Immersive High Fidelity Simulation of Critically Ill Patients to Study Cognitive Errors: A Pilot Study

BMC Med Educ. 2017 Feb 8;17(1):36. doi: 10.1186/s12909-017-0871-x.


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.

Keywords: Cognitive bias; Decision-making; Diagnostic errors; Patient simulation; Physicians.

MeSH terms

  • Cognition*
  • Critical Illness / psychology*
  • Decision Making
  • Diagnostic Errors / prevention & control*
  • Diagnostic Errors / statistics & numerical data
  • Education, Medical, Graduate / methods*
  • Humans
  • Internship and Residency
  • Patient Care Team / organization & administration
  • Patient Care Team / standards*
  • Physicians / psychology*
  • Pilot Projects
  • Simulation Training / methods*
  • South Australia