Clinical trial NCT05424497: Outcome, Hindsight and Implicit Bias in Emergency Medicine and Medical Disciplinary Law.
Official title: Outcome, Hindsight and Implicit Bias in Emergency Medicine and Medical Disciplinary Law.
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Emergencies
Implicit Bias
Lead sponsor: Maxima Medical Center
Sponsor class: OTHER
First posted: 2022-06-21
Enrollment: 350
Sex: ALL
Minimum age (years): 18
Maximum age (years): 100
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Emergency physicians selected through email plus physicians with experience in disciplinary law.

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.


Eligibility criteria: Inclusion Criteria:

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

Exclusion Criteria:

* others

Primary outcomes:
measure: Quality of care
timeFrame: Throughout the study, 1day
measure: Diagnostic imaging
timeFrame: Throughout the study, 1day
Secondary outcomes:
measure: Hindsight bias
timeFrame: Throughout the study, 1day
measure: Pain medication
timeFrame: Throughout the study, 1day
Other outcomes:
Locations:
Study officials:
References: