Cognitive debiasing strategies in otorhinolaryngology: a framework for clinical excellence and patient safety

Abstract

To present a comprehensive debiasing framework to mitigate systematic cognitive errors in Otorhinolaryngology Head and Neck Surgery (OHNS), establishing it as a fundamental requirement for patient safety and clinical excellence. This study utilizes a systematic review that identified 71 OHNS-relevant cognitive biases. It evaluates the dual-process theory of cognition, differentiating rapid, intuitive System 1 processing from analytical System 2 deliberation and synthesizes current evidence regarding structural safety protocols, educational mnemonics, and artificial intelligence (AI) applications. Cognitive biases span the entire patient care lifecycle and contribute to approximately 20% of surgical "never events," with confirmation bias being the most prevalent factor. Effective mitigation strategies include cognitive forcing functions such as the WHO surgical checklist, "Stop, Pause, and Agree" protocols, and the SKAIR mnemonic for resident assessments. Furthermore, explainable AI (XAI) and large language models (LLMs) demonstrate significant promise as "second observers" to objectively challenge subjective clinical assessments. Achieving clinical excellence in OHNS requires a paradigm shift from individual awareness to systemic institutional change. By embedding simulation-based education and Bayesian decision-making into daily surgical practice, the specialty can ensure accurate and precise decision-making, though future research is necessitated to experimentally validate these interventions in real-world clinical environments.