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0088 Exploring the nontechnical skills of cognitive and personal bias to improve clinical skills and risks assessments
  1. Zainab Jabur1,2,
  2. Chris Attoe1,2
  1. 1Maudsley Centre for Mental Health Simulation, London, UK
  2. 2King’s College London, London, UK


Background Cognitive bias is the tendency to make decisions or take action in an illogical way. According to Borstein and Emler, “The simplest approach to improving doctors’ decision making is to educate them about the existence of the biases...”Our course explores subjectivity and bias in mental health settings and reinforce evidence-based guidelines for clinical practice.

Methodology The course was developed by senior clinicians and is made up of three scenarios, designed to be uncertain cases of increasing difficulty. Participants were tasked with taking a targeted history and performing a risk assessment. The debrief followed the decision making cycle and culminated in a treatment decision made by the group, which then was portrayed in the next scenario. Data was collected on treatment decisions. Participants were asked to complete anonymised questionnaires that explored their internal thought process throughout the patient presentations as well as pre and post course self-assessments. Questions consisted of Likert-style questions and open responses.

Results/outcomes Course was run 11 times in the last year.

N = 94 (Multidisciplinary mental health clinicians)

Results showed that there is not inter-patient consistency in practice with treatment decisions in respect to symptomology and current risk assessment and participant’s stated reasoning. Decisions appear to be more closely linked to perceptions about patient.

There was also a statistically significant increase in familiarity of decision making steps and familiarity with bias as well as self-reported increase in exploration of these factors.

Qualitative themes showed a changed in focus less narrowly on perceived risk and safety and more towards building a complete picture of the patient and relevant decisions from the information and fact gathering.

Conclusions and recommendations Further research into the different aspects of the clinical decision making are clearly indicated. There are also possibilities for further development of simulation of clinical decision making to other clinical specialties.


  1. Bornstein BH, Emler AC. Rationality in medical decision making: a review of the literature on doctors’ decision-making biases. J Eval Clin Pract. 2001;4(7):97–107

  2. Round A. Introduction to clinical reasoning. J Eval Clin Pract. 2000;7(2):109–117

  3. Muslin SB, Greene HL. Decision making in medicine, an algorithmic approach. 2010;656–685

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