Understanding and addressing cognitive bias in medical education
Open accessAbstract
Cognitive biases can impede the utilization of logical/statistical strategies in clinical decision-making. This paper reports on research and educational findings using the Inventory of Cognitive Biases in Medicine (ICBM). The ICBM was administered to groups of medical students before their clinical years and to practicing physicians to determine (a) the extent of cognitive bias in medical decision-making and whether experienced physicians differed from novices, (b) whether cognitive bias varied by medical speciality and (c) whether awareness of cognitive bias in medical decision-making could be taught. Preclinical medical students' mean score (41 %) was near the chance level (42%). While practicing physicians scored higher (49%), they also demonstrated considerable susceptibility to cognitive bias. Cognitive bias varied by medical speciality with internal medicine physicians (57%) scoring best on the ICBM. A controlled educational research study with preclinical medical students showed that learners exposed to a seminar on cognitive bias in medical decision-making scored better on the ICBM than their peers (55% vs. 41%, p < 0.001). Susceptibility to cognitive bias was found to be present substantially among both novices and experts in medicine, but carefully crafted educational strategies in both classroom and clinical settings may lessen the problem.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Despite concerted efforts involving educational strategies, optimal work environments, and a culture promoting bias awareness and correction, the eradication of these biases remains an elusive goal.
“Despite concerted efforts involving educational strategies, optimal work environments, and a culture promoting bias awareness and correction [5,6], the eradication of these biases remains an elusive goal.”
From Mitigating cognitive biases in clinical decision-making through multi-agent conversations using large language models: simulation study (2024) · cites this paper as [6]
Cites
Tversky, A., & Kahneman, D. (1974) · Science · doi:10.1126/science.185.4157.1124 · Cited by 28,810 · see citing works
Judgment under Uncertainty: Heuristics and Biases
Tversky, A., & Kahneman, D. (1975) · Utility, Probability, and Human Decision Making · doi:10.1007/978-94-010-1834-0_8 · Cited by 22,650 · see citing works
(1963) · Medical Entomology and Zoology · Cited by 15,085 · see citing works
(2020) · Journal of Medical Education · doi:10.5812/jme · Cited by 3,505 · see citing works
On the Elicitation of Preferences for Alternative Therapies
McNeil, B. J., Pauker, S. G., Sox, H. C., & Tversky, A. (1982) · New England Journal of Medicine · doi:10.1056/nejm198205273062103 · Cited by 1,668 · see citing works
Poses, R. M., & Anthony, M. (1991) · Medical Decision Making · doi:10.1177/0272989x9101100303 · Cited by 190 · see citing works
Critical Decisions under Uncertainty: Representation and Structure
Kuipers, B. J., Moskowitz, A. J., & Kassirer, J. P. (1988) · Cognitive Science · doi:10.1207/s15516709cog1202_2 · Cited by 147 · see citing works
Dealing with Uncertainty, Risks, and Tradeoffs in Clinical Decisions
Moskowitz, A. J., Kuipers, B. J., & Kassirer, J. P. (1988) · Annals of Internal Medicine · doi:10.7326/0003-4819-108-3-435 · Cited by 140 · see citing works
Heuristics and biases in medical decision-making
Detmer, D. E., Fryback, D. G., & Gassner, K. (1978) · Academic Medicine · doi:10.1097/00001888-197808000-00012 · Cited by 135 · see citing works
Educating physicians for the twenty-first century
Greenlick, M. R. (1995) · Academic Medicine · doi:10.1097/00001888-199503000-00007 · Cited by 51 · see citing works
Framing bias among expert and novice physicians
Christensen, C., Heckerling, P. S., Mackesy, M. E., Bernstein, L. M., & Elstein, A. S. (1991) · Academic Medicine · doi:10.1097/00001888-199109000-00047 · Cited by 38 · see citing works
Development of a test of cognitive bias in medical decision making
Hershberger, P. J., Part, H. M., Markert, R. J., Cohen, S. M., & Finger, W. W. (1994) · Academic Medicine · doi:10.1097/00001888-199410000-00014 · Cited by 31 · see citing works
Self-citationFamily physicians and internists: differences in practice styles and proposed reasons.
