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February 2020 SEA-Q


While preparing for a presentation on regional anesthesia, a resident selectively includes papers into the presentation that support the utilization of regional anesthesia. Of note: the resident is interested in pursuing a regional anesthesia fellowship. You are providing feedback about the presentation and report that the resident is demonstrating:

  • A.) Transference (Visceral) Bias
  • B.) Confirmation Bias
  • C.) Omission Bias
  • D.) Retrospective Bias

B.) In this question, the presenter is demonstrating confirmation bias.


Everyone is prone to bias. Having a working knowledge about potential bias is important in ensuring that the impact of bias is minimized. In this question, the presenter is demonstrating confirmation bias. Confirmation bias is defined as a tendency toward only seeking or seeing information that supports a hypothesis or diagnosis rather than information that refutes it. As highlighted in this stem, because the presenter is interested in regional anesthesia, he/she has preferentially included studies that demonstrate the advantages of regional anesthesia and dismissed those that demonstrate negative findings. This will lead to an unbalanced presentation of the evidence and can lead to errors in clinical decision making, as the safety profile and efficacy of regional anesthesia will be overstated.

The other biases mentioned, although important, do not conform to the stem. Transference or visceral bias is the tendency to allow personal feelings about the patient to interfere with clinical judgement. This is often seen in pediatric cases or in instances of “VIP Syndrome”. Omission bias is the tendency towards inaction rather than action, for fear of causing harm to the patient or to one’s sense of self; for example, not performing an awake intubation for fear of causing trauma to the patient, or because of feeling uncomfortable performing a task that may not go smoothly. Finally, Retrospective bias, also known as Hindsight bias, is the tendency to view events as being more predictable than they were at that time. Knowing the outcome of the event may make a correct action seem incorrect if the patient had a poor outcome, or vice versa. This type of bias is often present in performance improvement work.


  • Andrews, M. A., Kelly, W. F., & DeZee, K. J. (2018). Why Does This Learner Perform Poorly on Tests? Using Self-Regulated Learning Theory to Diagnose the Problem and Implement Solutions. Academic Medicine, 93(4), 612-615.
  • Artino, A. R., Cleary, T. J., Dong, T., Hemmer, P. A., & Durning, S. J. (2014). Exploring clinical reasoning in novices: a self-regulated learning microanalytic assessment approach. Medical Education, 48(3), 280-291. 
  • Cleary, T. J., Sandars, J. (2011). Assessing self-regulatory processes during clinical skill performance: A pilot study. Medical Teacher, 33, e368–e374. 
  • DiBenedetto, M. K., & Zimmerman, B. J. (2010). Differences in self-regulatory processes among students studying science: A microanalytic investigation. The International Journal of Education and Psychological Assessment, 5, 2-24. 
  • Leggett, H., Sandars, J., & Burns, P. (2012). Helping students to improve their academic performance: A pilot study of a workbook with self-monitoring exercises. Medical Teacher, 34(9), 751-753.
  • Lucey, C. R., & Boote, R. M. Working with Problem Residents: A Systematic Approach. In: Holmboe, E. S., & Hawkins, R. E. eds. (2008). Working with Problem Residents: A Systematic Approach. In Practical Guide to the Evaluation of Clinical Competence. Philadelphia, PA: Mosby, Inc. 
  • Zimmerman, B. J. Attaining self-regulation: A social-cognitive perspective. In: Boekaerts, M., Pintrich, P., & Zeidner, M., eds. (2000).  Handbook of self-regulation. Orlando, PA: Academic Press, 

Author Information:

Daniel Katz, MD
Vice Chair of Education 
Associate Professor
Department of Anesthesiology, Pain, & Perioperative Medicine
Icahn School of Medicine at Mount Sinai

Dr. Katz is an associate professor and vice chair of education in the Department of Anesthesiology, Pain, and Perioperative Medicine at the Icahn School of Medicine at Mount Sinai. He is also the Director of Education of the Mount Sinai HELPS center. His research focuses on human factors and crisis resource management as well as on education in novel environments including serious games and virtual/mixed reality. In the clinical research arena Dr. Katz’s area of interest included hemostasis and coagulation as well and the quantification of blood loss for labor and delivery.


The SEA is proud to be a member-driven organization, dedicated to the teaching and development of future anesthesiologists, and to the advancement of those who educate them.

Contact Info:

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