Specific Disease Knowledge as Predictor of Susceptibility to Availability Bias in Diagnostic Reasoning: a Randomized Controlled Experiment.
Specific Disease Knowledge as Predictor of Susceptibility to Availability Bias in Diagnostic Reasoning: a Randomized Controlled Experiment.
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特定疾病知识作为诊断推理中可用性偏差易感性的预测因子：一项随机对照实验。
DOI：
10.1007/s11606-020-06182-6
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发表时间：
2021-03
影响因子：
5.7
通讯作者：
Schmidt HG
中科院分区：
文献类型：
--
作者：
Mamede S;Goeijenbier M;Schuit SCE;de Carvalho Filho MA;Staal J;Zwaan L;Schmidt HG
推理中的偏见而不是知识差距已被确定为大多数诊断错误的起源。然而，知识在抵消偏见中的作用尚不清楚。检查是否知识的区别特征（发现之间的区别看起来像疾病）预测易感性偏见。三阶段随机试验。第1阶段（偏倚诱导）：参与者暴露于一组临床病例（肝炎-IBD或AMI-脑病）。第2阶段（诊断）：所有参与者诊断相同的病例; 4例类似于肝炎-IBD，4例类似于AMI-脑病（但所有诊断均不同）。在与第1阶段中遇到的情况相似的4例病例中，预期存在可用性偏倚。第三阶段（知识评估）：对于每种疾病，参与者决定（最大。2s）24个结果中的哪一个与疾病相关。作为知识的衡量标准，对区分特征的决策的准确性预计将预测对偏见的敏感性。荷兰伊拉斯谟MC的内科住院医师。知识水平较高和知识水平较低的医生基于第1阶段暴露给出偏倚诊断的频率（范围0-4）。还测量了诊断时间。62名医生参加了会议。知识水平较高的医生比知识水平较低的医生更少屈服于可用性偏倚（0.35 vs 0.97; p = 0.001;差异，0.62 [95%CI，0.28-0.95]）。知识水平较低的医生在有偏倚的病例中比在无偏倚的病例中更容易犯错误（p = 0.06;差异0.35 [CI，-0.02-0.73]），而知识水平较高的医生则抵制偏倚（p = 0.28）。两组花费更多的时间来诊断受偏见的情况下比不受偏见（p = 0.04），没有组间差异。在模拟环境中，识别相似疾病的特征知识降低了对偏见的敏感性。可能需要进一步反思以克服偏见，但成功取决于拥有适当的知识。未来的研究应该检查这些发现是否适用于真实的实践和更有经验的医生。本文的在线版本（10.1007/s11606-020-06182-6）包含补充材料，可供授权用户使用。
Bias in reasoning rather than knowledge gaps has been identified as the origin of most diagnostic errors. However, the role of knowledge in counteracting bias is unclear. To examine whether knowledge of discriminating features (findings that discriminate between look-alike diseases) predicts susceptibility to bias. Three-phase randomized experiment. Phase 1 (bias-inducing): Participants were exposed to a set of clinical cases (either hepatitis-IBD or AMI-encephalopathy). Phase 2 (diagnosis): All participants diagnosed the same cases; 4 resembled hepatitis-IBD, 4 AMI-encephalopathy (but all with different diagnoses). Availability bias was expected in the 4 cases similar to those encountered in phase 1. Phase 3 (knowledge evaluation): For each disease, participants decided (max. 2 s) which of 24 findings was associated with the disease. Accuracy of decisions on discriminating features, taken as a measure of knowledge, was expected to predict susceptibility to bias. Internal medicine residents at Erasmus MC, Netherlands. The frequency with which higher-knowledge and lower-knowledge physicians gave biased diagnoses based on phase 1 exposure (range 0–4). Time to diagnose was also measured. Sixty-two physicians participated. Higher-knowledge physicians yielded to availability bias less often than lower-knowledge physicians (0.35 vs 0.97; p = 0.001; difference, 0.62 [95% CI, 0.28–0.95]). Whereas lower-knowledge physicians tended to make more of these errors on subjected-to-bias than on not-subjected-to-bias cases (p = 0.06; difference, 0.35 [CI, − 0.02–0.73]), higher-knowledge physicians resisted the bias (p = 0.28). Both groups spent more time to diagnose subjected-to-bias than not-subjected-to-bias cases (p = 0.04), without differences between groups. Knowledge of features that discriminate between look-alike diseases reduced susceptibility to bias in a simulated setting. Reflecting further may be required to overcome bias, but succeeding depends on having the appropriate knowledge. Future research should examine whether the findings apply to real practice and to more experienced physicians. The online version of this article (10.1007/s11606-020-06182-6) contains supplementary material, which is available to authorized users.
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