This thesis project aims to explore avenues to address cognitive biases in medical education, focusing on the COVID-19 pandemic, existing tools and interventions in behavioral sciences, psychology, and medicine, an intervention (serious game) to mitigate Intrinsic Cognitive Biases (ICB), and using a validated scale to evaluate an individual's interest in thinking and motivation for challenging cognitive tasks. The research will inform future studies and provide insights on both a scientific and personal level.
The methodology used in each study includes a bias grid, scoping review, a multi-centric randomized controlled trial and a correlation study using the Need for Cognition Scale (NCS). The results show that the COVID-19 pandemic significantly impacted physicians' clinical reasoning processes, as each clinical case presented distinct inherent risks for cognitive biases. Cognitive biases are multifaceted and cannot be "deleted" from one's mind, as they are intrinsically linked to the neurological sense of the term.
The literature in the field of medicine is still somewhat at a standstill in regard to potential new tools and avenues to diminish intrinsic cognitive bias rates. Examining other fields (e.g., computer science, behavioural economics, psychology) and grey literature may offer alternative perspectives on ideas and methods to address cognitive biases. The RCT results demonstrated that the serious game intervention showed enhanced long-term effectiveness in diminishing the intrinsic cognitive bias rate among medical residents. A serious game proved to be more successful in reducing intrinsic cognitive bias rates compared to an instructional video, and this impact was more lasting over time, specifically eight weeks after the intervention.
The study found a significant negative correlation between Need for Cognition (NCS) scores and Intrinsic Cognitive Bias rate (ICB) pre-intervention, suggesting that higher NCS scores were associated with lower bias levels. The findings suggest the importance of promoting active mental engagement during the initial phases of medical school to potentially mitigate cognitive bias susceptibility.
The debate on reducing bias in medicine has led to various methods and tools, with different studies highlighting the results. The bottleneck theory may be used as a construct, as it suggests that individuals have a finite capacity of attentional resources available for simultaneous use, resulting in information and stimuli being filtered to ensure the most salient and significant information is viewed. Fostering active mental engagement, particularly in the early stages of medical school, seems crucial to effectively reduce vulnerability to cognitive biases in medicine.
In conclusion, the main conclusion of this thesis project is related to the notion that cognitive biases are intrinsically embedded within cognition and cannot be "erased." Therefore, it is crucial to develop multifaceted tools for all stakeholders, institutions, policy makers, clinical teachers, healthcare professionals, patients, and their caregivers. The key results indicate that the serious game used in the RCT and the NFC scale have the potential to be valuable instruments for improving problem-solving skills and increasing users' awareness of their own biases or motivation towards complex cognitive tasks, further research is needed.
