Trial reportJournal of general internal medicine2021
Specific Disease Knowledge as Predictor of Susceptibility to Availability Bias in Diagnostic Reasoning: a Randomized Controlled Experiment.
Trial report in Journal of general internal medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Premature closure underlies bias in medical diagnosis in students: A randomised controlled experiment.Medical education · 2026Trial
- The effect of a provisional diagnosis on intern diagnostic reasoning: a mixed methods study.Diagnosis (Berlin, Germany) · 2025Trial
- Resident Physician Recognition of Tachypnea in Clinical Simulation Videos in Japan: Cross-Sectional Study.JMIR medical education · 2025Article
- Selective processing of clinical information related to correct and incorrect diagnoses: An eye-tracking experiment.Medical education · 2025Article
- Articulating What Makes Sense: An Exercise in Clinical Reasoning.Journal of general internal medicine · 2025Article
- Rising to the Challenge of Rare Diagnoses.Journal of general internal medicine · 2025Article
- Pitfalls of reasoning in hospital-based transfusion medicine.Transfusion medicine (Oxford, England) · 2024Review
- Insights into diagnostic errors in endocrinology: a prospective, case-based, international study.BMC medical education · 2023Article
- Deliberate reflection and clinical reasoning: Founding ideas and empirical findings.Medical education · 2023Article
- Does a suggested diagnosis in a general practitioners' referral question impact diagnostic reasoning: an experimental study.BMC medical education · 2022Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBias in reasoning rather than knowledge gaps has been identified as the origin of most diagnostic errors. However, the role of knowledge in counteracting bias is unclear.
objectiveTo examine whether knowledge of discriminating features (findings that discriminate between look-alike diseases) predicts susceptibility to bias.
designThree-phase randomized experiment. Phase 1 (bias-inducing): Participants were exposed to a set of clinical cases (either hepatitis-IBD or AMI-encephalopathy). Phase 2 (diagnosis): All participants diagnosed the same cases; 4 resembled hepatitis-IBD, 4 AMI-encephalopathy (but all with different diagnoses). Availability bias was expected in the 4 cases similar to those encountered in phase 1. Phase 3 (knowledge evaluation): For each disease, participants decided (max. 2 s) which of 24 findings was associated with the disease. Accuracy of decisions on discriminating features, taken as a measure of knowledge, was expected to predict susceptibility to bias.
participantsInternal medicine residents at Erasmus MC, Netherlands. MAIN MEASURES: The frequency with which higher-knowledge and lower-knowledge physicians gave biased diagnoses based on phase 1 exposure (range 0-4). Time to diagnose was also measured. KEY
resultsSixty-two physicians participated. Higher-knowledge physicians yielded to availability bias less often than lower-knowledge physicians (0.35 vs 0.97; p = 0.001; difference, 0.62 [95% CI, 0.28-0.95]). Whereas lower-knowledge physicians tended to make more of these errors on subjected-to-bias than on not-subjected-to-bias cases (p = 0.06; difference, 0.35 [CI, - 0.02-0.73]), higher-knowledge physicians resisted the bias (p = 0.28). Both groups spent more time to diagnose subjected-to-bias than not-subjected-to-bias cases (p = 0.04), without differences between groups.
conclusionsKnowledge of features that discriminate between look-alike diseases reduced susceptibility to bias in a simulated setting. Reflecting further may be required to overcome bias, but succeeding depends on having the appropriate knowledge. Future research should examine whether the findings apply to real practice and to more experienced physicians.
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