University of Bristol    Bristol Veterinary School

Supervisor: Dr John Fennell

Last Date: Friday, November 15, 2024

Competition Funded PhD Project (Students Worldwide)

About the Project

Background:

Cognitive biases describe unconscious, automatic processes that tend to help us to get stuff done, enabling quicker and more efficient decision-making in many contexts. However, despite their benefit in much of what we do, they are not effective where a slower, more deliberative approach is needed. This is particularly true in medical and veterinary contexts. As a natural product of human nature, biases are typically difficult to identify and control. A wealth of literature has identified and analysed them, with >180 biases documented.

The central idea for this PhD is identification and reduction of cognitive bias in vets post qualification, with the ultimate goal of improving outcomes for patients. While there has been some work on biases in medical diagnosis, it is perhaps less extensive than might be expected and there is little that relates to vets and the veterinary profession.

Aims and objectives:

We envisage that the aims of the PhD will be met in collaboration with BVS and veterinary practices. It follows on from preliminary research carried out by the primary supervisor in collaboration with Bristol Royal Infirmary (O’Hagan et al. 2019) and will be extended into an existing veterinary collaboration network. While this research focuses on veterinary scenarios, it has broad applicability, in particular management contexts and accordingly, we include a co-supervisor from Bristol Business School.

O’Hagan et al. (2019)

https://doi.org/10.7861/futurehosp.6-1-s113

The aims and objectives for the PhD will include

·       Investigate reduction of bias before it becomes and entrenched part of everyday practice. Most literature only offers very general advice on bias reduction that could be used in diagnosis​. There is little empirical research on actively introducing bias reduction based on psychological principles and measuring effectiveness.

·       Aiming interventions at early career vets is important because they are under a great deal of pressure during this period of their career and together with inevitable time pressures, means that these vets are highly susceptible to cognitive bias​​ and potentially making mistakes (this also applies to medics more generally).

·       Significantly, there has been no attempt, that we know of, to provide an aid to decision making in diagnosis that is context sensitive.

Methods:

·   Assess cognitive bias in veterinary students (ideally all years, 1-5), new vets in practice and experienced vets in practice, in order to demonstrate cognitive biases at all careers stages, in particular using examples of framing, anchoring and noise.

·   Investigate morbidity/mortality data from critical instances to identify bias as a potential cause of error in diagnosis/treatment.

·   Design interventions using a simple and general structure, with the aim to reduce errors related to cognitive bias. The details of each action taken for a patient requires a set of specific judgments about the case. Each judgment must be based on considering the pertinent facts and these facts must be learned. Very broadly, judgements and fact gathering is organised to prevent framing and anchoring of current information by previously gathered information.

·   Assess whether the interventions are effective?

·   Consider suggestions for additions to the undergraduate curriculum that might ameliorate the effects of bias.

Key references:

1.   Kahneman, D. Thinking, Fast and Slow. (Farrar, Straus and Giroux, 2011).

2.   Tversky, A. & Kahneman, D. Rational choice and the framing of decisions. Journal of business 251–278 (1986).

3.   Tversky, A. & Kahneman, D. The framing of decisions and the psychology of choice. Science 211, 453–458 (1981).

4.   Kahneman, D. & Tversky, A. Prospect theory: An analysis of decision under risk. Econometrica 263–291 (1979).

5.   Tversky, A. & Kahneman, D. Advances in prospect theory: Cumulative representation of uncertainty. J Risk Uncertain 5, 297–323 (1992).

6.   Kahneman, D., Slovic, P. & Tversky, A. Judgement under Uncertainty: Heuristics and Biases. Science (Cambridge University Press, 1982).

7.   Croskerry, P. ED cognition: Any decision by anyone at any time. Canadian Journal of Emergency Medicine 16, 13–19 (2014).

8.   Croskerry, P. A universal model of diagnostic reasoning. Acad Med 84, 1022–1028 (2009).

9.   Croskerry, P. Diagnostic Failure : A Cognitive and Affective Approach. Advances 14 (2005) doi:10.1037/e448242006-001.

10. Kipperman, B. Diagnostic Errors. 179–187 (2023) doi:10.1002/9781119986355.CH19.

11. Turner, M. From the Side-lines to the Spotlight: Confronting Bias in Veterinary Medicine. RCVS Knowledge https://knowledge.rcvs.org.uk/about-us/news-and-events/features/from-the-side-lines-to-the-spotlight-confronting-bias-in/ (2024).

12. Vinten, C. E. K. Clinical reasoning in veterinary practice. Veterinary Evidence 5, (2020).

13. McKenzie, B. A. Veterinary clinical decision-making: cognitive biases, external constraints, and strategies for improvement. J Am Vet Med Assoc 244, 271–276 (2014).

Supervisors:

Dr John Fennell (BVS), Dr Laszlo Talas (BVS), Dr Jasmina Stevanov (BBS).

How to apply:

Please visit the Bristol Veterinary School website Funded 4-year PhD Scholarship | Bristol Veterinary School | University of Bristol for details of how to apply and the information you must include in your application. If your application is shortlisted, you will be invited to interview on or before 17th January. Interviews will take place on Microsoft Teams on 29th January. Start date September 2025.

Candidate requirements: Standard University of Bristol eligibility rules apply. Please visit PhD Veterinary Sciences | Study at Bristol | University of Bristol for more information.

Contacts: please contact fohs-pgadmissions@bristol.ac.uk with any queries about your application. Please contact the project supervisor for project-related queries john.fennell@bristol.ac.uk

Funding Notes The studentship is available to UK and International applicants. This studentship is for a four-year PhD, funded through a University of Bristol “Bristol Veterinary School” scholarship. It consists of a waiver of tuition fees, as well as a tax-free stipend matching UK Research Council National Minimum (£19,237 p.a. for 2024/25, updated each year)