Type of Cognitive Error

Reflective educators "facilitate reflective observation, encourage conceptual thinking, and provide feedback and testing of insights drawn from the experience" (Ryan 2010, 117).

"Train for a reflective approach to problem solving: stepping back from the immediate problem to examine and reflect on the thinking process."
- Croskerry (2003, 779)

Encourage learners to examine their approach to clinical problem-solving for Cognitive Error.

Types of Cognitive Error

Framing error

• Did I frame my inquiry so that I was looking to confirm a particular diagnosis?
• Is it possible that in looking for "X" I missed "Y“?

Attribution error

• Did I attribute the problem to an immediate cause without investigating multiple hypotheses as to the cause of symptoms?

Availability error

• How might the most recent experience I’ve had or heard about affect my opinion or judgment?

Diagnosis momentum

• Did I simply adopt previous diagnoses of other physicians without being mindful or critical about whether the facts support it?
• Did I neglect other plausible explanations for the patient’s symptoms?

Affective interference

• Do I have some emotional connection to this case?
• Did I allow an emotional response to cloud my thinking and judgment?

Bayesian analysis

• Did I miss information peculiar to this patient because I limited consideration to the most likely disease or condition?

Commission bias

• Is it possible that I just wanted to DO something, rather than take a more reflective approach?

Vertical line error

• Was I thinking inside the box to find one cause to explain it all?
• Did I neglect to review test results critically?

Search Satisfaction error

• Is it possible that I stopped looking or thinking once I found something?

"Reflection is an analytic skill that must be mastered”
• Plack & Santasier (2005, 1550)

Provide Multiple Opportunities for Reflection

• Invite Self-assessment!
• Engage in constructive feedback as a conversation
• Encourage students to examine for cognitive error

References

• Ryan CA. Reflective Inquiry in the Medical Profession. In, Handbook of Reflection and Reflective Inquiry: Mapping a Way of Knowing for Professional Reflective Inquiry. Springer, 101-130; 2010.
• Croskerry P. Cognitive Forcing Strategies in Clinical Decisionmaking. Annals of Emergency Medicine 41(1): 110-20; 2003.

References

• Groopman, J. (2007). How Doctors Think. New York, Houghton Mifflin, 2007.
• Plack MM & Greenberg L. The Reflective Practitioner: Reaching for Excellence in Practice. Pediatrics 116: 1546-52; 2005.

Director, Faculty Instructional Development

FID.medicine.arizona.edu