Medical Decision-Making

In the clinical setting, the decision-making process employed by physicians must be as reflective, unbiased, and purposefully thoughtful as is humanly possible. This decision-making process should be informed by the specific circumstances of each individual patient, calibrated by relevant findings of evidence, and mindful of the pitfalls of cognitive biases and conflicts of interest.

Columbia University Vagelos College of Physicians and Surgeons (VP&S) is committed to providing students with opportunities to develop the knowledge, skills, and attitudes necessary for effective medical decision-making. Throughout their four years of medical school, VP&S students participate in educational activities focused on the learning objectives of the medical decision-making process. These activities are organized as a thematic thread that is woven into the curriculum.

There are four major themes in the medical decision-making thread: Clinical reasoning and decision analysis, processes utilized in nearly every patient encounter to make a diagnosis and choose an appropriate therapy; and conflicts of interest and cognitive biases, unconscious influences that routinely threaten to undermine optimal decision-making. The table below lists the thread's themes, topics, and locations within the MD curriculum, as well as the curriculum phases: Fundamentals (FND), Major Clinical Year (MCY), or Differentiation and Integration (D&I).

Theme Topic Location in Curriculum Phase
Clinical Reasoning Introduction Foundations of Clinical Medicine FND
Clinical Reasoning Slow and Fast Thinking Mechanisms and Practice MCY
Decision Analysis Decision Trees Mechanisms and Practice MCY
Decision Analysis Sensitivity Analysis Ready 4 Residency D&I
Cognitive Biases Recognition of Biases Mechanisms and Practice MCY
Cognitive Biases Managing Biases Ready 4 Residency D&I
Conflicts of Interest Overview Foundations of Clinical Medicine FND
Conflicts of Interest Managing Conflicts Mechanisms and Practice MCY