Supervision of students may protect academic physicians from cognitive bias: a study of decision making and multiple treatment alternatives in medicine.

OBJECTIVE: To determine how professional characteristics and practices of physicians alter the selection of medical treatments involving multiple alternatives. Situations involving multiple alternatives can increase the difficulty of making a decision, resulting in more choice deferral than when fewer alternatives are available. DESIGN, SETTING, PARTICIPANTS: A survey and scenario were mailed to a random sample of 314 primary and emergency care physicians affiliated with the Indiana University Medical Center. Using a scenario involving treatment decisions for a patient with osteoarthritis, the effects of multiple treatment alternatives on decision making were explored. Other physician factors included experience, workload, fatigue, continuing education, and supervision. MAIN OUTCOME MEASURES: Physicians' treatment decisions. RESULTS: Physician response was 61% (n = 192). In contrast to previous studies, physicians in the present study were equally likely to prescribe a new medication, regardless of whether they were deciding about 1 medication or between 2 similar medications (54.5% v. 56.0%, P = 0.841). However, physicians who supervise medical students were far less influenced by the cognitive bias associated with multiple choices than those who did not supervise medical students. Supervising physicians were more likely to defer making a decision when there was only 1 treatment option than when there were 2 (49.3% v. 37%, P = 0.143), whereas the opposite was true for nonsupervising physicians (33.3% v. 63%, P = 0.040). The number of hours spent supervising medical students and the number of years as a physician were also important factors in the decision-making process. CONCLUSIONS: Multiple treatment alternatives may result in a deferral of choice. However, this cognitive bias is attenuated by experience and supervision, thus enhancing decision making. Implicit and explicit learning gained through experience and the supervisory process appears to be a central mechanism by which the physicians are protected from this cognitive bias.