Debiasing and Educational Interventions in Medical Diagnosis: A Systematic Review

Abstract

Background: The prevalence of cognitive bias and its contribution to diagnostic errors has been documented in recent research. Debiasing interventions or educational initiatives are key in reducing the effects and prevalence of cognitive biases, contributing to the prevention of diagnostic errors. The objectives of this review were to 1) characterize common debiasing strategies implemented to reduce diagnosis-related cognitive biases, 2) report the cognitive biases targeted, and 3) determine the effectiveness of these interventions on diagnostic accuracy. Methods: Searches were conducted on April 25, 2022, in MEDLINE, EMBASE, Healthstar, and PsycInfo. Studies were included if they presented a debiasing intervention that aimed to improve diagnostic accuracy. The Rayyan review software was used for screening. Quality assessments were conducted using the JBI Critical Appraisal Tools. Extraction, quality assessment and analysis were recorded in Excel. Results: Searches resulted in 2232 studies. 17 studies were included in the final analysis. Three major debiasing interventions were identified: tool use, education of biases, and education of debiasing strategies. All intervention types reported mixed results. Common biases targeted include confirmation, availability, and search satisfying bias. Conclusion: While all three major debiasing interventions identified demonstrate some effectiveness in improving diagnostic accuracy, included studies reported mixed results when implemented. Furthermore, no studies examined decision-making in a clinical setting, and no studies reported long-term follow-up. Future research should look to identify why some interventions demonstrate low effectiveness, the conditions which enable high effectiveness, and effectiveness in environments beyond vignettes and among attending physicians.