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{
    "pk": 13810,
    "title": "Review of the Basics of Cognitive Error in Emergency Medicine and Updates: Still No Easy Answers",
    "subtitle": null,
    "abstract": "Emergency physicians (EP) make clinical decisions multiple times daily. In some instances, medical errors occur due to flaws in the complex process of clinical reasoning and decision-making. Cognitive error can be difficult to identify and is equally difficult to prevent. To reduce the risk of patient harm resulting from errors in critical thinking, it has been proposed that we train physicians to understand and maintain awareness of their thought process, to identify error-prone clinical situations, to recognize predictable vulnerabilities in thinking, and to employ strategies to avert cognitive errors. The first step to this approach is to gain an understanding of how physicians make decisions and what conditions may predispose to faulty decision-making. We review the dual-process theory, which offers a framework to understand both intuitive and analytical reasoning, and to identify the necessary conditions to support optimal cognitive processing. We also discuss systematic deviations from normative reasoning known as cognitive biases, which were first described in cognitive psychology and have been identified as a contributing factor to errors in medicine. Training physicians in common biases and strategies to mitigate their effect is known as debiasing. A variety of debiasing techniques have been proposed for use by clinicians. We sought to review the current evidence supporting the effectiveness of these strategies in the clinical setting. This discussion of improving clinical reasoning is relevant to medical educators as well as practicing EPs engaged in continuing medical education.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "cognitive debiasing"
        }
    ],
    "section": "Medical Decision Making",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/6298x35g",
    "frozenauthors": [
        {
            "first_name": "Sarah",
            "middle_name": "",
            "last_name": "Hartigan",
            "name_suffix": "",
            "institution": "Virginia Commonwealth University School of Medicine/VCU Health, Department of Internal Medicine, Richmond, Virginia",
            "department": "None"
        },
        {
            "first_name": "Michelle",
            "middle_name": "",
            "last_name": "Brooks",
            "name_suffix": "",
            "institution": "Virginia Commonwealth University School of Medicine/VCU Health, Department of Internal Medicine, Richmond, Virginia",
            "department": "None"
        },
        {
            "first_name": "Sarah",
            "middle_name": "",
            "last_name": "Hartley",
            "name_suffix": "",
            "institution": "University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan",
            "department": "None"
        },
        {
            "first_name": "Rebecca",
            "middle_name": "E.",
            "last_name": "Miller",
            "name_suffix": "",
            "institution": "Virginia Commonwealth University School of Medicine/VCU Health, Department of Internal Medicine, Richmond, Virginia",
            "department": "None"
        },
        {
            "first_name": "Sally",
            "middle_name": "A.",
            "last_name": "Santen",
            "name_suffix": "",
            "institution": "Virginia Commonwealth University School of Medicine/VCU Health, Department of Emergency Medicine, Richmond, Virginia",
            "department": "None"
        },
        {
            "first_name": "Robin",
            "middle_name": "R.",
            "last_name": "Hemphill",
            "name_suffix": "",
            "institution": "Virginia Commonwealth University School of Medicine/VCU Health, Department of Emergency Medicine, Richmond, Virginia",
            "department": "None"
        }
    ],
    "date_submitted": "2020-04-23T20:56:55Z",
    "date_accepted": "2020-04-23T20:56:55Z",
    "date_published": "2020-11-04T08:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/13810/galley/7193/download/"
        }
    ]
}