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The Etiology of Diagnostic Errors : A Controlled Trial of System 1 Versus System 2 Reasoning

The Etiology of Diagnostic Errors : A Controlled Trial of System 1 Versus System 2 Reasoning

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NORMAN, Geoffrey, Jonathan SHERBINO, Kelly DORE, Tim WOOD, Meredith YOUNG, Wolfgang GAISSMAIER, Sharyn KREUGER, Sandra MONTEIRO, 2014. The Etiology of Diagnostic Errors : A Controlled Trial of System 1 Versus System 2 Reasoning. In: Academic Medicine. 89(2), pp. 277-284. ISSN 1040-2446. eISSN 1938-808X. Available under: doi: 10.1097/ACM.0000000000000105

@article{Norman2014-02Etiol-28043, title={The Etiology of Diagnostic Errors : A Controlled Trial of System 1 Versus System 2 Reasoning}, year={2014}, doi={10.1097/ACM.0000000000000105}, number={2}, volume={89}, issn={1040-2446}, journal={Academic Medicine}, pages={277--284}, author={Norman, Geoffrey and Sherbino, Jonathan and Dore, Kelly and Wood, Tim and Young, Meredith and Gaissmaier, Wolfgang and Kreuger, Sharyn and Monteiro, Sandra} }

Kreuger, Sharyn 2014-06-26T10:04:34Z Dore, Kelly Sherbino, Jonathan Gaissmaier, Wolfgang The Etiology of Diagnostic Errors : A Controlled Trial of System 1 Versus System 2 Reasoning Purpose:<br />Diagnostic errors are thought to arise from cognitive biases associated with System 1 reasoning, which is rapid and unconscious. The primary hypothesis of this study was that the instruction to be slow and thorough will have no advantage in diagnostic accuracy over the instruction to proceed rapidly.<br /><br /><br />Method:<br />Participants were second-year residents who volunteered after they had<br />taken the Medical Council of Canada (MCC) Qualifying Examination Part<br />II. Participants were tested at three Canadian medical schools (McMaster,Ottawa, and McGill) in 2010 (n = 96) and 2011 (n = 108). The intervention consisted of 20 computer-based internal medicine cases, with instructions either (1) to be as quick as possible but not make mistakes (the Speed cohort, 2010), or (2) to be careful, thorough, and reflective (the Reflect cohort, 2011). The authors examined accuracy scores on the 20 cases, time taken to diagnose cases, and MCC examination performance.<br /><br /><br />Results:<br />Overall accuracy in the Speed condition was 44.5%, and in the Reflect condition was 45.0%; this was not significant. The Speed cohort took an average of69 seconds per case versus 89 seconds for the Reflect cohort (P < .001). In both cohorts, cases diagnosed incorrectly took an average of 17 seconds longer than cases diagnosed correctly. Diagnostic accuracy was moderately correlated<br />with performance on both written and problem-solving components of the MCC licensure examination and inversely correlated with time.<br /><br /><br />Conclusions:<br />The study demonstrates that simply encouraging slowing down and increasing attention to analytical thinking is insufficient to increase diagnostic accuracy. Norman, Geoffrey Gaissmaier, Wolfgang 2014-06-26T10:04:34Z Academic Medicine ; 89 (2014), 2. - S. 277-284 Monteiro, Sandra Dore, Kelly Young, Meredith Norman, Geoffrey Wood, Tim 2014-02 Monteiro, Sandra Wood, Tim Sherbino, Jonathan Kreuger, Sharyn Young, Meredith eng deposit-license

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