The use of deliberate reflection to reduce confirmation bias among orthopedic surgery residents

Keywords: clinical reasoning, bias, deliberate reflection, medical education, medical resident

Abstract

Introduction: cognitive biases might affect decision-making processes such as clinical reasoning and confirmation bias is among the most important ones. The use of strategies that stimulate deliberate reflection during the diagnostic process seems to reduce availability bias, but its effect in reducing confirmation bias needs to be evaluated.
Aims: to examine whether deliberate reflection reduces confirmation bias and increases the diagnostic accuracy of orthopedic residents solving written clinical cases.
Methods: experimental study comparing the diagnostic accuracy of orthopedic residents in the resolution of eight written clinical cases containing a referral diagnosis. Half of the written cases had a wrong referral diagnosis. One group of residents used deliberate reflection (RG), which stimulates comparison and contrast of clinical hypotheses in a systematic manner, and a control group (CG), was asked to provide differential diagnoses with no further instruction. The study included 55 third-year orthopedic residents, 27 allocated to the RG and 28 to the CG.
Results: residents on the RG had higher diagnostic scores than the CG for clinical cases with a correct referral diagnosis (62.0±20.1 vs. 49.1±21.0 respectively; p = 0.021). For clinical cases with incorrect referral diagnosis, diagnostic accuracy was similar between residents on the RG and those on the CG (39.8±24.3 vs. 44.6±26.7 respectively; p = 0.662). We observed an overall confirmation bias in 26.3% of initial diagnoses (non-analytic phase) and 19.5% of final diagnoses (analytic phase) when solving clinical cases with incorrect referral diagnosis. Residents from RG showed a reduction in confirmation of incorrect referral diagnosis when comparing the initial diagnosis given in the non-analytic phase with the one provided as the final diagnosis (25.9±17.7 vs. 17.6±18.1, respectively; Cohen d: 0.46; p = 0.003). In the CG, the reduction in the confirmation of incorrect diagnosis was not statistically significant.
Conclusions: confirmation bias was present when residents solved written clinical cases with incorrect referral diagnoses, and deliberate reflection reduced such bias. Despite the reduction in confirmation bias, diagnostic accuracy of residents from the RG was similar to those from the CG when solving the set of clinical cases with a wrong referral diagnosis.

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Author Biographies

Antônio Barbosa Chaves, Universidade José do Rosário Vellano (UNIFENAS-BH), Belo Horizonte, MG, Brazil.

Orthopedic physician and hand surgeon. Master in Health Education, José do Rosário Vellano University (UNIFENAS), Belo Horizonte, MG, Brazil. Preceptor in Hand Surgery at the Hand Surgery Residency Service at São Francisco Hospital – Santa Lucia Unit, Belo Horizonte, MG, Brazil. Head of the Orthopedics Residency Service at Hospital Belo Horizonte, Belo Horizonte, MG, Brazil.

Alexandre Sampaio Moura, Universidade José do Rosário Vellano (UNIFENAS-BH), Belo Horizonte, MG, Brazil.

Infectious Diseases physician. Master in Public Health, Columbia University, NY, USA. PhD in Infectious Diseases, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Research professor at the Masters in Health Education Program, José do Rosário Vellano University (UNIFENAS), Belo Horizonte, MG, Brazil. Research professor at the Stricto Sensu Postgraduate Course, Faculdade Santa Casa, Belo Horizonte, MG, Brazil.

 

Rosa Malena Delbone de Faria, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.

Hematologist physician; Master and PhD in Hematology, Escola Paulista de Medicina (EPM), Universidade de São Paulo (UNIFESP), São Paulo, SP. Specialist in Education for Health Professions, Federal University of Ceará (UFC), Fortaleza, CE, Brazil. Professor at the School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Academic Director, Faculdade Santa Casa, Belo Horizonte, MG, Brazil BH. Professor of the Specialization Course in Health Education, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.

Ligia Cayres Ribeiro, Universidade José do Rosário Vellano (UNIFENAS-BH), Belo Horizonte, MG, Brazil.

Physician, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. Master in health professions education, Maastricht University (UM), Maastricht, Netherlands. Research professor at the Masters in Health Education Program, José do Rosário Vellano University (UNIFENAS), Belo Horizonte, MG, Brazil.

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Published
2022-03-07
How to Cite
Chaves, A. B., Moura, A. S., Faria, R. M. D. de, & Ribeiro, L. C. (2022). The use of deliberate reflection to reduce confirmation bias among orthopedic surgery residents. Scientia Medica, 32(1), e42216. https://doi.org/10.15448/1980-6108.2022.1.42216
Section
Education in Health Sciences