Cognitive debiasing 1: origins of bias and theory of debiasing

被引:313
作者
Croskerry, Pat [1 ]
Singhal, Geeta [2 ]
Mamede, Silvia [3 ]
机构
[1] Dalhousie Univ, Dept Pediat, Div Med Educ, Halifax, NS B3H 4R2, Canada
[2] Texas Childrens Hosp, Baylor Coll Med, Houston, TX 77030 USA
[3] Erasmus Univ, Med Ctr, Inst Med Educ Res, Rotterdam, Netherlands
关键词
Patient safety; Cognitive biases; Decision making; Diagnostic errors; DIAGNOSTIC ERROR; INTERNAL-MEDICINE; JUDGMENT; CARE; STRATEGIES; ACCURACY; MODEL;
D O I
10.1136/bmjqs-2012-001712
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Numerous studies have shown that diagnostic failure depends upon a variety of factors. Psychological factors are fundamental in influencing the cognitive performance of the decision maker. In this first of two papers, we discuss the basics of reasoning and the Dual Process Theory (DPT) of decision making. The general properties of the DPT model, as it applies to diagnostic reasoning, are reviewed. A variety of cognitive and affective biases are known to compromise the decision-making process. They mostly appear to originate in the fast intuitive processes of Type 1 that dominate (or drive) decision making. Type 1 processes work well most of the time but they may open the door for biases. Removing or at least mitigating these biases would appear to be an important goal. We will also review the origins of biases. The consensus is that there are two major sources: innate, hard-wired biases that developed in our evolutionary past, and acquired biases established in the course of development and within our working environments. Both are associated with abbreviated decision making in the form of heuristics. Other work suggests that ambient and contextual factors may create high risk situations that dispose decision makers to particular biases. Fatigue, sleep deprivation and cognitive overload appear to be important determinants. The theoretical basis of several approaches towards debiasing is then discussed. All share a common feature that involves a deliberate decoupling from Type 1 intuitive processing and moving to Type 2 analytical processing so that eventually unexamined intuitive judgments can be submitted to verification. This decoupling step appears to be the critical feature of cognitive and affective debiasing.
引用
收藏
页码:ii58 / ii64
页数:7
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