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

Study Overview
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Brief Summary
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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.

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

Conditions
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Emergencies, Implicit Bias

Intervention / Treatment
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* Other: Vignettes


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Emergency physicians or residents, General practitioners, and physicians with experience in disciplinary law. Exclusion Criteria: others

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No outcome provided<br> | Other: Vignettes<br>* Presenting vignettes with fictive cases<br>|
| outcome positive<br> | Other: Vignettes<br>* Presenting vignettes with fictive cases<br>|
| outcome negative<br> | Other: Vignettes<br>* Presenting vignettes with fictive cases<br>|
| implicit bias group<br> | Other: Vignettes<br>* Presenting vignettes with fictive cases<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hindsight bias | The estimate of the chance of getting the negative outcome (0 to 100%). Compared between the group of vignettes without outcome, with a positive outcome and with a negative outcome. | Throughout the study, 1day | 
| Pain medication | Whether pain medication is prescribed (y/n) and how many milligrams. Compared between group of patients with somatic medical history and nonsomatic medical history. | Throughout the study, 1day |