ABSTRACT #57 EXPLORATION OF DECISION-MAKING PROCESS AND COGNITIVE BIASES AMONG INTERNAL MEDICINE RESIDENTS: AN INNOVATIVE SIMULATION CURRICULUM Edith T. Robin, Susannah Kurtz, Priscilla Loanzon, Barbara Sierra, Harrindra Seepersaud, James Salonia PURPOSE AND GOALS: Our study aims to increase learners’ awareness of their own clinical decisionmaking process and cognitive biases, as well as provide de-biasing tools and develop metacognition skills. Utilizing high-fidelity simulation, we explore the effect of theoretical background and awareness, on cognitive biases and decision-making processes in medicine. METHODS: We developed an educational session for Internal Medicine Residents (PGY1-3, n=99), comprised of a theoretical part and a high-fidelity simulation-based case. Our learners were randomly assigned to two groups. Both received the same educational experience and materials. Group 1 received the theoretical background before the simulation case, allowing us to use our simulation case to assess the effect of the theoretical session. The simulation scenario was a case of an undifferentiated shock, designed so that specific common cognitive biases were easier to identify and discuss. Our theoretical session focused on Kahneman’s Dual Process Theory. We discussed weighting and prioritization of data, cognitive biases, debiasing tools and concluded with a theoretical clinical case to practice and implement these new concepts. EVALUATION PLAN: We used 3 assessment instruments. First, pre-test and post-test questionnaires – assessing learners’ ability to recognize cognitive biases as a source of medical errors. Second, a team performance checklist, divided into medical and cognitive aspects, completed by the debriefer in real-time, during the simulation case. Third, was the Post-case Cognitive Time Out (PCTO) – a brief pause before the debrief for an individual worksheet, allowing the learners to reflect on their decision-making process and practice metacognition. We also used it to “probe” elements in their thinking process and potential biases before these are influenced by the group discussion. SUMMARY OF RESULTS: We found a significant increase in the post-test compared to the pre-test scores. The team performance checklist showed no significant difference between the groups. A trend was noted toward improved cognitive scores among Group 1. Specifically in using explicit uncertainty, avoiding search satisfying bias, and performing diagnostic time out. The PCTO showed that learners from group 1 were 2.7 times less likely to demonstrate the cognitive bias of base rate neglect. There was no significant difference in the learners’ situational awareness and data weighing. REFLECTIVE CRITIQUE: Our study suggests that theoretical background on clinical decision-making processes may be an effective educational intervention to increase awareness of the cognitive aspect of medical errors and potentially decrease cognitive biases through metacognition and debiasing techniques. In our experience, simulation is an effective tool to facilitate discussion and increase awareness of these processes. We propose the PCTO as a potential tool to assist learners to reflect and practice metacognition, and educators to evaluate, provide feedback, and study cognitive processes in medicine.
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