Bowman, M. A. (1990) · PubMed · Cited by 19 · see citing works
Applicability of decision analysis to everyday clinical practice
Morabia, A., Steinig-Stamm, M., Unger, P.-F., Slosman, D. O., Schneider, P.-A., Perrier, A., & Junod, A. F. (1994) · Journal of General Internal Medicine · doi:10.1007/bf02599219 · Cited by 16 · see citing works
Cognitive Psychology and Medical Judgment
Redelmeier, D. A. (1991) · Medical Decision Making · doi:10.1177/0272989x9101100304 · Cited by 10 · see citing works
Medical studentsʼ risk-taking behavior in “patient” versus “physician” decision frames
Schroth, W. S., Riegelman, R. K., & Blacklow, B. G. (1994) · Academic Medicine · doi:10.1097/00001888-199410000-00041 · Cited by 6 · see citing works
Formal decision supports in medical practice and education
Christensen, C., Elstein, A. S., Bernstein, L. M., & Balla, J. I. (1991) · Teaching and Learning in Medicine · doi:10.1080/10401339109539484 · Cited by 5 · see citing works
Teaching Clinical Decision Making in a Family Practice Clerkship
Holtgräve, D. R., Lawler, F. H., & Schwiebert, L. P. (1993) · Medical Decision Making · doi:10.1177/0272989x9301300204 · Cited by 3 · see citing works
Flagged first, then by citations
1 of the 19 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Cognitive interventions to reduce diagnostic error: a narrative review
Graber, M. L., KISSAM, S. M., Payne, V. L., Meyer, A. N. D., Sorensen, A. V., Lenfestey, N. F., Tant, E. M., Henriksen, K., LaBresh, K. A., & Singh, H. (2012) · BMJ Quality & Safety · doi:10.1136/bmjqs-2011-000149 · Cited by 448 · see citing works
Cognitive debiasing 2: impediments to and strategies for change
Croskerry, P., Singhal, G., & Mamede, S. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001713 · Cited by 419 · see citing works
Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review
Lambe, K. A., O'Reilly, G., Kelly, B. D., & Curristan, S. (2016) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004417 · Cited by 215 · see citing works
Can we reduce facial biases? Persistent effects of facial trustworthiness on sentencing decisions
Jaeger, B., Todorov, A. T., Evans, A. M., & van Beest, I. (2020) · Journal of Experimental Social Psychology · doi:10.1016/j.jesp.2020.104004 · Cited by 95 · see citing works
Overconfidence in Managing Health Concerns: The Dunning–Kruger Effect and Health Literacy
Canady, B. E., & Larzo, M. (2022) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-022-09895-4 · Cited by 89 · see citing works
Believing in Overcoming Cognitive Biases
(2020) · AMA Journal of Ethics · doi:10.1001/amajethics.2020.773 · Cited by 80 · see citing works
Ke, Y., Yang, R., Lie, S. A., Lim, T. X. Y., Ning, Y., Li, I., Abdullah, H. R., Ting, D. S. W., & Liu, N. (2024) · Journal of Medical Internet Research · doi:10.2196/59439 · Cited by 64 · see citing works
“Despite concerted efforts involving educational strategies, optimal work environments, and a culture promoting bias awareness and correction [5,6], the eradication of these biases remains an elusive goal.”
Thompson, J. P., Bujalka, H., McKeever, S., Lipscomb, A., Moore, S., Hill, N., Kinney, S., Cham, K. M., Martín, J. M. M., Bowers, P. J., et al. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04371-5 · Cited by 59 · see citing works
Bias: a normal operating characteristic of the diagnosing brain
Croskerry, P. (2014) · Diagnosis · doi:10.1515/dx-2013-0028 · Cited by 47 · see citing works
Cognitive bias in clinical practice – nurturing healthy skepticism among medical students
Bhatti, A. (2018) · Advances in Medical Education and Practice · doi:10.2147/amep.s149558 · Cited by 22 · see citing works
Baillie, A., Proudfoot, H., Knight, R., Peters, L., Sweller, J., Schwartz, S. S., & Pachana, N. A. (2011) · Australian Psychologist · doi:10.1111/j.1742-9544.2011.00036.x · Cited by 13 · see citing works
Uncovering potential bias in engineering design: a comparative review of bias research in medicine
Agyemang, M., Andreae, D. A., & McComb, C. (2023) · Design Science · doi:10.1017/dsj.2023.17 · Cited by 15 · see citing works
Croskerry, P. (2015) · Springer eBooks · doi:10.1007/978-1-4471-6566-8_33 · Cited by 5 · see citing works
Moderators of the Liking Bias in Judgments of Moral Character
Bocian, K., Baryła, W., & Wojciszke, B. (2021) · Personality and Social Psychology Bulletin · doi:10.1177/01461672211013272 · Cited by 10 · see citing works
Markert, R. J., O’Neill, S., & Bhatia, S. C. (2003) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.1340230306 · Cited by 10 · see citing works
