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Cited by 419Clinical Reasoning and Diagnostic SkillsDecision-Making and Behavioral EconomicsPatient Safety and Medication Errors

Cognitive debiasing 2: impediments to and strategies for change

Open access
Croskerry, Pat, Singhal, Geeta, Mamede, Sílvia·2013·BMJ Quality & Safety
DOI 10.1136/bmjqs-2012-001713PMC PMC3786644
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Abstract

In a companion paper, we proposed that cognitive debiasing is a skill essential in developing sound clinical reasoning to mitigate the incidence of diagnostic failure. We reviewed the origins of cognitive biases and some proposed mechanisms for how debiasing processes might work. In this paper, we first outline a general schema of how cognitive change occurs and the constraints that may apply. We review a variety of individual factors, many of them biases themselves, which may be impediments to change. We then examine the major strategies that have been developed in the social sciences and in medicine to achieve cognitive and affective debiasing, including the important concept of forcing functions. The abundance and rich variety of approaches that exist in the literature and in individual clinical domains illustrate the difficulties inherent in achieving cognitive change, and also the need for such interventions. Ongoing cognitive debiasing is arguably the most important feature of the critical thinker and the well-calibrated mind. We outline three groups of suggested interventions going forward: educational strategies, workplace strategies and forcing functions. We stress the importance of ambient and contextual influences on the quality of individual decision making and the need to address factors known to impair calibration of the decision maker. We also emphasise the importance of introducing these concepts and corollary development of training in critical thinking in the undergraduate level in medical education.

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  • Cognitive forcing strategies, such as diagnostic timeouts, may be effective in preventing failed heuristics by prompting providers to analytically engage with their decisions.

    “Cognitive forcing strategies, such as diagnostic timeouts, may be effective in preventing failed heuristics by prompting providers to analytically engage with their decisions [19, 40].”

    From To Recommend or Not to Recommend: Designing and Evaluating AI-Enabled Decision Support for Time-Critical Medical Events (2025) · cites this paper as [19]

    In “Strategies for cognitive debiasing” (Tables 1–2; page unavailable), the paper says cognitive forcing strategies can mitigate biases leading to decision errors and describes deliberate reflection as a way to check initial diagnoses. It mentions a planned time-out in the operating room, but does not identify diagnostic timeouts as a cognitive forcing strategy or establish their effectiveness in preventing failed heuristics. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In time-critical decision making, providers may look for and prioritize evidence that supports their initial decisions instead of seeking evidence that challenges these decisions.

    “In time-critical decision making, providers may look for and prioritize evidence that supports their initial decisions instead of seeking evidence that challenges these decisions (e.g., anchoring and confirmation biases) [19, 22].”

    From To Recommend or Not to Recommend: Designing and Evaluating AI-Enabled Decision Support for Time-Critical Medical Events (2025) · cites this paper as [19]

    The ‘Strategies for cognitive debiasing’ section (page unavailable) recommends seeking evidence for a decision opposite to an initial impression and warns against relying on early diagnoses. This supports the concern about failing to challenge an initial decision, but the passages do not specifically establish that providers prioritize confirming evidence in time-critical decisions. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 63

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Authors
Croskerry, P., Singhal, G., & Mamede, S.
Affiliations
  • Dalhousie University (CA)
  • Baylor College of Medicine (US)
  • Erasmus University Rotterdam (NL)
Corresponding author
Croskerry, Pat
ORCID
Venue
BMJ Quality & Safety
Publisher
BMJ
Published
2013-08-30
Volume
22
Issue
Suppl 2
Pages
ii65-ii72
ISSN
  • 1475-3898 (ISSN-L)
  • 2044-5415
  • 2044-5423
DOI
10.1136/bmjqs-2012-001713
PMC
PMC3786644
OpenAlex
W2147558794
Cited by
419
References
12
Citations by year
2026: 32 · 2025: 31 · 2024: 29 · 2023: 41 · 2022: 28 · 2021: 35 · 2020: 34 · 2019: 56 · 2018: 27 · 2017: 34 · 2016: 38 · 2015: 15 · 2014: 17 · 2013: 2
FWCI
20.37
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Quality & Safety (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (acceptedVersion, cc-by-nc)
  • RePub (Erasmus University Rotterdam) (submittedVersion, cc-by-nc)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
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 › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
cognitive debiasing, cognitive biases, clinical reasoning, diagnostic failure, cognitive change, forcing functions, critical thinking, medical education, workplace interventions, decision-making, bias mitigation strategies
MeSH terms
Clinical Competence, Cognition, Decision Making, Diagnosis, Differential, Diagnostic Errors, Humans, Prejudice, Thinking

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