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Availability Bias Has Role in Residents' Medical Errors

Second-year residents make more errors in diagnosing cases similar to those previously seen

TUESDAY, Sept. 14 (HealthDay News) -- When second-year medical residents use non-analytic reasoning and are faced with cases similar to others they recently dealt with, they are more likely to make errors related to availability bias; however, subsequent application of diagnostic reflection may counteract this bias and improve diagnostic accuracy in both first- and second-year residents, according to a study published in the Sept. 15 issue of the Journal of the American Medical Association.

Sílvia Mamede, M.D., of Erasmus University Rotterdam in the Netherlands, and colleagues assessed whether recent experience with clinical problems triggered availability bias -- defined as overestimation of the likelihood of a diagnosis based on how easily it comes to mind -- resulting in diagnostic errors. They also assessed whether structured reanalysis of case findings, known as reflection, offset this bias. Eighteen first-year and 18 second-year internal medicine residents evaluated diagnoses of six clinical cases (phase 1) and then diagnosed eight different cases through non-analytical reasoning, including four that had findings similar to previously evaluated cases but different diagnoses (phase 2). The residents diagnosed these four cases again through reflection (phase 3).

The investigators found that second-year residents scored lower on the cases similar to those previously encountered (mean diagnostic accuracy score, 1.55) than on the other cases (2.19). However, this did not occur among first-year residents (2.03 versus 1.42). Second-year residents provided the phase 1 diagnosis more frequently for phase 2 cases they had previously seen than for those they had not encountered (mean frequency per resident, 1.44), but reflection improved the diagnoses of the similar cases compared with non-analytical reasoning in second-year (2.03) and first-year residents (2.31).

"When faced with cases similar to previous ones and using non-analytic reasoning, second-year residents made errors consistent with the availability bias," the authors write. "Subsequent application of diagnostic reflection tended to counter this bias; it improved diagnostic accuracy in both first- and second-year residents."

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