Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study.
BACKGROUND
The majority of human errors in healthcare originate from cognitive errors or biases. There is dearth of evidence around relative prevalence and significance of various cognitive errors amongst doctors in their first post-graduate year. This study was conducted with the objective of using high fidelity clinical simulation as a tool to study the relative occurrence of selected cognitive errors amongst doctors in their first post-graduate year.


METHODS
Intern simulation sessions on acute clinical problems, conducted in year 2014, were reviewed by two independent assessors with expertise in critical care. The occurrence of cognitive errors was identified using Likert scale based questionnaire and think-aloud technique. Teamwork and leadership skills were assessed using Ottawa Global Rating Scale.


RESULTS
The most prevalent cognitive errors included search satisfying (90%), followed by premature closure (PC) (78.6%), and anchoring (75.7%). The odds of occurrence of various cognitive errors did not change with time during internship, in contrast to teamwork and leadership skills (x2= 11.9, P = 0.01). Anchoring appeared to be significantly associated with delay in diagnoses (P = 0.007) and occurrence of PC (P = 0.005). There was a negative association between occurrence of confirmation bias and the ability to make correct diagnosis (P = 0.05).


CONCLUSIONS
Our study demonstrated a high prevalence of anchoring, premature closure, and search satisfying amongst doctors in their first post-graduate year, using high fidelity simulation as a tool. The occurrence of selected cognitive errors impaired clinical performance and their prevalence did not change with time.
Prideaux Centre for Research in Health Professions Education, Flinders University, Bedford Park, South Australia, 5042, Australia. shivesh.prakash@health.sa.gov.au.|Department of Intensive care, Flinders Medical Centre, 1 Flinders drive, Bedford Park, South Australia, 5042, Australia. shivesh.prakash@health.sa.gov.au.
Shivesh
S
Prakash
Department of Intensive care, Flinders Medical Centre, 1 Flinders drive, Bedford Park, South Australia, 5042, Australia.
Shailesh
S
Bihari
Director of General Practice Training, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.
Penelope
P
Need
Simulation Unit, School of Medicine - Flinders University, Bedford Park, South Australia, 5042, Australia.
Cyle
C
Sprick
Prideaux Centre for Research in Health Professions Education, Flinders University, Bedford Park, South Australia, 5042, Australia.|Health Professions Education, School of Medicine, Flinders University, Bedford Park, South Australia, 5042, Australia.
Lambert
L
Schuwirth
D003071:Cognition; D016638:Critical Illness / Q000523:psychology*; D003657:Decision Making; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D010820:Physicians / Q000523:psychology*; D010865:Pilot Projects; D000066908:Simulation Training / Q000379:methods*; D013021:South Australia
Cognitive bias; Decision-making; Diagnostic errors; Patient simulation; Physicians