Automated detection of heuristics and biases among pathologists in a computer-based system

Abstract

The purpose of this study is threefold: (1) to develop an automated, computer-based method to detect heuristics and biases as pathologists examine virtual slide cases, (2) to measure the frequency and distribution of heuristics and errors across three levels of training, and (3) to examine relationships of heuristics to biases, and biases to diagnostic errors. The authors conducted the study using a computer-based system to view and diagnose virtual slide cases. The software recorded participant responses throughout the diagnostic process, and automatically classified participant actions based on definitions of eight common heuristics and/or biases. The authors measured frequency of heuristic use and bias across three levels of training. Biases studied were detected at varying frequencies, with availability and search satisficing observed most frequently. There were few significant differences by level of training. For representativeness and anchoring, the heuristic was used appropriately as often or more often than it was used in biased judgment. Approximately half of the diagnostic errors were associated with one or more biases. We conclude that heuristic use and biases were observed among physicians at all levels of training using the virtual slide system, although their frequencies varied. The system can be employed to detect heuristic use and to test methods for decreasing diagnostic errors resulting from cognitive biases.

Effect of Exposure to Good vs Poor Medical Trainee Performance on Attending Physician Ratings of Subsequent Performances

“…This suggests that despite considerable experience, raters may still not possess well-developed fixed criteria against which to judge observed performance. 26 In other contexts such as clinical reasoning, experts have been shown to be just as susceptible to heuristics as novices, 27 which further supports this finding.…”

Cognitive biases associated with medical decisions: a systematic review

“…Overall, at least one cognitive factor or bias was present in all studies. Studies evaluating more than two cognitive biases, found that 50 to 100 % of physicians were affected by at least one [39, 50, 52]. Only three manuscripts evaluated more than 5 cognitive biases in the same study, in-line with the narrow scope of most studies [39, 50, 52].…”

“…Twenty studies comprising 6810 physicians (median 180 per study; range: 36–2206) met the inclusion criteria (Fig. 2) [30, 34–52]. …”

Decision Style in a Clinical Reasoning Corpus

“…Crowley et al (2013) created an instructional system to detect cognitive biases in clinical decision-making, while Coderre et al (2003) used protocol analysis on think-aloud diagnostic narratives, and found that features of intuitive reasoning implied diagnostic accuracy.…”