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Hindsight bias definition10/27/2022 ![]() ![]() In light of knowledge that the patient progressed to cardiac arrest, it is possible to look back at the simulation and conclude that calling for help early was obvious and would have avoided challenges encountered with the arrest resuscitation. This picture of context-specific complexity contrasts sharply with that of relative simplicity made with hindsight during the debriefing described in our vignette. A learner who is overwhelmed with negotiating competing demands and goals might even overlook the decision-making step of seeking extra assistance for a prolonged period of time. In the face of such a situation, the judgement of when to relinquish immediately valuable and limited human resources to call for help is unlikely to be a clear and easy one. Further, they are to be accomplished when the trajectory of the patient’s progress is uncertain and unknown. These may include assessing and managing the patient’s immediate condition, resolving diagnostic dilemmas, prioritising tasks and deciding when and where to allocate scarce human resources. The decision to call for help is likely to be embedded within a range of potential concerns faced by practitioners in the moment during a clinical situation. As learners demonstrate this step in subsequent simulations, often immediately prompted by any sign of patient deterioration, it is reasonable to think that this learning point was successfully processed. A timely call for assistance can have significant implications to patient morbidity and mortality, and may therefore be considered an important learning point. The situation is likely to resonate with many facilitators during debriefing. The vignette in Box 1 is used to illustrate relevant concepts. These explanations seem to fail to account for the complexity encountered by participants in the simulation. ![]() However, it is our experience that when examining past simulation events (debriefing), there is a tendency for facilitators and learners to construct and accept very simplified explanations for actions and occurrences. After all, management in the context of uncertainty and complexity is surely an indisputable feature of clinical practice. When conducting or observing debriefings, there are occasions where it might be suitable to explore a broad range of factors related to how and why learners managed a simulation scenario the way they did, in the face of uncertainty and complexity. Simulation-based education for complex clinical practice The potential relevance and implications of hindsight bias to SBE are then examined and strategies to mitigate their impact offered. We describe features of the hindsight bias literature, including the broad empirical support base, and the types of populations and contexts where hindsight bias has been investigated. Such demands and goals are context-dependent, and exist under conditions of variable time pressure. Often entailing multiple, dynamic, and sometimes conflicting demands and goals, clinical practice is complex. We have observed that on occasion only limited consideration is given to potentially relevant issues related to the complexities of clinical practice. Using a vignette, the review explores our notion that debriefing is sometimes oversimplified and biased by outcome knowledge. ![]() The purpose of this commentary is to review hindsight bias in simulation-based education (SBE). However, the potential influences of hindsight bias on the nature of reflective processes in this context are unknown, as there is a gap in the literature exploring this issue. Debriefing that includes a deliberate re-examination of simulation experiences is established practice, and studies have investigated methods of promoting learners’ reflections. This can systematically influence perceptions of past events, and therefore potentially the processes of reflection, debriefing, and learning. Hindsight bias can be defined as the tendency to overestimate the foreseeability, inevitability, or likelihood of outcomes after they become manifest and known. ![]()
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