Last updated 2023-02-02T16:20:22Z

Cognitive Biases in Medical Diagnosis Workshop

Biases are inherent in both human cognition and machine learning, and are often referred to as "systems errors" of the brain. Health care providers, just like every human being, exhibit these biases, which are primary contributors to diagnostic errors. Cognitive Biases can be mitigated with an appreciation of our inherent decision-making fallibility, a culture in which we can learn from our errors, and the support of our peers.

Origin:

May 2021, Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri)

Adoptions:

1 successful

Overview

Problem

Cognitive biases are errors in thinking that affect how we make decisions. These errors are systematic and reliable, often referred to as “systems errors” of the brain to which we all are susceptible. Informed by the work of Kahneman and Tversky starting in the 1970’s, there has been increasing interest among health care providers in how cognitive biases af ... Cognitive biases are errors in thinking that affect how we make decisions. These errors are systematic and reliable, often referred to as “systems errors” of the brain to which we all are susceptible. Informed by the work of Kahneman and Tversky starting in the 1970’s, there has been increasing interest among health care providers in how cognitive biases affect health care decision-making, particularly with regard to diagnosis. Research in this area points to cognitive biases as a cause of medical error. Recent texts have been devoted entirely to cognitive biases in Medicine. Efforts toward mitigating the effects of these biases are increasing. The goal of this training is to enhance both the understanding and appreciation of these cognitive biases, along with specific strategies for cognitive bias mitigation. See more

Solution

We developed a training on cognitive biases in medical diagnosis. A member of the planning committee and the keynote speaker was Patrick Croskerry, M.D., Ph.D., a leading expert in cognitive biases in medicine. The training includes self-assessments designed to reveal susceptibility to cognitive bias and improvement in knowledge of bias as the result of the ... We developed a training on cognitive biases in medical diagnosis. A member of the planning committee and the keynote speaker was Patrick Croskerry, M.D., Ph.D., a leading expert in cognitive biases in medicine. The training includes self-assessments designed to reveal susceptibility to cognitive bias and improvement in knowledge of bias as the result of the training. Lastly, a cognitive bias mitigation checklist is reviewed during the training. See more

Results

As part of the workshop we created a cognitive bias questionnaire that the attendees completed prior to the workshop. Review of the results of the questionnaire was a primary method of instruction on cognitive biases. The results of the questionnaire revealed strong evidence of biases among the initial training group. The majority of the group exhibited b ... As part of the workshop we created a cognitive bias questionnaire that the attendees completed prior to the workshop. Review of the results of the questionnaire was a primary method of instruction on cognitive biases. The results of the questionnaire revealed strong evidence of biases among the initial training group. The majority of the group exhibited biases on each of the seven biases examined. For more information please see the summary of the training program.

The pre- and post-training knowledge questionnaire revealed a 68% improvement in the test scores. Average percent correct was 40.44% and 68.21% for the pre- and post-training questionnaires, respectively.

Attendees completed a post-workshop evaluation. Briefly, 96.15% of providers indicated they learned either a Fair Amount (50%) or a Great Deal (46.15%) from the workshop. Similarly, 96.15% of providers indicated the workshop was Useful (50%) or Extremely Useful (46.15%).

Thirty-five percent of the initial training group completed a one-month follow-up questionnaire. Attendees reported thinking about cognitive biases an average of three times in the past week, with a range of one to seven. Seventy-eight percent of the attendees indicated they would like continued training in cognitive biases. These results suggest that the workshop had a lasting impact on the providers, who were interested in ongoing training in cognitive biases. See more

Metrics

Metrics have been limited to results described above focused on results of workshop questionnaires

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

MO: Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri)

Started adoption on 05/2021.

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

Implementation

Departments

Primary care
Emergency care
Whole health
Psychiatry
Psychology
Mental health care
Marketing
Education and training
Administration

Core Resources

Resource type	Resource description
PEOPLE	Administration: Participation in planning the workshop by local executive leadership will send a message that the workshop is important for Veterans and providers. Further, an ELT champion for the workshop will identify administrative or system-related issues important to successful implementation of the workshop. Education and Training: Participation by staff in local education/training departments will provide knowledge and resources that are important in successful implementation of training programs. These resources may range from finding a suitable space for the workshop, setting up technology, registration for the workshop, and compliance with local procedures. Marketing: Staff from a local marketing, medical media, or public affairs office can help with the development and dissemination of information and promotional materials about the workshop. Mental Health / Psychology / Psychiatry: Behavioral Health providers are a primary target audience for this workshop. Local Behavioral Health staff can champion the development and promotion of the workshop. Further, psychologists in particular may have specialized knowledge in cognitive biases that can contribute to the workshop. Emergency Care / Primary Care: Emergency and Primary Care providers are a primary target audience for this workshop. In fact, research in cognitive biases in medicine identifies the Emergency Department as the setting in which providers may be most vulnerable to cognitive biases. Emergency and Primary Care staff can champion the development and promotion of the workshop. Whole Health: The initial workshop was funded by a Whole Health grant from the Office of Patient Centered Care and Cultural Transformation. Local and National Whole Health staff provided a variety of supports in the development and implementation of the training program.

