Abstract
Cognitive biases can impede the utilization of logical/statistical strategies in clinical decision-making. This paper reports on research and educational findings using the Inventory of Cognitive Biases in Medicine (ICBM). The ICBM was administered to groups of medical students before their clinical years and to practicing physicians to determine (a) the extent of cognitive bias in medical decision-making and whether experienced physicians differed from novices, (b) whether cognitive bias varied by medical speciality and (c) whether awareness of cognitive bias in medical decision-making could be taught. Preclinical medical students' mean score (41 %) was near the chance level (42%). While practicing physicians scored higher (49%), they also demonstrated considerable susceptibility to cognitive bias. Cognitive bias varied by medical speciality with internal medicine physicians (57%) scoring best on the ICBM. A controlled educational research study with preclinical medical students showed that learners exposed to a seminar on cognitive bias in medical decision-making scored better on the ICBM than their peers (55% vs. 41%, p < 0.001). Susceptibility to cognitive bias was found to be present substantially among both novices and experts in medicine, but carefully crafted educational strategies in both classroom and clinical settings may lessen the problem.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bowman, M.A. (1990). Family physicians and internists: Differences in practice styles and proposed reasons. Journal of the American Board of Family Practice 3: 43–49.
Campbell, D.T. & Stanley, J.C. (1963). Experimental and Quasi-Experimental Designs for Research. Chicago: Rand McNally College Publishing Company.
Christensen, C., Elstein, A.S., Bernstein, L.M. & Balla, J.I. (1991). Formal decision supports in medical practice and education. Teaching and Learning in Medicine 3: 62–70.
Christensen, C., Heckerling, P.S., Mackesy, M.E., Bernstein, L.M. & Elstein, A.S. (1991). Framing bias among expert and novice physicians. Academic Medicine 66: S76-S78.
Detmer, D.E., Fryback, D.G. & Gassner, K. (1978). Heuristics and biases in medical decision-making. Journal of Medical Education 53: 682–683.
Greenlick, M.R. (1995). Educating physicians for the twenty-first century. Academic Medicine 70: 179–185.
Hershberger, P.J., Part, H.M., Markert, R.J., Cohen, S.M. & Finger, W.W. (1994). Development of a test of cognitive bias in medical decision-making. Academic Medicine 69: 839–842.
Holtgrave, D.R., Lawler, F.H. & Schwiebert, L.P. (1993). Teaching clinical decision-making in a family practice clerkship. Medical Decision Making 13: 114–117.
Kuipers, B., Moskowitz, A.J. & Kassirer, J.P. (1988). Critical decisions under uncertainty; representation and structure. Cognitive Science 12: 177–210.
McNeil, B.J., Pauker, S.G., Sox, H.C. & Tversky, A. (1982). On the elicitation of preferences for alternative therapies. New England Journal of Medicine 306: 1259–1262.
Morabia, A., Steinig-Stamm, M., Unger, P., Slosman, D., Schneider, P., Perrier, A. & Junod, A.F. (1994). Applicability of decision analysis to everyday clinical practice. Journal of General Internal Medicine 9: 496–502.
Moskowitz, A.J., Kuipers, B.J. & Kassirer, J.P. (1988). Dealing with uncertainty, risks, and tradeoffs in clinical decisions. Annals of Internal Medicine 108: 435–449.
Poses, R.M. & Anthony, M. (1991). Availability, wishful thinking, and physicians' diagnostic judgments for patients with suspected bacteremia. Medical Decision Making 11: 159–168.
Redelmeier, D.A. (1991). Cognitive psychology and medical judgment: Some downfalls of studying pitfalls. Medical Decision Making 11: 169–170.
Schroth, W.S., Riegelman, R.K. & Blacklow, B.G. (1994). Medical students' risk-taking behavior in “patient” versus “physician” decision frames: Implications for medical education. Academic Medicine 69: S54-S56.
Tversky, A. & Kahneman, D. (1974). Judgement under uncertainty: Heuristics and biases. Science 185: 1124–1131.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hershberger, P.J., Markert, R.J., Part, H.M. et al. Understanding and addressing cognitive bias in medical education. Adv Health Sci Educ 1, 221–226 (1996). https://doi.org/10.1007/BF00162919
Issue Date:
DOI: https://doi.org/10.1007/BF00162919