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Critical Thinking 2-2 (Bias 2)

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5 views19 pages

Critical Thinking 2-2 (Bias 2)

Uploaded by

pwjt4ydjng
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Bias ?

Outcomes -objectives
What is bias
How it occur/ causes
Types of biases
Bias in medical profession
How to avoid
Bias in medical professions
• Caring of patients
• Clinical decisions (diagnosis, treatments, procedures….)
• research
Cognitive bias in clinical medicine
• An important concept in understanding error is that of cognitive bias, and
the influence this can have on our decision making. Cognitive biases, also
known as ‘heuristics’, are cognitive short cuts used to aid our decision-
making.
• A heuristic can be thought of as a cognitive ‘rule of thumb’ or cognitive
guideline that one subconsciously applies to a complex situation to make
decision-making easier and more efficient.
• Bias has been recognised within the medical community since the 1970s but
research has been sporadic and largely in fields outside of medicine, such as
the military, economics and business.
• It is now becoming increasingly apparent that significant diagnostic
error can result from cognitive bias.
Cognitive bias in clinical medicine
It is probable that optimal diagnostic approaches use both type 1 and type 2 thinking at appropriate
times.
• Non-analytical (type 1) reasoning is shown to be as effective as reflective reasoning for diagnosing
routine clinical cases. There is additional evidence in the field of emergency medicine that a type 1 ‘gut
feeling’ assessment of patient’s illness has a role in clinical practice, with a reported sensitivity of 74–
87% for assessing whether a patient is ‘sick’ which is a reasonable output for a quick and essentially
cost-free test.
• However, this type 1, rapid decision was poor at predicting diagnosis or aiding further prognostication.
• Furthermore, not all biases originate in type 1 processing, but when bias does occur it is thought this
can only be dealt with by activating type 2 processing.
• Thus, an appropriate balance of type 1 and type 2 processes is required for optimal clinical
performance.
• Situations of stress, fatigue, sleep deprivation and cognitive overload may predispose to error and
allow cognitive bias to emerge.
Bias in research
• Every research needs to be designed, conducted and reported in a
transparent way, honestly and without any deviation from the
truth.
• Research which is not compliant with those basic principles is
misleading. Such studies create distorted impressions and false
conclusions and thus can cause wrong medical decisions, harm to
the patient as well as substantial financial losses.
Definition of bias

• Bias is any trend or deviation from the truth in data collection,


data analysis, interpretation and publication which can cause
false conclusions.
• Bias can occur either intentionally or unintentionally
• Bias in data collection(selection bias)
• sampling is a crucial step for every research. While collecting data for
research, there are numerous ways by which researchers can introduce
bias in the study.

• Bias in data analysis


• A researcher can introduce bias in data analysis by analysing data in a way
which gives preference to the conclusions in favour of research hypothesis.
• Bias in data interpretation
• By interpreting the results, one needs to make sure that proper statistical
tests were used, that results were presented correctly and that data are
interpreted only if there was a statistical significance of the observed
relationship. Otherwise, there may be some bias in a research.
• Publication bias
• Unfortunately, scientific journals are much more likely to accept for
publication a study which reports some positive than a study with negative
findings.
• Funding bias
How can we ‘debias’ ourselves?

1. Bias-specific teaching sessions

2. Slowing down

3. Metacognition and ‘considering alternatives’

4. Checklists

5. Teaching statistical principles


1.Bias-specific teaching sessions

Bias-specific teaching seems the most immediately sensible


approach to the problem.
2. Slowing down

slowing down during cognition could allow the diagnostician to


transition into ‘type 2’ thinking, reflect more critically on data and
ultimately make fewer errors.
3. Metacognition and ‘considering alternatives’
• There are a number of positive studies supporting the role of
metacognition in improving decision-making.
• For example, experimentally, ‘considering the opposite’ has been
shown to help mitigate against the anchoring effect. Similarly,
overconfidence bias has been tackled rather elegantly in a
classroom setting, by simply asking students to give an estimate of
their confidence. This was sufficient to improve diagnostic accuracy
as they reassessed their position and often changed their mind –
effectively debiasing themselves
4. Checklists

• Checklists have been a simple and popular debiasing strategy used


clinically and in many industries.
• They are ideal for deployment in a controlled environment with
predictable patients and procedures, hence their popularity in the
surgical world.
• Checklists can be thought of as a cognitive forcing tool that
demand the user think in a more ordered fashion.
5. Teaching statistical principles

• Lack of formal education in statistics and logic is often bemoaned


by clinicians and researchers alike as an explanation for poor
insight into underlying principles, thus leading to error.
Thanks

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