how to teach about cognitive bias

Thomas Westover twest54973 at YAHOO.COM
Fri Dec 7 06:02:59 UTC 2018


 Thanks for that tip Lorie
I spent a little time today glancing thru the tool kits; It seems that they are more academic overviews than specific examples
would it be worthwhile for the SIDM community to "crowd source" and have interested SIDM members submit short (1-2 paragraph) case descriptions/illness scripts that illustrate specific cognitive biases (anchoring premature closure etc etc)
these could be reviewed by an ad hoc expert group of senior SIDM leaders for vetting and then posted on the SIDM website for dissemination to residency program directors, medical school faculty members etc
I would certainly be interested in such a teaching tool

ThanksTom

Thomas Westover MDCooper Medical SchoolNJ




    On Thursday, December 6, 2018, 2:32:44 PM EST, Lorie Slass <Lorie.Slass at IMPROVEDIAGNOSIS.ORG> wrote:  
 
 
There is info on the SIDM site that may be helpful –
 
  
    
   - Assessment of ReasoningTool – this was developed as a tool to support educators in assessing a learner’s clinical reasoning skills during patient presentations. On the page there are a number of videos that look at elements of clinical reasoning.
   - The Clinical ReasoningToolkit includes great resources.  Resources in the ‘how we make decisions’ section includes many that focus on cognitive bias -https://www.improvediagnosis.org/clinical-reasoning-toolkit-how-we-make-decisions/
   - We maintain a ‘foundational reading’section that includes readings/studies related to cognitive reasoning.
 
  
 
Hope these are helpful.
 
  
 
  
 
_________________________________________
 
Lorie Slass
Vice President of Communications and Marketing
Society to Improve Diagnosis in Medicine (SIDM)
Lorie.Slass at ImproveDiagnosis.org
Phone: 215.801.4057
www.improvediagnosis.org

 
  
 
From: Thomas Westover <000000040134e744-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Thursday, December 6, 2018 2:05 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] how to teach about cognitive bias
 
  
 
Does the sidm website have a list of short case presentations that are good examples of the various cognitive biases that have been reviewed in the literature ?
 
  
 
I would like to do a short cognitive bias review session at the beginning of our weekly M&M rounds 
 
  
 
To teach students and residents about what these constructs are and how they are relevant in decision making 
 
  
 
And to teach them that understanding clinical reasoning is just as important as obtaining the correct dx
 
  
 
Thanks
 
  
 
Tom
 
  
 
Thomas Westover MD
 
Sent from my iPhone
 

On Dec 6, 2018, at 1:04 PM, Jarrett, Mark P <MJarrett at NORTHWELL.EDU> wrote:
 

Mark
 
 
 
I agree – but we often see anchoring based on the initial diagnosis that leads to less than ideal outcomes. The key to me is both a good differential (don’t always have to be right out of the gate) and purposeful reflection and re-evaluation.
 
 
 
Mark
 
 
 
 
 
Mark Jarrett, MD, MBA, MS
 
SVP & Chief Quality Officer
 
Associate Chief Medical Officer
 
Northwell Health
 
Professor of Medicine
 
Zucker School of Medicine at Hofstra/Northwell
 
(O): 516-321-6044
 
(C): 917-796-3935
 
mjarrett at northwell.edu
 
 
 
 
 
 
 
From: Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG>
Date: Thursday, December 6, 2018 at 11:31 AM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [EXTERNAL] Re: [IMPROVEDX] DX measures
 
 
 
External Email. Use Caution.
 
Jason – thanks for continuing to press us all to develop practical measures we could all support that would lead to improved diagnosis. 
 
 
 
I do agree that concordance between an admission and discharge diagnosis might be one measure of the adequacy of the diagnostic process in the ambulatory setting.  But at the end of the day, I’d argue that ‘getting it right’ is likely more important than getting it right in the clinic alone.
 
 
 
The agreement between admission and discharge diagnosis is fairly easy to measure and study, but this parameter is complicated !  First, in many hospitals the discharge diagnoses are assigned by coders whose primary goal seems to be centered on optimizing billing, not to capture diagnostic accuracy.  Second, and I may be old-fashioned here, but in my humble opinion there is no better time or place to make a diagnosis or to revise an initial impression.  It is so much easier to concentrate on a patient’s problems, consider and complete diagnostic evaluations, and get opinions from others during an inpatient stay compared to stretching these out over time and space in the ambulatory setting.  In this framework, any difference between the admitting and the discharge diagnosis is likely to be to the patient’s advantage and a good thing.  The disagreement noted in this study is almost certainly multifactorial, but if I had to guess, this data may be saying something positive about the diagnostic process in showing that the recorded diagnosis did in fact evolve during the admission.
 
 
 
    Mark
 
 
 
Mark L Graber, MD FACP
 
Chief Medical Officer; Founder and President Emeritus, SIDM
 
Professor Emeritus, Stony Brook University, NY
 
 
 
 
 
From: Jason Maude <jason.maude at ISABELHEALTHCARE.COM>
Reply-To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Jason Maude <jason.maude at ISABELHEALTHCARE.COM>
Date: Thursday, December 6, 2018 at 9:41 AM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] DX measures
 
 
 
This is a very interesting study (freely available) looking at the degree of match between the admission diagnosis and what the authors call the exit diagnosis.
 
 
 
“Our results show that only the 21.67% of cases are identified correctly on admission….”
 
 
 
Could this be used as a measure for diagnosis quality in hospitals? I am sure there will be concerns about the admitting diagnosis and clinicians being rushed to put something down without enough time but the ratio between the 2 diagnoses for an institution as a whole should be a useful indicator as would the trend over time. If the measure drove institutions to focus of getting the admitting diagnosis more accurate then that would be good.
 
 
 
This should also be practical to produce as would not involve the clinicians in any additional work.
 
 
 
In an earlier discussion, I asked if there were any measures that were practical, where there were no concerns and that we could all support but got replies. I really feel that if we are to get diagnosis the respect it deserves from hospitals and health systems then we need a measure. We have all been talking about this for a long time, but I do not sense we are any further forward!
 
 
 
Regards
 
 
 
Jason Maude
 
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com
 
 
 
 
 


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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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