Monday, October 25, 2010
Vide Lobby (Sheraton Centre Toronto Hotel)
Patrick A. Williams, University of Mississippi Medical Center, Jackson, MS

Statement of problem: This paper presents a checklist to be used to reduce cognitive error in physicians during formulation of a diagnosis.  Checklists have been shown to be effective in reducing systematic error in medicine (Haynes AB 2009).  Prior research contains psychology jargon that physicians need not learn.  Also, research has suggested that cognitive strategy courses may reduce systematic error in medicine (Dunphy et al 2010).  However, given the mountain of information that must be learned, medical students and physicians would lack the motivation to remember cognitive strategies (Kassam et al 2009).    It is also unlikely that physicians in training would attend additional courses, given their burden of information required to practice medicine.  Should a case prove to be particularly complicated, the convenience of a quick checklist to skim may improve performance. 

Description of the intervention or program: The mnemonic and checklist is below:

(*These would not be included in the checklist and are for clarification.) These terms deliberately avoid psychology jargon and are generic enough to extract meaning quickly (e.g.  'Eureka' for 'Heuristics', 'Anti-evidence' for 'Confirmation bias', and 'Think aboutÉ' for 'Metacognition').  The checklist requires little extra time and effort from the physician, and six falls within the seven bits of working memory (Miller 1956).  The six terms have been designed to address as many of the most common cognitive contributions to diagnostic error as possible for such a short list (Graber et al 2005; Croskerry 2002; Croskerry 2003).  The mnemonic 'sea tow' references the importance of the task and is not easily forgotten. Any physician could print this on a 2"x2" sheet of paper and tape it to their working surface or where they are when establishing a diagnosis (e.g. monitor).  Also, this is free. Medicine cannot pause until the 'best' solution to reduce cognitive error is found.  This checklist may serve a useful purpose until then. This can be tested using three groups; in the first group no checklist is used, in the second a thoughtful but useless checklist is used, and in the third this checklist is used.

Findings to date: Pending.

Lessons learned: Pending.