Common Cognitive Biases Among Student Pharmacists

Cognitive biases have been recognized as contributors to a number of events, from unintended detention of foreign objects (search satisfactory bias), wrong site surgeries (confirmation bias), and patient accidents/falls (availability bias). There are also diagnostic errors, which eventually leads to a delay in treatment (anchoring, framing bias). According to literature, diagnostic errors are associated with 6-17% of adverse events in hospitals, and 28% of errors have been associated with cognitive errors.

There are two processes in thinking and decision-making that describes how cognitive biases are perceived. The process known as System I, is associated with the unconscious, automatic, “fast” thinking, whereas the systematic process, known as System II, is calculated, thorough, “slow” thinking. Much of today’s daily activities are achieved either by slow or fast thinking. We tend to use more of the fast thinking in our daily routines such as driving to class, looking at facial expressions, and working out problems. Fast thinking is often very convenient, however it is flawed and predisposed to judgment-cognitive biases. This project is a survey to determine which cognitive biases are most often committed by student pharmacists.

Student pharmacists are able to participate in leadership roles throughout the pharmacy curriculum such as class presidents, student organization officers, class representatives, and secretaries. All pharmacists will have to manage and lead in day-to-day professional lives. Part of this leadership will be to cross-cultural norms and find ways to help any patient and any learner. This research will help to start the body literature on cognitive biases in pharmacy students to help academicians teach cultural competencies.

Methods

This study consisted of a survey through Qualtrics online survey software. All pharmacy students within a college of health science were invited to take part in this study via email. Demographic information obtained included: year of pharmacy school, if pharmacy is a second career, highest level of education, self-identification as a leader, involvement in a pharmacy professional organization, leadership roles in organizations, dual degree student (Master of Business Administration, Master of Public Health, and Master of Science in Health Informatics), experience with Dobelli, and estimated number of perceptual biases. A five-point Likert Scale was used to quantitatively assess the principles of various cognitive biases. The list of biases is adapted from Rolf Dobelli's "The Art of Thinking Clearly. " The Dobelli list is an aggregate of ninety-nine cognitive biases. The list was divided into a matrix style question with each matrix consisting of nine of the biases, a brief description of each bias, and then the Likert Scale. The Likert Scale was strongly agree to strongly disagree whether or not the respondent committed the bias (intentionally or not). A sixth option was available as “no idea what this is. ” A reminder email was sent on day seven and fourteen.

Results

The survey was sent to 477 pharmacy students. Only 128 students responded, 86 (68%) completed the survey and 2 (2%) did not consent. There were 72 (84%) student pharmacists that self-identified themselves as a leader. Every student committed at least a few biases, all ninety-nine biases were committed, and no student selected strongly disagreed to any bias. Students ranked each bias strongly agree or agree with an average of 68%. The most frequently agreed upon bias was the Availability bias 55 (64%) participants. Students from all four academic years participated, but most were P4 students (n = 13, 15%). Most students stated that pharmacy is not a second career (n = 29, 34%), and the same number identified as a leader (n = 29, 34%). No student had read The Art of Thinking Clearing. The number of self-identified perceptual biases ranged from five to millions. The cognitive bias that pharmacy students agreed upon was procrastination (n = 13, 15%) while the most disagreed bias was the illusion of control (n = 4, 5%). There was also a high percentage of students that were completely unaware of the Will Rodgers phenomenon (n= 17, 20%).

The recognition of literature on cognitive biases increases awareness among all healthcare providers. The involvement of training in cognitive biases in pharmacy programs might increase medical education and perceptions, which may improve health care overall. A self-serving bias can be extrapolated from the 72 student pharmacists that self-identified as a leader yet only 32 students reported holding current leadership roles. Out of a total of 99 biases, 52 agreed to all 99; whereas, 34 either disagreed completely or varied amongst biases.

A limiting to the study was a failure for all respondents to complete the entirety of the survey. This project shows the wide range of perceptual biases within pharmacy students. Future aims include determining trends in perceptual biases. Applying this data to pharmacy education will help students be able to avoid cognitive traps, and become a better leader. This data will also provide a better understanding of different backgrounds and how leaders will adapt to different scenarios.

In this study, most pharmacy students consider themselves leaders and were a part of an organization with a leadership role, yet committed multiple perceptual biases. These biases could impact leadership potential and the ability to make responsible decisions.

Conclusion

This survey adds to the body of literature by integrating cognitive biases in cultural competencies. This data also provides a better understanding of different cultural backgrounds and adaptations to different scenarios.