To the Editor:
I thank Royce and colleagues1 for their support of integrating heuristic and bias awareness education into the medical curriculum. As a current medical student, I want to suggest topics2 that ought to be included in a cognitive bias awareness curriculum but were not an explicit focus of their article.
Due to the team-based nature of medical practice, there must be a focus on the social biases that impact decisions. The authors recommend that professionals engage other “health care professionals, patients, and families” to reduce error in the diagnostic process. To maximize the benefit of this engagement, one must be educated on the underlying social psychology promoting group decisions and deliberation. Haidt3 offers a social intuitionist model that is strongly applicable to a medical context, detailing social influences that impact our reasoning, such as the anticipation of judgment or the interpretation of others’ reasoning. Although this is not an exhaustive review of social biases, it is a good place to start.3
Further, students would benefit from medical educators incorporating a general introduction to a wider range of validated decisional heuristics than those discussed by Royce and colleagues. Suggested topics include, but are not limited to, availability, anchoring, and adjustment; representativeness; egocentrism; attribution error; confirmation bias; attitude polarization; motivated reasoning; cognitive dissonance; affect heuristic; implicit biases; and system justification theory.4 Though it may be unreasonable to expect a medical professional to recall in detail each topic introduced early in his or her education, standardizing this introduction will prime medical professionals’ awareness of the major decisional crutches in his or her later career, reducing diagnostic errors and improving patient safety.
1. Royce CS, Hayes MM, Schwartzstein RM. Teaching critical thinking: A case for instruction in cognitive biases to reduce diagnostic errors and improve patient safety. Acad Med. 2019;94:187–194.
2. Burk-Rafel J, Jones RL, Farlow JL. Engaging learners to advance medical education. Acad Med. 2017;92:437–440.
3. Haidt J. The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychol Rev. 2001;108:814–834.
4. Gilovich T, Griffin D, Kahneman D. Heuristics and Biases: The Psychology of Intuitive Judgment. 2002.New York, NY: Cambridge University Press.