Occult Sepsis Masked by Trauma—Exploration of Cognitive Biases Through Simulation With Emergency Medicine Residents

Abstract

Introduction: There is a paucity of simulation literature and curricula addressing cognitive bias and the skills necessary to overcome this common source of clinical error. We designed a scenario for emergency medicine (EM) residents with the intent to trigger an anchoring bias as a nidus for conversation about metacognition. Methods: We implemented this case for teams of two to three PGYs 1-5, including both EM and EM/internal medicine residents within a longitudinal simulation curriculum. The case was designed to simulate a major trauma wherein evaluation according to standard advanced trauma life support principles failed to identify a traumatic injury to explain the patient's hemodynamic instability. Residents had to reorient their thought process towards other etiologies of shock, ultimately identifying sepsis as the driving force behind the trauma. The scenario ran over 10-15 minutes followed by a 30-minute debrief. Case satisfaction and the success of various learning objectives were assessed via a postsimulation survey. Results: Forty-four EM and combined EM/IM residents ranging from PGY 1-5 participated in the simulation over a 5-week period. Nearly 82% of respondents expressed an overall satisfaction with the case. About 76% felt the case succeeded in contributing to their understanding of cognitive biases. Discussion: The implementation of misdirection in this simulation was an effective means by which to engage learners in education about cognitive biases.

A Resident Morbidity and Mortality Conference Curriculum to Teach Identification of Cognitive Biases, Errors, and Debiasing Strategies

“…A small number of curricula primarily aimed at teaching the identification and prevention of cognitive errors currently exist in MedEdPORTAL. These take a variety of formats, including workshop, 12,13 simulation, 14,15 case-based discussion, 16 video, 17 and lecture. 13,18 While the majority of these curricula use patient cases to help learners meet the objectives, only one encourages learners to reflect on a real case in which they were involved.…”