PEOPLE

Administration: Participation in planning the workshop by local executive leadership will send a message that the workshop is important for Veterans and providers. Further, an ELT champion for the workshop will identify administrative or system-related issues important to successful implementation of the workshop.
Education and Training: Participation by staff in local education/training departments will provide knowledge and resources that are important in successful implementation of training programs. These resources may range from finding a suitable space for the workshop, setting up technology, registration for the workshop, and compliance with local procedures.
Marketing: Staff from a local marketing, medical media, or public affairs office can help with the development and dissemination of information and promotional materials about the workshop.
Mental Health / Psychology / Psychiatry: Behavioral Health providers are a primary target audience for this workshop. Local Behavioral Health staff can champion the development and promotion of the workshop. Further, psychologists in particular may have specialized knowledge in cognitive biases that can contribute to the workshop.
Emergency Care / Primary Care: Emergency and Primary Care providers are a primary target audience for this workshop. In fact, research in cognitive biases in medicine identifies the Emergency Department as the setting in which providers may be most vulnerable to cognitive biases. Emergency and Primary Care staff can champion the development and promotion of the workshop.
Whole Health: The initial workshop was funded by a Whole Health grant from the Office of Patient Centered Care and Cultural Transformation. Local and National Whole Health staff provided a variety of supports in the development and implementation of the training program.

Files

This document is a detailed description of the development and implementation of the initial training program that occurred at Truman VA in May, 2021. Cognitive Biases in Medical Diagnosis Training Program for Clinicians Initial Training Report

This is the scoring and interpretation manual for the Cognitive Biases Questionnaire. This questionnaire can be found in the appendices of the initial training report. It is important that workshop attendees complete this questionnaire prior to the workshop. Review of the results of the workshop is a primary method of instruction on cognitive biases. Cognitive Biases Questionnaire Manual

This one-page checklist is designed to be used during the diagnostic process. It includes a review of situational factors that can increase the likelihood of bias as well as several common biases that may occur during while making a diagnosis. Cognitive Biases in Diagnosis Checklist

This 20-item questionnaire can be administered immediately before and after the Cognitive Biases training. The purpose of this questionnaire is to quantify the amount of knowledge gained about cognitive biases among the attendees of the training. Cognitive Biases Pre and Post Training Knowledge Questionnaire

This provide a list of tasks for developing, marketing, and implementing a cognitive biases workshop. CBMD Workshop Task List and Timeline

Links

This video is an introduction to the cognitive biases workshop. Cognitive Biases Workshop Introduction

This is the second video in the cognitive biases workshop. This video provides an overview of diagnostic errors in medical diagnosis, with emphasis on the role of cognitive biases. Diagnostic Errors in Medical Diagnosis

This is the third video in the cognitive biases workshop. This video provides an introduction to cognitive biases. Introduction to Cognitive Biases

This is the forth video in the cognitive biases workshop. This video provides detailed discussion about cognitive biases that providers are most likely to encounter in medical diagnosis. What are Cognitive Biases

This is the fifth video in the cognitive biases workshop. In this video, Patrick Croskerry, M.D., Ph.D., a leading expert in cognitive biases in medicine, provides an overview of the area and suggestions for cognitive bias mitigation. Cognitive Failures in Medicine

This is the sixth and final video in the cognitive biases workshop. This video provides information about cognitive bias mitigation. Cognitive Bias Mitigation.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email randall.rogers2@va.gov with questions about this innovation.

About

Origin story

Our first conversations at Truman VA about cognitive biases in medicine occurred mid-2019. The Supervisory Patient Safety Manager started these conversations with a group of psychologists, as cognitive biases in medicine had been attracting more attention in the patient safety community and psychologists are the health care providers who were most likely to ... Our first conversations at Truman VA about cognitive biases in medicine occurred mid-2019. The Supervisory Patient Safety Manager started these conversations with a group of psychologists, as cognitive biases in medicine had been attracting more attention in the patient safety community and psychologists are the health care providers who were most likely to have some education about cognitive biases (there happened to be a few psychologists at Truman VA who had much familiarity with this research literature). We decided to work toward the goal of developing ongoing case conference-like experiences about cognitive biases for physicians. However, as our conversations progressed, the COVID pandemic emerged. Like many health care facilities, we focused on essential patient-care efforts to ensure our Veterans did not experience a disruption in care throughout the pandemic. Near the end of the year 2020, the Integrative Health and Wellness Instructor at Truman VA expressed interest in applying for Whole Health Innovations Grant from the Office of Patient Centered Care and Cultural Transformation. We wanted to focus on education for providers that may enhance Veteran care and we viewed this as an opportunity to continue the development of a cognitive biases training. We are grateful to the Office of Patient Centered Care and Cultural Transformation for awarding the grant to us. In May, 2021, we held our first in-person workshop in cognitive biases in medicine, which was one part of the three-part training program we developed entitled, “Innovations in Provider and Patient Care.” The other two trainings were in the development of a health care peer support program and the My Life My Story program.

Original team

Timothy Anderson

VISN Chief High Reliability Officer, workshop planning committee

LuAnn Tandy

Integrative Health and Wellness Instructor, workshop planning committee

Randall Rogers

Clinical Health Psychologist, Local Recovery Coordinator, workshop planning committee, presenter

Paul Korte

Clinical Psychologist, PCMHI, workshop planning committee, presenter

Nicholas Madaffer

Physician, PM&R, workshop planning committee, presenter

Patrick Croskerry

Professor in Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, workshop planning committee, presenter, subject matter expert

Heather Brown

Strategic Partnership Officer, workshop planning committee

Stephen Long

CIS Vocational Services Supervisor, workshop planning committee

Erin Morrisey

Physician Assistant, workshop planning committee

Courtney Kominek

Pharmacist, workshop planning committee

Merla Deo

Occupational Therapist, workshop planning committee

Cathy Beamer

Veterans Health Education Coordinator, Field Accreditation Services/Agent in Place, workshop planning committee

Search tags

Emergency Care Employee Experience Healthcare Administration High Reliability Mental Health Primary Care Psychiatry Whole Health

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