Improving decision-making and cognitive bias using innovative approaches to simulated scenario and debrief design

Publication piece on simulation training to tackle bias in clinician decision making

Jabur, Z., Lavelle, M., & Attoe, C. (2020)


  • Clinicians tend to focus on finding the right decision rather than understanding the decisionmaking process that influences actions.
  • Participants often appeared to have made decisions regarding risk and treatment before the scenarios began, although they were unaware of this.
  • There were large shifts in clinical decisions from pre to post debrief discussion, indicating the influence of others in group decision-making and the impact of open discussions around cases and the decision-making processes.
  • Participants were able to recognise how biases and preconceptions caused them to shortcut the full process and miss potentially important information that would impact clinical care and risk management.




Over the last 20 years, healthcare systems globally have reduced the number of acute inpatient psychiatry beds, diverting resources to community-based teams.  When patients are in crisis, they are assessed by multidisciplinary mental health teams. Mental health professionals must balance the potential costs and benefits of several courses of action. However, clinicians appear not to use the same process to make decisions or agree on treatment options. Clinicians tend to focus on finding the right decision rather than understanding the decisionmaking process that influences actions. Many different factors, including bias, contribute to variability in clinical decision-making, with some clinical presentations managed more consistently than others.


To address subjectivity and bias in practice, bring clinical practice in line with evidence-based guidelines, and improve clinical decision-making, a simulation course was developed and piloted. The cognitive processes and biases that underpin decision-making were the focus of the course, including scenarios and debriefing, rather than core clinical or technical information. Participants (n =33) were trainee psychiatrists, mental health nurses, and social workers.


The course feedback has been very positive thus far with extremely positive word of mouth, feedback and ongoing demand. Participants lauded having the opportunity for a forum to explore and examine their personal biases, while being able to see, for the first time, the consequences of clinician decisions to patient care. We are analysing the outcomes observed in the course, examining factors that accounted for differences in clinical practice.


There is a great potential for further development of this course, including a more advanced level for more senior clinicians such as senior consultants and on call bed managers. In addition, we hope to be able to adapt the course to other clinical specialties in medicine as well as potentially branching it out to non-medical fields, such as business, law, other areas if academia, where similar factors seem to be at play.

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