Trial reportBMC medical education2019
A cognitive forcing tool to mitigate cognitive bias - a randomised control trial.
Trial report in BMC medical education, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Effect on diagnostic accuracy of cognitive reasoning tools for the workplace setting: systematic review and meta-analysis.BMJ quality & safety · 2022Pooled it
- Checklists to reduce diagnostic error: a systematic review of the literature using a human factors framework.BMJ open · 2022Pooled it
- Differential diagnosis checklists reduce diagnostic error differentially: A randomised experiment.Medical education · 2021Trial
- Cognitive Tunneling in Obstetrics and Gynecology: A Critical Review of Implications for Clinical Practice and Mitigation Strategies.Diseases (Basel, Switzerland) · 2026Review
- Physicians' metacognition in medical decision-making.Neuroscience of consciousness · 2026Article
- Teaching common cognitive biases and associated errors in veterinary neurologic diagnosis using clinical vignettes: a narrative review.Frontiers in veterinary science · 2026Review
- Cognitive Frame and Time Pressure as Moderators Of Clinical Reasoning: A Case Control Study.The western journal of emergency medicine · 2025Article
- Diagnostic reasoning and cognitive error in emergency medicine: Implications for teaching and learning.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Review
- Letter to the Editor: Editorial: Keep the Conversation Going-The Importance of Post-Publication Dialogue.Clinical orthopaedics and related research · 2024Article
- Article
- Japanese Internists' Most Memorable Diagnostic Error Cases: A Self-reflection Survey.Internal medicine (Tokyo, Japan) · 2024Article
- Article
- Exploring Knowledge of Cognitive Disposition to Respond in Clinical Decision-Making among Early Clinical Learners.Maedica · 2023Article
- Defining the tasks of clinical reasoning in forensic psychiatric evaluation: Psychomedicolegal analysis competency.Heliyon · 2023Article
- Medical Malpractice and Diagnostic Errors in Japanese Emergency Departments.The western journal of emergency medicine · 2023Article
- Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis.BMC emergency medicine · 2021Article
- Clinician Recognition of First Episode Psychosis.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2021Article
- The relationship between time to diagnose and diagnostic accuracy among internal medicine residents: a randomized experiment.BMC medical education · 2021Article
- Article
- Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls.Frontiers in psychiatry · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCognitive bias is an important source of diagnostic error yet is a challenging area to understand and teach. Our aim was to determine whether a cognitive forcing tool can reduce the rates of error in clinical decision making. A secondary objective was to understand the process by which this effect might occur.
methodsWe hypothesised that using a cognitive forcing tool would reduce diagnostic error rates. To test this hypothesis, a novel online case-based approach was used to conduct a single blinded randomized clinical trial conducted from January 2017 to September 2018. In addition, a qualitative series of "think aloud" interviews were conducted with 20 doctors from a UK teaching hospital in 2018. The primary outcome was the diagnostic error rate when solving bias inducing clinical vignettes. A volunteer sample of medical professionals from across the UK, Republic of Ireland and North America. They ranged in seniority from medical student to Attending Physician.
resultsSeventy six participants were included in the study. The data showed doctors of all grades routinely made errors related to cognitive bias. There was no difference in error rates between groups (mean 2.8 cases correct in intervention vs 3.1 in control group, 95% CI -0.94 - 0.45 P = 0.49). The qualitative protocol revealed that the cognitive forcing strategy was well received and a produced a subjectively positive impact on doctors' accuracy and thoughtfulness in clinical cases.
conclusionsThe quantitative data failed to show an improvement in accuracy despite a positive qualitative experience. There is insufficient evidence to recommend this tool in clinical practice, however the qualitative data suggests such an approach has some merit and face validity to users.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.