Teaching common cognitive biases and associated errors in veterinary neurologic diagnosis using clinical vignettes: a narrative review

Clinical evaluation and management of veterinary patients is a human endeavor and therefore dependent on the capacity and limitations of human cognition in forming clinical opinions of patient health and decisions relative to patient care. Consequently, numerous cognitive biases are pervasive in the clinical evaluation of animal patients. These biases include, but are not limited to, representativeness bias, confirmation bias, availability bias, selection bias, and overconfidence bias. While these mental constructs can support positive patient outcomes through rational thinking, recognition of common clinical patterns, and intuitive experiences, in other instances these cognitive biases can contribute to cognitive error and medical decision-making mistakes. The astute clinician is cognizant of when cognitive bias becomes a cognitive limitation to compensate for, and ideally avoid, the potential negative consequences of these decision-making strategies. Most importantly, these mental phenomena can and should be formally taught to veterinary students as a component of learning the clinical method, so developing clinicians become familiar with these important influences on clinical thinking as they cultivate their clinical acumen. This narrative review explores teaching common clinical judgment biases using contextual clinical case vignettes which illustrate the operational dynamics associated with these biases during clinical assessments. By identifying and actively debriefing on how clinical thinking paradigms influence case situational dynamics, aspiring clinicians will improve their clinical judgment benefiting clinical science, patient care, and ultimately, patient safety.