REDUCING COGNITIVE ERRORS BY CAPTURING AND DISSEMINATING EXPERT REASONING

Background: Expert reasoning strategies for identifying and correctly using the right information and knowledge are currently developed over the course of many years of practice. A formal process for capturing and disseminating expert reasoning could significantly shorten the learning curve and change the diagnostic process. We have begun to apply such a process – called Thought Process Optimization ® (TPO) – which was previously applied in the financial and engineering domains, to medical reasoning.

Methods: TPO captures and disseminates the reasoning strategies of domain experts, referred to as their Thought Process Models ™ (TPMs). Through a series of interviews, information is obtained about how an expert thinks. Following each interview the TPO consultant identifies and adds the expert’s reasoning to the TPM, refines the TPM based on the expert’s feedback and establishes common semantics using a “One-Term One- Meaning” process. Disseminating the expert’s reasoning to learners takes a few hours to a few days. In this feasibility study, the investigators introspectively performed the TPO process on two of their own members: an experienced emergency physician (focusing on initial assessment of patients presenting to the ED) and an experienced internist (focusing on assessment of challenging inpatient presentations).

Results: In the first case study, the emergency medicine TPM was elicited, and was reported to be easily transferred, understood and adopted by medical students and residents who informally reported positive changes in their diagnostic process and immediate improvements to their clinical reasoning. In the second case study, after the internal medicine TPM was developed, the expert engaged in a member verification process and confirmed that the TPM not only accurately characterized his thinking, but  also provided insights into his own reasoning processes and how they differ from those of other physicians and the residents he trains. The TPM highlighted the important role of rapid automatic thinking in this expert’s diagnostic reasoning. It emphasized the importance of comparing patient and physician perceptions about the nature and severity of the illness in order to identify cases in which diagnostic errors may be more likely.

Conclusion: Methods developed to capture and disseminate reasoning in other fields can be applied to clinical reasoning in medicine to reduce diagnostic errors. Additional research will replicate these findings more formally. Future development will store each physician’s TPM in a cloud software application where reasoning strategies can be examined, replicated, updated and shared with others regardless of geographical location.