BACKGROUND: Recent literature describes "cognitive dispositions to respond" (CDRs) that may lead physicians to err in their clinical reasoning.

OBJECTIVES: To assess learner perception of high-fidelity mannequin-based simulation and debriefing to improve understanding of CDRs.

METHODS: Emergency medicine (EM) residents were exposed to two simulations designed to bring out the CDR concept known as "vertical line failure." Residents were then block-randomized to a technical/knowledge debriefing covering the medical subject matter or a CDR debriefing covering vertical line failure. They then completed a written survey and were interviewed by an ethnographer. Four investigators blinded to group assignment reviewed the interview transcripts and coded the comments. The comments were qualitatively analyzed and those upon which three out of four raters agreed were quantified. A random sample of 84 comments was assessed for interrater reliability using a kappa statistic.

RESULTS: Sixty-two residents from two EM residencies participated. Survey results were compared by technical (group A, n = 32) or cognitive (group B, n = 30) debriefing. There were 255 group A and 176 group B comments quantified. The kappa statistic for coding the interview comments was 0.42. The CDR debriefing group made more, and qualitatively richer, comments regarding CDR concepts. The technical debriefing group made more comments on the medical subjects of cases. Both groups showed an appreciation for the risk of diagnostic error.

CONCLUSIONS: Survey data indicate that technical debriefing was better received than cognitive debriefing. The authors theorize that an understanding of CDRs can be facilitated through simulation training based on the analysis of interview comments.