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Reflecting on Cognitive Error

Published on Nov 19, 2015

A graphic guide for clinical educators to encourage medical students to engage in reflective thinking, especially with respect to possible cognitive error, before, during and after patient encounters. Author: Karen Spear Ellinwood, PhD, JD, EdS, Director, Faculty Instructional Development, Residents as Educators Program; Assistant Professor, Department of Obstetrics and Gynecology, University of Arizona College of Medicine.

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Cultivate a Habit of Reflection:

Looking for Cognitive Error
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If you agree that...

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"Anyone who has never made a mistake has never tried anything new."

- Albert Einstein (1879-1955)

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"I believe in being a reflective practitioner — learning from our mistakes by a process of reflection, both personally and with others."

Charlotte Elder
Clinical lecturer in Paediatrics, University of Sheffield, BMJ Blogs

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Reflective educators "facilitate reflective observation, encourage conceptual thinking, and provide feedback and testing of insights drawn
from the experience"

(Ryan 2010, 117).

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Then, advise your students ...

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"Reflection is particularly important in medicine" where physicians are required to "analyze best evidence while considering his or her values and assumptions vis-à-vis the values, beliefs, and goals of each patient."

Plack & Greenberg (2005, 1547)

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"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)

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Patients appreciate

when you get it right!
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Reflect BEFORE

clinical experiences
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Cognitive Error

Prevent it when possible - Reflect on it first
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Safety First

prevent cognitive error
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Know your Limitations

prevent cognitive error
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Rethink it

before you try it
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Reflect DURING

Clinical Experiences
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Reflect & Rethink

as you collect and process information
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Reflect AFTER

Clinical Experiences
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Self-assess:

Did I make an error?
Could I have avoided it?
Could I avoid it next time?
How could I improve my approach?

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Cognitive Debiasing Strategies

(Croskerry 03)
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Provide adequate time for quality decision-making

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Ask students to consider alternative possibilities

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Provide guidance for learning clinical knowledge

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Help students develop awareness & insight

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Remind your students

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You're not alone

Ask for help - Ask for feedback
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Remind yourself

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You're not alone

Ask Colleagues for Ideas on Giving Feedback
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References

  • Croskerry P. Cognitive Forcing Strategies in Clinical Decisionmaking. Annals of Emergency Medicine 41(1): 110-20; 2003.
29.

References

  • Plack MM & Greenberg L. The Reflective Practitioner: Reaching for Excellence in Practice. Pediatrics 116: 1546-52; 2005.
30.

References

  • Ryan CA. Refective 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.
31.

Karen Spear Ellinwood, PhD, JD

Director, Faculty Instructional Development
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FID.medicine.arizona.edu

Visit
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Karen Spear Ellinwood

Haiku Deck Pro User
http://fid.medicine.arizona.edu