Using an experiential learning model to teach clinical reasoning theory and cognitive bias: an evaluation of a first-year medical student curriculum

References

• Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226–12.
   PubMed Web of Science ®Google Scholar
• Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493–1499.
   PubMed Web of Science ®Google Scholar
• Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145(7):488–496.
   PubMed Web of Science ®Google Scholar
• Kachalia A, Gandhi TK, Puopolo AL, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49(2):196–205.
   PubMed Web of Science ®Google Scholar
• Schiff GD, Puopolo AL, Huben-Kearney A, et al. Primary care closed claims experience of Massachusetts malpractice insurers. JAMA Intern Med. 2013;173(22):2063–2068.
   PubMed Web of Science ®Google Scholar
• Saber Tehrani AS, Lee H, Mathews SC, et al. 25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the national practitioner data bank. BMJ Qual Saf. 2013;22(8):672–680.
   PubMed Web of Science ®Google Scholar
• Schnapp BH, Sun JE, Kim JL, et al. Cognitive error in an academic emergency department. Diagnosis (Berl). 2018;5(3):135–142.
   PubMedGoogle Scholar
• Restrepo D, Armstrong KA, Metlay JP. Annals clinical decision making: avoiding cognitive errors in clinical decision making. Ann Intern Med. 2020;172(11):747–751.
   PubMed Web of Science ®Google Scholar
• Rencic J, Trowbridge RL, Fagan M, et al. Clinical reasoning education at US medical schools: results from a national survey of internal medicine clerkship directors. J Gen Intern Med. 2017;32(11):1242–1246.
   PubMed Web of Science ®Google Scholar
• Connor DM, Durning SJ, Rencic JJ. Clinical reasoning as a core competency. Acad Med. 2020;95(8):1166–1171.
   PubMed Web of Science ®Google Scholar
• Committee on Diagnostic Error in Health Care, Board on Health Care Services. Institute of medicine, The national academies of sciences, engineering, and medicine. In: Balogh EP, Miller BT, Ball JR, editors. Improving diagnosis in health care. National Academies Press (US); 2015. 10.17226/21794.
   Google Scholar
• Eva KW. What every teacher needs to know about clinical reasoning. Med Educ. 2005;39(1):98–106.
   PubMed Web of Science ®Google Scholar
• Sherbino J, Yip S, Dore KL, et al. The effectiveness of cognitive forcing strategies to decrease diagnostic error: an exploratory study. Teach Learn Med. 2011;23(1):78–84.
   PubMed Web of Science ®Google Scholar
• Sherbino J, Kulasegaram K, Howey E, et al. Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial. Cjem. 2014;16(1):34–40.
   PubMedGoogle Scholar
• Royce CS, Hayes MM, Schwartzstein RM. Teaching critical thinking: a case for instruction in cognitive biases to reduce diagnostic errors and improve patient safety. Acad Med. 2019;94(2):187–194.
   PubMed Web of Science ®Google Scholar
• Edgell SE, Harbison JI, Neace WP, et al. What is learned from experience in a probabilistic environment? J Behav Decis Mak. 2004;17(3):213–229.
   Web of Science ®Google Scholar
• Croskerry P. From mindless to mindful practice–cognitive bias and clinical decision making. N Engl J Med. 2013;368(26):2445–2448.
   PubMed Web of Science ®Google Scholar
• Schaye V, Eliasz KL, Janjigian M, et al. Theory-guided teaching: implementation of a clinical reasoning curriculum in residents. Med Teach. 2019;41(10):1192–1199.
   PubMed Web of Science ®Google Scholar
• Norman G, Sherbino J, Dore K, et al. The etiology of diagnostic errors: a controlled trial of system 1 versus system 2 reasoning. Acad Med. 2014;89(2):277–284.
   PubMed Web of Science ®Google Scholar
• Ruedinger E, Mathews B, Olson A. Decision – diagnosis: an introduction to diagnostic error and medical decision-Making. MedEdPORTAL. 2016;12(1). DOI:10.15766/mep_2374-8265.10378
   Google Scholar
• Hunzeker A, Amin R. Teaching cognitive bias in a hurry: single-Session workshop approach for psychiatry residents and students. MedEdPORTAL. 2016;12:10451.
   PubMedGoogle Scholar
• Hess BJ, Lipner RS, Thompson V, et al. Blink or think: can further reflection improve initial diagnostic impressions? Acad Med. 2015;90(1):112–118.
   PubMed Web of Science ®Google Scholar
• Monteiro SD, Sherbino J, Patel A, et al. Reflecting on diagnostic errors: taking a second look is not enough. J Gen Intern Med. 2015;30(9):1270–1274.
   PubMed Web of Science ®Google Scholar
• Schmidt HG, Mamede S, van den Berge K, et al. Exposure to media information about a disease can cause doctors to misdiagnose similar-looking clinical cases. Acad Med. 2014;89(2):285–291.
   PubMed Web of Science ®Google Scholar
• Lubarsky S, Dory V, Audétat M-C, et al. Using script theory to cultivate illness script formation and clinical reasoning in health professions education. Can Med Educ J. 2015;6(2):e61–70.
   PubMedGoogle Scholar
• Lambe KA, O’Reilly G, Kelly BD, et al. Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. BMJ Qual Saf. 2016;25(10):808–820.
   PubMed Web of Science ®Google Scholar
• Norman GR, Monteiro SD, Sherbino J, et al. The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Acad Med. 2017;92(1):23–30.
   PubMed Web of Science ®Google Scholar
• Schmidt HG, Rmjp R. How expertise develops in medicine: knowledge encapsulation and illness script formation. Med Educ. 2007;41(12):1133–1139.
