Online workshop about clinical reasoning and cognitive dispositions to respond for medical residents

Abstract

Introduction: Errors occur frequently in medicine, mainly due to cognitive biases. There are many biases or “cognitive dispositions to respond” (CDR) that influence the diagnostic process, and there is a need for interventions to improve knowledge and skills about it in residency education.

Objective: To develop an online workshop about clinical reasoning and CDR and test it in residents.

Method: Kern’s model for curriculum development and Kolb’s experiential learning model were used for workshop design. Croskerry’s conceptual framework was used for course contents. A one-group pre-post study was performed in Internal Medicine residents at the National Autonomous University of Mexico (UNAM) Faculty of Medicine. Outcomes: knowledge, self-reported skills, and satisfaction. Instruments: pre and post-test multiple-choice question exams to measure knowledge; course opinion survey; retrospective pre-post questionnaire to assess skills. Psychometric analysis was done using classical measurement theory. Pre-post comparisons were done with paired Student’s t-test.

Results: The workshop had three two-hour synchronic sessions via Zoom, over a three-week period, with asynchronic activities for case preparation in Canvas. 22 Internal medicine residents took the workshop (13 M/9 F), average age 27.5 years. Pre-test exam average score was 12.8 (51.2% correct), post-test 14.6 (58.4% correct), p = 0.038. The retrospective pre-post questionnaire had substantial positive increases in all areas (p < 0.001). The satisfaction questionnaire showed positive responses. Small groups analyzed real-life clinical cases, identifying cognitive biases, their impact on the patients’ clinical course and proposed strategies to mitigate CDR.

Conclusions: An online educational intervention for residents about clinical reasoning, cognitive biases and strategies to cope with CDR, was developed and implemented. The workshop showed an increase in knowledge and self-reported skills and was satisfactory for the residents. The research design cannot exclude several validity threats, so studies in other populations, with larger sample size and control groups, using more robust research designs are needed.