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Abstract：
Bias 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.
To examine whether knowledge of discriminating features (findings that discriminate between look-alike diseases) predicts susceptibility to bias.
Three-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.
Internal medicine residents at Erasmus MC, Netherlands.
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.
Sixty-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.
Knowledge 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.
To examine whether knowledge of discriminating features (findings that discriminate between look-alike diseases) predicts susceptibility to bias.
Three-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.
Internal medicine residents at Erasmus MC, Netherlands.
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.
Sixty-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.
Knowledge 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.
摘要：
推理中的偏见而不是知识差距已被确定为大多数诊断错误的根源。然而,知识在抵消偏见中的作用尚不清楚.
研究辨别特征（区分相像疾病的发现）的知识是否能预测偏倚的易感性。
三阶段随机实验。第一阶段（偏倚诱导）：参与者暴露于一组临床病例（肝炎-IBD或AMI-脑病）。第2阶段（诊断）：所有参与者诊断出相同的病例；4例类似于肝炎-IBD，4AMI-脑病（但都有不同的诊断）。预计4例病例的可用性偏差与第1阶段中遇到的情况相似。第三阶段（知识评估）：对于每种疾病，参与者决定(最大2s)24项发现中的哪一项与该疾病相关。区分特征的决策的准确性，作为知识的衡量标准，预计将预测对偏倚的易感性。
伊拉斯谟MC内科住院医师,荷兰。
知识较高和知识较低的医生根据1期暴露（范围0-4）进行有偏差的诊断的频率。还测量了诊断时间。
六十二名医生参加。知识较高的医师比知识较低的医师对可用性偏差的影响较小（0.35vs0.97；p=0.001；差异，0.62[95%CI，0.28-0.95]）。而知识较低的医生倾向于使更多的这些错误在受偏倚比不受偏倚的情况下(p=0.06;差异,0.35[CI，-0.02-0.73])，知识较高的医生抵制了这种偏见(p=0.28)。两组都花费更多的时间来诊断受偏倚的病例比不受偏倚的病例（p=0.04），没有组间差异。
在模拟环境中，区分相似疾病的特征的知识降低了对偏见的易感性。可能需要进一步反射来克服偏见，但是成功取决于拥有适当的知识。未来的研究应该检查这些发现是否适用于实际实践和更有经验的医生。
研究辨别特征（区分相像疾病的发现）的知识是否能预测偏倚的易感性。
三阶段随机实验。第一阶段（偏倚诱导）：参与者暴露于一组临床病例（肝炎-IBD或AMI-脑病）。第2阶段（诊断）：所有参与者诊断出相同的病例；4例类似于肝炎-IBD，4AMI-脑病（但都有不同的诊断）。预计4例病例的可用性偏差与第1阶段中遇到的情况相似。第三阶段（知识评估）：对于每种疾病，参与者决定(最大2s)24项发现中的哪一项与该疾病相关。区分特征的决策的准确性，作为知识的衡量标准，预计将预测对偏倚的易感性。
伊拉斯谟MC内科住院医师,荷兰。
知识较高和知识较低的医生根据1期暴露（范围0-4）进行有偏差的诊断的频率。还测量了诊断时间。
六十二名医生参加。知识较高的医师比知识较低的医师对可用性偏差的影响较小（0.35vs0.97；p=0.001；差异，0.62[95%CI，0.28-0.95]）。而知识较低的医生倾向于使更多的这些错误在受偏倚比不受偏倚的情况下(p=0.06;差异,0.35[CI，-0.02-0.73])，知识较高的医生抵制了这种偏见(p=0.28)。两组都花费更多的时间来诊断受偏倚的病例比不受偏倚的病例（p=0.04），没有组间差异。
在模拟环境中，区分相似疾病的特征的知识降低了对偏见的易感性。可能需要进一步反射来克服偏见，但是成功取决于拥有适当的知识。未来的研究应该检查这些发现是否适用于实际实践和更有经验的医生。
