Pitt Logo LinkContact Us

Effect of a metacognitive intervention on cognitive heuristic use during diagnostic reasoning

Payne, Velma Lucille (2011) Effect of a metacognitive intervention on cognitive heuristic use during diagnostic reasoning. Doctoral Dissertation, University of Pittsburgh.

[img]
Preview
PDF - Primary Text
Download (1711Kb) | Preview

    Abstract

    Medical judgment and decision-making frequently occur under conditions of uncertainty. In order to reduce the complexity of diagnosis, physicians often rely on cognitive heuristics. Use of heuristics during clinical reasoning can be effective; however when used inappropriately the result can be flawed reasoning, medical errors and patient harm. Many researchers have attempted to debias individuals from inappropriate heuristic use by designing interventions based on normative theories of decision-making. There have been few attempts to debias individuals using interventions based on descriptive decision-making theories. Objectives: (1) Assess use of Anchoring and Adjustment and Confirmation Bias during diagnostic reasoning; (2) Investigate the impact of heuristic use on diagnostic accuracy; (3) Determine the impact of a metacognitive intervention based on the Mental Model Theory designed to reduce biased judgment by inducing physicians to 'think about how they think'; and (4) Test a novel technique using eye-tracking to determine heuristic use and diagnostic accuracy within mode of thinking as defined by the Dual Process Theory. Methods: Medical students and residents assessed clinical scenarios using a computer system, specified a diagnosis, and designated the data used to arrive at the diagnosis. During case analysis, subjects either verbalized their thoughts or wore eye-tracking equipment to capture eye movements and pupil size as they diagnosed cases. Diagnostic data specified by the subject was used to measure heuristic use and assess the impact of heuristic use on diagnostic accuracy. Eye-tracking data was used to determine the frequency of heuristic use (Confirmation Bias only) and mode of thinking. Statistic models were executed to determine the effect of the metacognitive intervention. Results: Use of cognitive heuristics during diagnostic reasoning was common for this subject population. Logistic regression showed case difficulty to be an important factor contributing to diagnostic error. The metacognitive intervention had no effect on heuristic use and diagnostic accuracy. Eye-tracking data reveal this subject population infrequently assess cases in the Intuitive mode of thinking; spend more time in the Analytical mode of thinking, and switches between the two modes frequently as they reason through a case to arrive at a diagnosis.


    Share

    Citation/Export:
    Social Networking:

    Details

    Item Type: University of Pittsburgh ETD
    ETD Committee:
    ETD Committee TypeCommittee MemberEmail
    Committee ChairCrowley, Rebecca SCrowleyRS@upmc.edu
    Committee MemberMello-Thoms, Claudiamellcr@mail.magee.edu
    Committee MemberGonzalez, Cleotildecoty@cmu.edu
    Committee MemberRoberts, Mark Srobertsm@upmc.edu
    Committee MemberCroskerry, Patrickcroskerry@eastlink.ca
    Title: Effect of a metacognitive intervention on cognitive heuristic use during diagnostic reasoning
    Status: Unpublished
    Abstract: Medical judgment and decision-making frequently occur under conditions of uncertainty. In order to reduce the complexity of diagnosis, physicians often rely on cognitive heuristics. Use of heuristics during clinical reasoning can be effective; however when used inappropriately the result can be flawed reasoning, medical errors and patient harm. Many researchers have attempted to debias individuals from inappropriate heuristic use by designing interventions based on normative theories of decision-making. There have been few attempts to debias individuals using interventions based on descriptive decision-making theories. Objectives: (1) Assess use of Anchoring and Adjustment and Confirmation Bias during diagnostic reasoning; (2) Investigate the impact of heuristic use on diagnostic accuracy; (3) Determine the impact of a metacognitive intervention based on the Mental Model Theory designed to reduce biased judgment by inducing physicians to 'think about how they think'; and (4) Test a novel technique using eye-tracking to determine heuristic use and diagnostic accuracy within mode of thinking as defined by the Dual Process Theory. Methods: Medical students and residents assessed clinical scenarios using a computer system, specified a diagnosis, and designated the data used to arrive at the diagnosis. During case analysis, subjects either verbalized their thoughts or wore eye-tracking equipment to capture eye movements and pupil size as they diagnosed cases. Diagnostic data specified by the subject was used to measure heuristic use and assess the impact of heuristic use on diagnostic accuracy. Eye-tracking data was used to determine the frequency of heuristic use (Confirmation Bias only) and mode of thinking. Statistic models were executed to determine the effect of the metacognitive intervention. Results: Use of cognitive heuristics during diagnostic reasoning was common for this subject population. Logistic regression showed case difficulty to be an important factor contributing to diagnostic error. The metacognitive intervention had no effect on heuristic use and diagnostic accuracy. Eye-tracking data reveal this subject population infrequently assess cases in the Intuitive mode of thinking; spend more time in the Analytical mode of thinking, and switches between the two modes frequently as they reason through a case to arrive at a diagnosis.
    Date: 16 May 2011
    Date Type: Completion
    Defense Date: 22 December 2010
    Approval Date: 16 May 2011
    Submission Date: 18 April 2011
    Access Restriction: No restriction; Release the ETD for access worldwide immediately.
    Patent pending: No
    Institution: University of Pittsburgh
    Thesis Type: Doctoral Dissertation
    Refereed: Yes
    Degree: PhD - Doctor of Philosophy
    URN: etd-04182011-191547
    Uncontrolled Keywords: clinical reasoning; cognitive heuristics; diagnostic reasoning; feedback; Medical decision making
    Schools and Programs: School of Medicine > Biomedical Informatics
    Date Deposited: 10 Nov 2011 14:38
    Last Modified: 22 May 2012 16:19
    Other ID: http://etd.library.pitt.edu/ETD/available/etd-04182011-191547/, etd-04182011-191547

    Actions (login required)

    View Item

    Document Downloads