NDLI: A mixed-methods exploration of cognitive dispositions to respond and clinical reasoning errors with multiple choice questions

Content Provider	Springer Nature : BioMed Central
Author	Surry, Luke T. Torre, Dario Trowbridge, Robert L. Durning, Steven J.
Abstract	Background Cognitive dispositions to respond (i.e., cognitive biases and heuristics) are well-established clinical reasoning phenomena. While thought by many to be error-prone, some scholars contest that these cognitive dispositions to respond are pragmatic solutions for reasoning through clinical complexity that are associated with errors largely due to hindsight bias and flawed experimental design. The purpose of this study was to prospectively identify cognitive dispositions to respond occurring during clinical reasoning to determine whether they are actually associated with increased odds of an incorrect answer (i.e., error). Methods Using the cognitive disposition to respond framework, this mixed-methods study applied a constant comparative qualitative thematic analysis to transcripts of think alouds performed during completion of clinical-vignette multiple-choice questions. The number and type of cognitive dispositions to respond associated with both correct and incorrect answers were identified. Participants included medical students, residents, and attending physicians recruited using maximum variation strategies. Data were analyzed using generalized estimating equations binary logistic model for repeated, within-subjects measures. Results Among 14 participants, there were 3 cognitive disposition to respond categories – Cognitive Bias, Flaws in Conceptual Understanding, and Other Vulnerabilities – with 13 themes identified from the think aloud transcripts. The odds of error increased to a statistically significant degree with a greater per-item number of distinct Cognitive Bias themes (OR = 1.729, 95% CI [1.226, 2.437], p = 0.002) and Other Vulnerabilities themes (OR = 2.014, 95% CI [1.280, 2.941], p < 0.001), but not with Flaws in Conceptual Understanding themes (OR = 1.617, 95% CI [0.961, 2.720], p = 0.070). Conclusion This study supports the theoretical understanding of cognitive dispositions to respond as phenomena associated with errors in a new prospective manner. With further research, these findings may inform teaching, learning, and assessment of clinical reasoning toward a reduction in patient harm due to clinical reasoning errors.
Related Links	https://bmcmededuc.biomedcentral.com/counter/pdf/10.1186/s12909-018-1372-2.pdf
Ending Page	11
Page Count	11
Starting Page	1
File Format	HTM / HTML
ISSN	14726920
DOI	10.1186/s12909-018-1372-2
Journal	BMC Medical Education
Issue Number	1
Volume Number	18
Language	English
Publisher	BioMed Central
Publisher Date	2018-11-23
Access Restriction	Open
Subject Keyword	Medical Education Theory of Medicine Bioethics Clinical reasoning Cognitive disposition to respond (CDR) Reasoning errors Medical errors Medical decision making Theory of Medicine/Bioethics
Content Type	Text
Resource Type	Article
Subject	Education Medicine
Journal Impact Factor	2.7/2023
5-Year Journal Impact Factor	3.4/2023

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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