CoChat
Sign Up
Cited by 242Clinical Reasoning and Diagnostic SkillsInnovations in Medical EducationEducation and Critical Thinking Development

Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety

Royce, Celeste S., Hayes, Margaret M., Schwartzstein, Richard M.·2019·Academic Medicine
DOI 10.1097/acm.0000000000002518
Open this paper in CoChat — free account

Abstract

Diagnostic errors contribute to as many as 70% of medical errors. Prevention of diagnostic errors is more complex than building safety checks into health care systems; it requires an understanding of critical thinking, of clinical reasoning, and of the cognitive processes through which diagnoses are made. When a diagnostic error is recognized, it is imperative to identify where and how the mistake in clinical reasoning occurred. Cognitive biases may contribute to errors in clinical reasoning. By understanding how physicians make clinical decisions, and examining how errors due to cognitive biases occur, cognitive bias awareness training and debiasing strategies may be developed to decrease diagnostic errors and patient harm. Studies of the impact of teaching critical thinking skills have mixed results but are limited by methodological problems.This Perspective explores the role of clinical reasoning and cognitive bias in diagnostic error, as well as the effect of instruction in metacognitive skills on improvement of diagnostic accuracy for both learners and practitioners. Recent literature questioning whether teaching critical thinking skills increases diagnostic accuracy is critically examined, as are studies suggesting that metacognitive practices result in better patient care and outcomes. Instruction in metacognition, reflective practice, and cognitive bias awareness may help learners move toward adaptive expertise and help clinicians improve diagnostic accuracy. The auth…

Integrity signals

Registry

Crossref · 10.1097/acm.0000000000002518

Cites

8 of 8 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

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?

  • A lack of metacognitive skills can lead to an overestimation of abilities or reduced self-monitoring and thus medical errors.

    “Conversely, a lack of metacognitive skills can lead to an overestimation of abilities or reduced self- monitoring and thus, medical errors (Medina et al.,2017, Royce et al.,2019 ).”

    From Promoting metacognition in an allied health anatomy course (2023) · cites this paper as Royce et al., 2019

  • Metacognitive clinicians are more adept at identifying and avoiding cognitive biases that often lead to diagnostic errors in clinical decision making.

    “Metacognitive clinicians were also more adept at identifying and avoiding cognitive biases that often lead to diagnostic errors in their clinical decision making (Royce et al.,2019 ).”

    From Promoting metacognition in an allied health anatomy course (2023) · cites this paper as Royce et al., 2019

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Royce, C. S., Hayes, M. M., & Schwartzstein, R. M.
Affiliations
Beth Israel Deaconess Medical Center (US)
Corresponding author
Royce, Celeste S.
ORCID
Venue
Academic Medicine
Publisher
Oxford University Press (OUP)
Published
2019-02
Volume
94
Issue
2
Pages
187-194
ISSN
1040-2446 (ISSN-L)
DOI
10.1097/acm.0000000000002518
OpenAlex
W2900338737
Cited by
242
References
8
Citations by year
2026: 17 · 2025: 41 · 2024: 38 · 2023: 38 · 2022: 44 · 2021: 25 · 2020: 28 · 2019: 10
FWCI
18.05
Type
journal article
Language
en
Open access
closed
Locations
  • Academic Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Social Sciences › Education › Education and Critical Thinking Development
Keywords
critical thinking, cognitive biases, diagnostic errors, clinical reasoning, bias mitigation, metacognition, patient safety, medical education, diagnostic accuracy, reflective practice, adaptive expertise, medical errors
MeSH terms
Cognition, Decision Making, Diagnostic Errors, Humans, Thinking, Bias, Patient Safety

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