Self-citationMeasurement properties of the Inventory of Cognitive Bias in Medicine (ICBM)
Sladek, R., Phillips, P. A., & Bond, M. J. (2008) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-8-20 · Cited by 9 · see citing works
Lakhlifi, C., & Rohaut, B. (2023) · La Presse Médicale · doi:10.1016/j.lpm.2023.104181 · Cited by 8 · see citing works
EFFECT OF A METACOGNITIVE INTERVENTION ON COGNITIVE HEURISTIC USE DURING DIAGNOSTIC REASONING
Payne, V. L. (2011) · D-Scholarship@Pitt (University of Pittsburgh) · Cited by 7 · see citing works
Purinton, T. (2012) · Action in Teacher Education · doi:10.1080/01626620.2012.712743 · Cited by 7 · see citing works
Can we reduce facial biases? Persistent effects of facial trustworthiness on sentencing decisionsPreprint
Jaeger, B., Todorov, A. T., Evans, A. M., & van Beest, I. (2019) · doi:10.31234/osf.io/a8w2d · Cited by 9 · see citing works
Petelinsek, S., Zhang, P., Colbert‐Getz, J. M., Hartridge, T., Furman, N., & Hughes, P. G. (2025) · Wilderness and Environmental Medicine · doi:10.1177/10806032251334298 · Cited by 6 · see citing works
COGConnect: A new visual resource for teaching and learning effective consulting
Thompson, T., Grove, L., Brown, J., Buchan, J., Kerry, A., & Burge, S. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2020.12.016 · Cited by 6 · see citing works
Susceptibility to cognitive biases in athlete-team selection
Ramanayaka, N. D., Dickson, G., Libich, J., & Rayne, D. (2025) · International Journal of Sports Science & Coaching · doi:10.1177/17479541251338508 · Cited by 4 · see citing works
Vinaykumar, N., Gugapriya, T. S., & KALAISELVI, S. (2023) · MAEDICA – a Journal of Clinical Medicine · doi:10.26574/maedica.2023.18.2.317 · Cited by 2 · see citing works
Lu, Y., Miazek, K., & Bocian, K. (2025) · Personality and Social Psychology Bulletin · doi:10.1177/01461672251364308 · Cited by 2 · see citing works
SKIRTINGO AMZIAUS ZMONIU VEIDU ATPAZINIMO YPATUMAI LIETUVOS POPULIACIJOJE
Saikauskienė, A., & Daugirdienė, A. (2015) · International Journal of Psychology a Biopsychosocial Approach · doi:10.7220/2345-024x.17.1 · Cited by 1 · see citing works
14. Medical Education and the Diagnostic Process
(2017) · CRC Press eBooks · doi:10.1201/9781315116334-20 · Cited by 1 · see citing works
Nakhapaksirat, D. (2024) · Journal of Dental Education · doi:10.1002/jdd.13811 · Cited by 1 · see citing works
Clinical decision-making of anesthesiology residents in emergency medical care
Maceina, T., Valickas, G., Šipylaitė, J., Macas, A., Olševska, J., & Puidokas, P. (2016) · International Journal of Psychology a Biopsychosocial Approach · doi:10.7220/2345-024x.19.1
製剤技術の粋を集めた口腔内崩壊製剤への挑戦 (口腔内崩壊製剤特集号) -- (口腔内崩壊錠と製剤機械技術の進歩)
槇野, 正. (2012) · 製剤機械技術学会誌 = Journal of pharmaceutical machinery and engineering
Introduction to Medical Diagnosis
Hirosawa, T. (2025) · Springer eBooks · doi:10.1007/978-981-95-4338-0_1
Thompson, J. P., Bujalka, H., McKeever, S., Lipscomb, A., Moore, S., Hill, N., Kinney, S., Cham, K. M., Martin, J., Bowers, P. J., et al. (2023) · Figshare · doi:10.6084/m9.figshare.23550374
Thompson, J. P., Bujalka, H., McKeever, S., Lipscomb, A., Moore, S., Hill, N., Kinney, S., Cham, K. M., Martin, J., Bowers, P. J., et al. (2023) · Figshare · doi:10.6084/m9.figshare.23550377
Petelinsek, S., Hartridge, T., Grant, E., Kelner, R., McKinnon, M., Domonoske, R., & Hughes, P. G. (2026) · Wilderness and Environmental Medicine · doi:10.1177/10806032261495963
- Authors
- Hershberger, P. J., Markert, R. J., Part, H. M., Cohen, S. M., & Finger, W. W.
- Affiliations
- Wright State University (US)
- Corresponding author
- Hershberger, Paul J.
- Venue
- Advances in Health Sciences Education
- Published
- 1996-01
- Volume
- 1
- Issue
- 3
- Pages
- 221-226
- ISSN
- 1382-4996 (ISSN-L)
- OpenAlex
- W1509618965
- Cited by
- 34
- References
- 19
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 6 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 3
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- green
- works.bepress.com
- Licence
- Locations
- Advances in Health Sciences Education (publishedVersion)
- PubMed (publishedVersion)
- Journal of Bioresource Management (submittedVersion)
- Journal of Bioresource Management (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Keywords
- cognitive biases, clinical decision-making, medical students, physicians, physician specialty differences, preclinical education, clinical reasoning
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
