Numerous studies have shown that diagnostic failure depends upon a variety of factors. Psychological factors are fundamental in influencing the cognitive performance decision maker. In this first two papers, we discuss basics reasoning and Dual Process Theory (DPT) making. The general properties DPT model, as it applies to reasoning, reviewed. A affective biases known compromise decision-making process. They mostly appear originate fast intuitive processes Type 1 dominate (or drive) work...

In a companion paper, we proposed that cognitive debiasing is skill essential in developing sound clinical reasoning to mitigate the incidence of diagnostic failure. We reviewed origins biases and some mechanisms for how processes might work. this first outline general schema change occurs constraints may apply. review variety individual factors, many them themselves, which be impediments change. then examine major strategies have been developed social sciences medicine achieve affective...

Reflective practice has been suggested to be an important instrument in improving clinical judgement and developing medical expertise. Empirical evidence supporting this suggestion, however, is absent. This paper reports on experiment conducted study the effects of reflective diagnostic accuracy.Participants were 42 internal medicine residents hospitals 2 states northeast Brazil. They diagnosed 16 cases. The employed a repeated measures design, with independent variables: complexity cases...

Diagnostic errors have been associated with bias in clinical reasoning. Empirical evidence on the cognitive mechanisms underlying biases and effectiveness of educational strategies to counteract them is lacking.To investigate whether recent experience problems provokes availability (overestimation likelihood a diagnosis based ease which it comes mind) resulting diagnostic reflection (structured reanalysis case findings) counteracts this bias.Experimental study conducted 2009 at Erasmus...

The capability to reflect consciously upon one's professional practice is generally considered important for the development of expertise and, hence, education. However, our knowledge no empirical research has been conducted date into nature reflective in medicine.To study structure medicine.A questionnaire based on literature was developed and administered a group primary care doctors. data were subjected confirmatory factor analysis using structural equations modelling.A 5-factor model...

Medical Education 2012: 46 : 464–472 Objectives Developing diagnostic competence in students is a major goal of medical education, but there little empirical evidence on instructional strategies that foster the acquisition this competence. The aim study was to investigate effects structured reflection compared with generation immediate or differential diagnosis while practising clinical cases learning diagnosis. Methods This three‐phase experimental study. During phase, Year 4 diagnosed six...

Contrary to what common sense makes us believe, deliberation without attention has recently been suggested produce better decisions in complex situations than with attention. Based on differences between cognitive processes of experts and novices, we hypothesized that make fact after consciously thinking about problems whereas novices may benefit from deliberation-without-attention. These hypotheses were confirmed a study among doctors medical students. They diagnosed routine under three...

Abstract Background Adverse effects of medical errors have received increasing attention. Diagnostic account for a substantial fraction all errors, and strategies their prevention been explored. A crucial requirement that is better understanding origins errors. Research on expertise may contribute to as far it explains reasoning processes involved in clinical judgements. The literature has indicated the capability critically reflecting upon one’s own practice key developing maintaining...

To develop diagnostic competence, students should practice with many examples of clinical problems to build rich mental representations diseases. How enhance learning from remains unknown. This study investigated the effects reflection on cases compared generating a single or differential diagnosis.In 2012, during phase, 110 fourth-year medical diagnosed four two criterion diseases under three different experimental conditions: structured reflection, single-diagnosis, differential-diagnosis....

Anecdotal evidence indicates that exposure to media-distributed disease information, such as news about an outbreak, can lead physicians errors; influenced by availability bias, they misdiagnose patients with similar-looking but different diseases. The authors investigated whether media-provided information causes diagnostic errors and reflection (systematic review of findings) counteracts bias.In 2010, 38 internal medicine residents first read the Wikipedia entry one or another two diseases...

Patients who display disruptive behaviours in the clinical encounter (the so-called 'difficult patients') may negatively affect doctors' diagnostic reasoning, thereby causing errors. The present study aimed at investigating mechanisms underlying negative influence of difficult patients' on performance.A randomised experiment with 74 internal medicine residents. Doctors diagnosed eight written vignettes that were exactly same except for (either or neutral). Each participant half a patient...

Background Literature suggests that patients who display disruptive behaviours in the consulting room fuel negative emotions doctors. These emotions, turn, are said to cause diagnostic errors. Evidence substantiating this claim is however lacking. The purpose of present experiment was study effect such difficult patients’ on doctors’ performance. Methods We created six vignettes which were depicted as (displaying distressing behaviours) or neutral. Three clinical cases deemed be...

The idea that reflection improves reasoning and learning, since long present in other fields, emerged the 90s medical education literature. Since then, number of publications on as a means to improve diagnostic learning clinical problem-solving has increased steeply. Recently, concerns with errors have raised further interest reflection. Several approaches based been proposed reduce clinicians' during reasoning. What entails varies substantially, most still require empirical examination.The...

Context Two modes of case processing have been shown to underlie diagnostic judgements: analytical and non-analytical reasoning. An optimal form clinical reasoning is suggested combine both modes. Conditions leading doctors shift from the usual mode reflective not identified. This paper reports a study aimed at exploring these conditions by investigating effects ambiguity cases on Methods Participants were 16 internal medicine residents in Brazilian state Ceará. They asked diagnose 20 recall...

Skill in clinical reasoning is a highly valued attribute of doctors, but instructional approaches to foster medical students' skills remain scarce. Self-explanation an procedure, the positive effects which on learning have been demonstrated variety domains, largely unexplored education.The purpose this study was investigate self-explanation during clerkships and examine whether these are affected by topic familiarity.An experimental with training phase assessment conducted 36 Year 3...

Purpose Diagnostic errors have been attributed to faulty reasoning and cognitive biases, but minimizing requires understanding the mechanisms underlying biases. The authors investigated whether salient distracting features (SDFs)—case findings that tend grab physicians' attention because they are strongly associated with a particular disease, indeed unrelated problem—misdirect diagnostic reasoning, causing errors. Method In 2012 study conducted at Erasmus Medical Centre, Rotterdam, 72...

Context Recent studies suggest that self-explanation (SE) while diagnosing cases fosters the development of clinical reasoning in medical students; however, conditions optimise impact SE remain unknown. The example-based learning framework justifies an exploration students' use their own SEs combined with study examples. This aimed to assess on diagnostic performance of: (i) combining listening examples residents' SEs, and (ii) addition prompts (specific questions) working Methods consisted...

Flaws in clinical reasoning are present most diagnostic errors and occur even when physicians have enough knowledge to solve the problem. Deliberate reflection has been shown improve diagnoses. The sources of faulty how counteracts them remain largely unknown.To explore causes mechanisms through which neutralises by investigating influence salient distracting features on decision-making.In a prior study, 34 internal medicine residents 50 medical students Erasmus Medical Centre, Rotterdam,...

Studies suggest time pressure has negative effects on physicians' working conditions and may lead to suboptimal patient care medical errors. Experimental evidence supporting this is lacking, however. This study investigated the effect of diagnostic accuracy.In 2013, senior internal medicine residents at three hospitals in Saudi Arabia were divided randomly into two groups: a time-pressure condition control without pressure. Both groups diagnosed eight written clinical cases presented...

Background Diagnostic errors have often been attributed to biases in physicians’ reasoning. Interventions ‘immunise’ physicians against bias focused on improving reasoning processes and largely failed. Objective To investigate the effect of increasing relevant knowledge their susceptibility availability bias. Design, settings participants Three-phase multicentre randomised experiment with second-year internal medicine residents from eight teaching hospitals Brazil. Immunisation: Physicians...