   PubMed Web of Science ®Google Scholar
• Boshuizen HPA, Schmidt HG. On the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices. Cogn Sci. 1992;16(2):153–184.
   Web of Science ®Google Scholar
• Norman G. The essential role of basic science in medical education: the perspective from psychology. Clin Invest Med. 2000;23(1):47–51. discussion 52.
   PubMed Web of Science ®Google Scholar
• Schmidt HG, Boshuizen HPA. On acquiring expertise in medicine. Educ Psychol Rev. 1993;5(3):205–221.
   Web of Science ®Google Scholar
• Thinking, fast and slow - PsycNET. Cited 2021 Jan 11. https://psycnet.apa.org/record/2011-26535-000
   Google Scholar
• Evans J, Stanovich KE. Dual-Process theories of higher cognition: advancing the debate. Perspect Psychol Sci. 2013;8(3):223–241.
   PubMedGoogle Scholar
• Schmidt HG, Norman GR, Boshuizen HP. A cognitive perspective on medical expertise: theory and implications. Acad Med. 1990;65(10):611–621.
   PubMed Web of Science ®Google Scholar
• Norman G. Research in clinical reasoning: past history and current trends. Med Educ. 2005;39(4):418–427.
   PubMed Web of Science ®Google Scholar
• Elstein AS, Schwartz A. Clinical problem solving and diagnostic decision making: selective review of the cognitive literature. BMJ. 2002;324(7339):729–732.
   PubMed Web of Science ®Google Scholar
• Custers EJ, Regehr G, Norman GR. Mental representations of medical diagnostic knowledge: a review. Acad Med. 1996;71(10 Suppl):S55–61.
   PubMed Web of Science ®Google Scholar
• Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006;355(21):2217–2225.
   PubMed Web of Science ®Google Scholar
• Kolb DA. Experiential learning: experience as the source of learning and development. 2nd ed. Upper Saddle River NJ: Pearson FT Press; 2014.
   Google Scholar
• Baker EA, Ledford CH, Fogg L, et al. The IDEA assessment tool: assessing the reporting, diagnostic reasoning, and decision-making skills demonstrated in medical students’ hospital admission notes. Teach Learn Med. 2015;27(2):163–173.
   PubMed Web of Science ®Google Scholar
• Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381.
   PubMed Web of Science ®Google Scholar
• Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
   PubMed Web of Science ®Google Scholar
• Konopasky A, Artino AR, Battista A, et al. Understanding context specificity: the effect of contextual factors on clinical reasoning. Diagnosis (Berl). 2020;7(3):257–264.
   PubMedGoogle Scholar
• Durning SJ, Artino AR, Boulet JR, et al. The impact of selected contextual factors on experts’ clinical reasoning performance (does context impact clinical reasoning performance in experts?). Adv Health Sci Educ Theory Pract. 2012;17(1):65–79.
   PubMed Web of Science ®Google Scholar
• Durning S, Artino AR, Pangaro L, et al. Context and clinical reasoning: understanding the perspective of the expert’s voice. Med Educ. 2011;45(9):927–938.
   PubMed Web of Science ®Google Scholar
• Kondracki NL, Wellman NS, Amundson DR. Content analysis: review of methods and their applications in nutrition education. J Nutr Educ Behav. 2002;34(4):224–230.
   PubMed Web of Science ®Google Scholar
• Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–112.
   PubMed Web of Science ®Google Scholar
• Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–115.
   PubMed Web of Science ®Google Scholar
• Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78(8):775–780.
   PubMed Web of Science ®Google Scholar
• Choi JJ, Durning SJ. Three learning concepts to improve diagnosis and enhance the practice of medicine. Diagnosis (Berl). [Published online 2021 Apr 26]. DOI:10.1515/dx-2021-0030
   Google Scholar
• Mannion R, Thompson C. Systematic biases in group decision-making: implications for patient safety. Int J Qual Health Care. 2014;26(6):606–612.
   PubMed Web of Science ®Google Scholar
• Si J. Strategies for developing pre-clinical medical students’ clinical reasoning based on illness script formation: a systematic review. Korean J Med Educ. 2022;34(1):49–61.
   PubMedGoogle Scholar
• Hennrikus EF, Skolka MP, Hennrikus N. Applying metacognition through patient encounters and illness scripts to create a conceptual framework for basic science integration, storage, and retrieval. JMECD. 2018;5:2382120518777770.
   Google Scholar
• Jackson JM, Strowd LC, Peters TR. The simulated virology clinic: a standardized patient exercise for preclinical medical students supporting basic and clinical science integration. MedEdPORTAL. 2020;16:10957.
   PubMedGoogle Scholar
• Monteiro SM, Norman G. Diagnostic reasoning: where we’ve been, where we’re going. Teach Learn Med. 2013;25(Suppl 1):S26–32.
   PubMedGoogle Scholar
• Morewedge CK, Yoon H, Scopelliti I, et al. Debiasing decisions: improved decision making with a single training intervention. Policy Insights Behav Brain Sci. 2015;2(1):129–140.
   Google Scholar
• Sellier A-L, Scopelliti I, Morewedge CK. Debiasing training improves decision making in the field. Psychol Sci. 2019;30(9):1371–1379.
   PubMed Web of Science ®Google Scholar
• Croskerry P, Singhal G, Mamede S. Cognitive debiasing 2: impediments to and strategies for change. BMJ Qual Saf. 2013;22 Suppl 2:ii65–ii72.
   PubMed Web of Science ®Google Scholar
• Bosch J, Maaz A, Hitzblech T, et al. Medical students’ preparedness for professional activities in early clerkships. BMC Med Educ. 2017;17(1):140.
   PubMedGoogle Scholar