Development of a test of cognitive bias in medical decision making

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Abstract
PURPOSE . To develop an inventory to measure the influence of cognitive biases on medical decisions . METHOD . The Inventory of Cognitive Biases in Medicine ( ICBM ) consists of 22 medical scenarios in which respondents choose between alternatives that represent bias-prone or statistically based decisions . In 1992 and 1993 the ICBM was administered to 102 medical students and residents and 318 physician faculty at the Wright State University School of Medicine . RESULTS . The statistically correct decision was made in fewer than half the ICBM scenarios for both groups ( students and residents , 41 %; faculty , 49 %); and only the faculty scored better than chance . Acceptable reliability ( KR 20 = . 62 for the faculty administration ) and item discrimination ( mean = . 49 ) were achieved . Further , the results suggest that the ICBM has both content and construct validity . CONCLUSION . The rather poor performances of the students and residents and the faculty on the ICBM suggest that cognitive biases constitute an important detraction from reliance on logical and statistical strategies . The ICBM shows promise for use as a tool in both instructional and research endeavors attempting to minimize and elucidate this phenomenon .

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