Uso da reflexão estruturada como método instrucional para reduzir viés de confirmação diagnóstica em estudantes de medicina

Abstract

Introduction: The cognitive bias of diagnostic confirmation is the tendency to remember, to interpret or to search for clinical data in order to confirm an initially accepted hypothesis rather than to refute it. The use of the educational strategy of structured reflection has shown in experimental studies to be effective in making the physician less susceptible to cognitive bias and, consequently, less prone to diagnostic errors. Objectives: To evaluate the occurrence of diagnostic confirmation bias in medical students of the 8th period during the resolution of clinical cases, already using diagnostic hypotheses for referral and to verify the potential effect of structured reflection in reducing diagnostic verification bias. Methodology: Experimental study with students from the 8th period of the Medical Course - UNIFENAS - Alfenas. 107 students participated in the study, divided into two groups, according to a diagnostic strategy: reflection x control group. Each of these groups was subdivided into two subgroups according to a diagnostic hypothesis of referral cases: correct hypothesis x plausible hypothesis. Being the correct hypothesis (resolution of clinical cases with the hypothesis of correct referral) and the plausible hypothesis (resolution of the same clinical cases, but with diagnostic hypothesis of plausible referral, but incorrect), resulting in four experimental conditions. The reflection group used structured reflection to solve cases and the control group used free resolution. Results: The percentage of diagnostic confirmation in relation to the diagnostic referral hypothesis found was 74,2% of diagnostic confirmation when the diagnostic hypothesis of referral was correct and 37,8% of diagnostic confirmation when the diagnostic hypothesis of referral was plausible. In the reflection group with a plausible but incorrect diagnostic hypothesis, the structured reflection improved the diagnostic accuracy both in clinical cases with intermediate degree of difficulty (p <0,05) and in difficult clinical cases (p <0,001) when compared with control group with diagnostic hypothesis of plausible referral. Conclusion: It became evident the occurrence of the cognitive bias of diagnostic confirmation in medical students and it was found that the use of the instructional method of structured reflection weakens the diagnostic confirmation bias in the resolution of clinical cases containing a plausible but incorrect diagnostic hypothesis of referral with intermediate or difficult degree of difficulty