For learning (and teaching) clinical decision making the process is much less well defined. In one possible approach, Croskerry, Wears, and Binder (2000) outlined their approach to a curriculum for error prevention in Emergency Medicine (1). In addition to proposing a multidisciplinary approach highlighting the importance of communication, team dynamics, and feedback, they also emphasize the need for “educational initiatives directed toward individual response to error” and identifying “meaningful patterns in practice that indicate impending error.” Croskerry has also written extensively on the importance of understanding cognitive errors (termed cognitive dispositions to respond) and cognitive forcing strategies in developing excellence in clinical decision making (2, 3, 4). Though there is some evidence that, at least in a simulated environment, cognitive forcing strategies might not lead to a decrease in diagnostic error (5). I would posit that, at a minimum, knowledge of cognitive biases/errors and of the mental processes involved in clinical decision making, can (or at least should) lead to improved, more resilient, clinical decision making.

But, how do we go about learning cognitive biases (also termed cognitive errors, also termed cognitive dispositions to respond)? Well, you could go to the wikipedia page that has an extensive listing of biases and learn one per day… for the next 165 days… (6). To best learn these cognitive biases, we need to situate them and tie them to real world clinical experiences. Croskerry outlined a process to do just that termed a “cognitive autopsy.” (7) In the podcast below, the process of this autopsy is outlined and an example clinical case, rife with cognitive biases, is presented by Dr. Ryan Gerecht.