Outcome, Hindsight and Implicit Bias in Emergency Medicine and Medical Disciplinary Law.

NCT ID: NCT05424497

Last Updated: 2022-06-21

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 350 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2022-06-16
• Study Completion Date: 2023-12-31

Brief Summary

Background Hindsight bias and outcome bias may play an important role in retrospective law of errors in Emergency Medicine and may affect judgement. In addition, differences in sex and medical history may affect treatment decisions (implicit bias).

Aims First, to assess if and to what extent knowledge of an outcome may affect the ability of Emergency Physicians and physicians with experience in disciplinary law to determine the quality of care given. Secondly, to investigate whether a medical history with nonspecific/functional/somatoform complaints and sex differences affect clinical decision making in Emergency Physicians.

Study design and analyses A web-based cross-sectional survey using vignettes with six clinical scenarios (four vignettes for outcome/hindsight bias, four vignettes for implicit bias). The survey was sent to all Emergency Physicians and residents in training in the Netherlands. Four scenarios were also sent to physicians with experience in disciplinary law. In four vignettes, participants received a scenario without an outcome, or with a positive or negative outcome. They were asked to rate the quality of care provided as sufficient or insufficient and, in more detail, poor/below average/average/good/outstanding and how likely they thought it would be that the patient would have had a negative outcome (in percent). In the other two vignettes, participants received one vignette describing a scenario of a patient presenting to the ED with acute abdominal pain and one vignette describing a scenario with chest pain. The sex and medical history differed among the participants (e.g. male/female, nonspecific medical history/somatic medical history). Participants were asked whether they would prescribe pain medication, and whether they would do diagnostic imaging.

Importance and impact This research may help to understand the impact of knowing the outcome in retrospective laws in Dutch Emergency Physicians and physicians with experience in disciplinary law. If outcome and hindsight bias are present, retrospective judgement may need a different approach in medicine, i.e. blinding judges for the outcome, to prevent wrong justice and adverse effect on clinicians well-being. Also, if implicit bias in sex and medical history is present, a training programme is needed to reduce certain bias and to improve equality in the provided care.

Conditions

Emergencies; Implicit Bias

Study Design

• Observational Model Type: CASE_CONTROL
• Study Time Perspective: PROSPECTIVE

Study Groups

No outcome provided

Vignettes

Intervention Type: OTHER

Presenting vignettes with fictive cases

outcome positive

Vignettes

Intervention Type: OTHER

Presenting vignettes with fictive cases

outcome negative

Vignettes

Intervention Type: OTHER

Presenting vignettes with fictive cases

implicit bias group

Vignettes

Intervention Type: OTHER

Presenting vignettes with fictive cases

Interventions

Vignettes

Presenting vignettes with fictive cases

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Emergency physicians or residents, General practitioners, and physicians with experience in disciplinary law.

Exclusion Criteria

• others

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 100 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Maxima Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Bart Candel

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Other Identifiers

N22.025

Identifier Type: -

Identifier Source: org_study_id