoshi Nawa Makoto Takahashi Makoto Tomita Yujiro Tanaka A cognitive bias in diagnostic reasoning and its remediation by the “2-Dimensional Approach” MedEdPublish the 2D Approach a bias for either organs or systems cognitive bias clinical reasoning diagnosis. |
| title | A cognitive bias in diagnostic reasoning and its remediation by the “2-Dimensional Approach” |
| title_full | A cognitive bias in diagnostic reasoning and its remediation by the “2-Dimensional Approach” |
| title_fullStr | A cognitive bias in diagnostic reasoning and its remediation by the “2-Dimensional Approach” |
| title_full_unstemmed | A cognitive bias in diagnostic reasoning and its remediation by the “2-Dimensional Approach” |
| title_short | A cognitive bias in diagnostic reasoning and its remediation by the “2-Dimensional Approach” |
| title_sort | cognitive bias in diagnostic reasoning and its remediation by the 2 dimensional approach |
| topic | the 2D Approach a bias for either organs or systems cognitive bias clinical reasoning diagnosis. |
| url | https://www.mededpublish.org/Manuscripts/2906 |
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