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

NCT05424497 | Unknown

• 1 other identifier: N22.025
• Study Type: observational
• Target: 350
• Locations: 0 countries
• Sites: N/A

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

Outcome Measures

Primary Outcomes (2)

• Quality of care

  The quality of care rated on a likert scale from 1 to 5 will be assessed for 4 fictive cases. The mean will be compared for each case without outcome, with positive outcome, and with negative outcome.

  Throughout the study, 1day

• Diagnostic imaging

  Whether the physician would perform diagnostic imaging after reading the vignette. The The outcome will be compared for vignettes including a somatic medical history with the vignettes with a nonsomatic medical history.

  Throughout the study, 1day

Secondary Outcomes (2)

• Hindsight bias

  Throughout the study, 1day

• Pain medication

  Throughout the study, 1day

Study Arms (4)

No outcome provided

Other: Vignettes

outcome positive

Other: Vignettes

outcome negative

Other: Vignettes

implicit bias group

Other: Vignettes

Interventions

Vignettes OTHER

Presenting vignettes with fictive cases

No outcome provided; implicit bias group; outcome negative; outcome positive

Eligibility Criteria

• Age: 18 Years - 100 Years
• Gender Eligibility Details: differences in sex in judgement and vignettes
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Emergency physicians selected through email plus physicians with experience in disciplinary law.

You may qualify if:

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

You may not qualify if:

• others

Sponsors & Collaborators

• Maxima Medical Center: lead

MeSH Terms

Conditions

Emergencies; Bias, Implicit

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Prejudice; Social Behavior; Behavior

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: June 7, 2022
• First Posted: June 21, 2022
• Study Start: June 16, 2022
• Primary Completion: December 31, 2022
• Study Completion: December 31, 2023
• Last Updated: June 21, 2022

Record last verified: 2022-06

Data Sharing

• IPD Sharing: Will not share