Other Titles
Guided Collaborative Reflection as a Teaching Strategy to Reduce Cognitive Bias and Improve Diagnostic Decision Making: A Quasi-experimental Study [Slide Deck Title]
Abstract
Background and Significance: Diagnoses based on previous patient experiences, heuristics, and pattern recognition have the potential for leading to bias and misdiagnosis (Doherty, 2020). A teaching technique that has shown to be successful in improving Diagnostic Decision Making (DDM) is guided reflection (Prakash et al., 2019). According to Griffith et al. (2020, 2023), structured reflection demonstrated the most consistent improvement in diagnostic accuracy when studying medical and nurse practitioner students. Cognitive bias occurs when a healthcare provider selectively determines a diagnosis without considering alternatives (Doherty & Carroll, 2020). Numerous debiasing educational techniques have been explored noting mixed results (Tung & Melchiorre, 2023).
Purpose: The purpose of this study is compare teaching techniques to improve DDM.
Methods: A quasi-experimental study was performed using a random convenience sampling of nurse practitioner students. Students were randomly assigned to work in either a group (Experimental) or individually (Control) during instructor-guided case study analysis. Pre-test and post-test scores were compared between students who worked in a group during case study analysis and students who worked individually during the case study activities. An independent paired t-test was performed to compare mean scores from the two study groups using the Statistical Package for Social Sciences (SPSS) software. The significance level was set at p < .05.
Results: An independent-sample t-test was conducted to compare DDM improvement in the control versus experimental group. There was a significant difference in the mean scores between the control group (M=4.71, SD = 1.54) and the experimental group (M=5.46, SD= 1.82) conditions; t (656)= 5.71, p = <.001. The effect size range, measured by Cohen’s d, was d = .32 - 1.8, indicating a small to large effect range.
Conclusions: This study supports collaborative guided reflection as an effective technique to reduce cognitive bias and improve DDM.
Notes
References:
Doherty, T. S. & Carroll, A. E. (2020). Believing in overcoming cognitive bias, AMA Journal of Ethics, 22(9), 773-778.
Griffith, P. B., Doherty, C., Smeltzer, S. C., & Mariani, B. (2020). Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: A scoping review. Journal of the American Association of Nurse Practitioners. 33(11), 862-871.
Griffith, P. B., Mariani, B., & Kelly, M. M. (2023). Diagnostic reasoning competency and accuracy by nurse practitioner students following the
use of structured reflection in simulation: A mixed-methods experiment. Nursing Education Perspectives, 44(6), 18-24.
Prakash, S., Sladek, R. M., & Schuwirth, L. (2019). Interventions to improve diagnostic decision making: A systematic review and meta-
analysis on reflective strategies. Medical Teacher, 41(5), 517-524. https://doi.org/10.1080/0142159x.2018.1497786
Tung, A. & Melchiorre, M. (2023). Debiasing and educational interventions in medical diagnosis: A systematic review. University of Toronto Medical Journal, 100(1), 48-57. https://doi.org/10.33137/utmj.v100i1.38937
Sigma Membership
Iota Mu
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quasi-Experimental Study, Other
Research Approach
Other
Keywords:
Teaching and Learning Strategies, Curriculum Development
Recommended Citation
Hatch, Daniel Forrest, "Teaching Strategies to Reduce Cognitive Bias in Diagnostic Decisions: A Quasi-Experimental Study" (2025). International Nursing Research Congress (INRC). 55.
https://www.sigmarepository.org/inrc/2025/presentations_2025/55
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Teaching Strategies to Reduce Cognitive Bias in Diagnostic Decisions: A Quasi-Experimental Study
Seattle, Washington, USA
Background and Significance: Diagnoses based on previous patient experiences, heuristics, and pattern recognition have the potential for leading to bias and misdiagnosis (Doherty, 2020). A teaching technique that has shown to be successful in improving Diagnostic Decision Making (DDM) is guided reflection (Prakash et al., 2019). According to Griffith et al. (2020, 2023), structured reflection demonstrated the most consistent improvement in diagnostic accuracy when studying medical and nurse practitioner students. Cognitive bias occurs when a healthcare provider selectively determines a diagnosis without considering alternatives (Doherty & Carroll, 2020). Numerous debiasing educational techniques have been explored noting mixed results (Tung & Melchiorre, 2023).
Purpose: The purpose of this study is compare teaching techniques to improve DDM.
Methods: A quasi-experimental study was performed using a random convenience sampling of nurse practitioner students. Students were randomly assigned to work in either a group (Experimental) or individually (Control) during instructor-guided case study analysis. Pre-test and post-test scores were compared between students who worked in a group during case study analysis and students who worked individually during the case study activities. An independent paired t-test was performed to compare mean scores from the two study groups using the Statistical Package for Social Sciences (SPSS) software. The significance level was set at p < .05.
Results: An independent-sample t-test was conducted to compare DDM improvement in the control versus experimental group. There was a significant difference in the mean scores between the control group (M=4.71, SD = 1.54) and the experimental group (M=5.46, SD= 1.82) conditions; t (656)= 5.71, p = <.001. The effect size range, measured by Cohen’s d, was d = .32 - 1.8, indicating a small to large effect range.
Conclusions: This study supports collaborative guided reflection as an effective technique to reduce cognitive bias and improve DDM.
Description
Diagnostic Decision Making (DDM) is a critical skill to foster in advanced practice nursing education through various teaching techniques. This research study compared two different teaching techniques to determine which is the most effective at reducing cognitive bias and improve DDM.