{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:06:23Z","timestamp":1792112783126,"version":"4.4.0"},"reference-count":49,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T00:00:00Z","timestamp":1580083200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2020,1,16]]},"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Diagnostic errors have often been attributed to biases in physicians\u2019 reasoning. Interventions to \u2018immunise\u2019 physicians against bias have focused on improving reasoning processes and have largely failed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate the effect of increasing physicians\u2019 relevant knowledge on their susceptibility to availability bias.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design, settings and participants<\/jats:title>\n                  <jats:p>Three-phase multicentre randomised experiment with second-year internal medicine residents from eight teaching hospitals in Brazil.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>Immunisation: Physicians diagnosed one of two sets of vignettes (either diseases associated with chronic diarrhoea or with jaundice) and compared\/contrasted alternative diagnoses with feedback. Biasing phase (1 week later): Physicians were biased towards either inflammatory bowel disease or viral hepatitis. Diagnostic performance test: All physicians diagnosed three vignettes resembling inflammatory bowel disease, three resembling hepatitis (however, all with different diagnoses). Physicians who increased their knowledge of either chronic diarrhoea or jaundice 1 week earlier were expected to resist the bias attempt.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measurements<\/jats:title>\n                  <jats:p>Diagnostic accuracy, measured by test score (range 0\u20131), computed for subjected-to-bias and not-subjected-to-bias vignettes diagnosed by immunised and not-immunised physicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Ninety-one residents participated in the experiment. Diagnostic accuracy differed on subjected-to-bias vignettes, with immunised physicians performing better than non-immunised physicians (0.40 vs 0.24; difference in accuracy 0.16 (95% CI 0.05 to 0.27); p=0.004), but not on not-subjected-to-bias vignettes (0.36 vs 0.41; difference \u22120.05 (95% CI \u22120.17 to 0.08); p=0.45). Bias only hampered non-immunised physicians, who performed worse on subjected-to-bias than not-subjected-to-bias vignettes (difference \u22120.17 (95% CI \u22120.28 to \u22120.05); p=0.005); immunised physicians\u2019 accuracy did not differ (p=0.56).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>An intervention directed at increasing knowledge of clinical findings that discriminate between similar-looking diseases decreased physicians\u2019 susceptibility to availability bias, reducing diagnostic errors, in a simulated setting. Future research needs to examine the degree to which the intervention benefits other disease clusters and performance in clinical practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>68745917.1.1001.0068.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2019-010079","type":"journal-article","created":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T17:24:35Z","timestamp":1580145875000},"page":"550-559","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":58,"title":["<b>\u2018<\/b>Immunising\u2019 physicians against availability bias in diagnostic reasoning: a randomised controlled experiment"],"prefix":"10.1136","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1187-2392","authenticated-orcid":false,"given":"S\u00edlvia","family":"Mamede","sequence":"first","affiliation":[{"name":"Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands"},{"name":"Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Antonio","family":"de Carvalho-Filho","sequence":"additional","affiliation":[{"name":"Internal Medicine, State University of Campinas, Campinas, Brazil"},{"name":"Center for Education Development and Research in the Health Professions, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa Malena Delbone","family":"de Faria","sequence":"additional","affiliation":[{"name":"Propeudeutics, Federal University of Minas Gerais, Belo Horizonte, Brazil"},{"name":"Education and Research Center, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Franci","sequence":"additional","affiliation":[{"name":"Internal Medicine, State University of Campinas, Campinas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria do Patrocinio Tenorio","family":"Nunes","sequence":"additional","affiliation":[{"name":"Internal Medicine, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligia Maria Cayres","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Medical Education Development, UNIFENAS Medical School, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Biegelmeyer","sequence":"additional","affiliation":[{"name":"Internal Medicine, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Zwaan","sequence":"additional","affiliation":[{"name":"Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henk G","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands"},{"name":"Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,1,27]]},"reference":[{"key":"2025090409281042000_29.7.550.1","unstructured":"Institute of Medicine . 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