Image credit: fiercehealthcare.com

The Effects of Rudeness, Experience, and Perspective-taking on Challenging Hand-off with the Wrong Diagnosis: A Randomized Simulation Trial

Image credit: fiercehealthcare.com

The Effects of Rudeness, Experience, and Perspective-taking on Challenging Hand-off with the Wrong Diagnosis: A Randomized Simulation Trial

Abstract

This study involves examining the effect of rudeness on whether a physician subsequently challenges a diagnosis that has been handed off to them in a simulated pediatric ICU. It also looks at experience and perspective taking. While rude exposure has been shown to inhibit diagnostic performance, the effects of rudeness on challenging a handed-off diagnostic error has not been studied. We deployed a randomized-control study of attending, fellow, and resident physicians in a tertiary care pediatric ICU. Participants underwent a standardized simulation that started with the wrong diagnosis in hand-off. The hand-off was randomized to neutral vs rude. Participants were not informed of the randomization nor diagnostic error prior to the simulation. Perspective taking questionnaires were administrated for each participant. Primary outcome was challenging diagnostic error post-simulation. Secondary outcomes included rate and frequency of diagnostic error challenge during simulation. Among 41 simulations (16 residents, 14 fellows, and 11 attendings), the neutral group challenged the diagnostic error more than the rude group neutral. The magnitude of this trend was larger among resident physicians only, although also not statistically significant. Experience was associated with a higher percentage of challenging diagnostic error. Experienced physicians were faster to challenge diagnostic error, and experience was associated with a greater frequency of diagnostic error challenges. High perspective taking scores were also associated with 1.63 times more diagnostic error challenges. Experience was strongly associated with likelihood to challenge diagnostic error. Rudeness may disproportionally hinder diagnostic performance among less experienced physicians. Perspective-taking merits further research in possibly reducing diagnostic error momentum.

Publication
Diagnosis