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The effects of rudeness, experience, and perspective-taking on challenging premature closure after pediatric ICU physicians receive hand-off with the wrong diagnosis: a randomized controlled simulation trial

  • Michael Avesar EMAIL logo , Amir Erez , Jenna Essakow , Caulette Young , Binyamin Cooper ORCID logo , Denizhan Akan , Margaret J. Klein , Todd P. Chang and Alyssa Rake
Published/Copyright: November 13, 2020
Diagnosis
From the journal Diagnosis Volume 8 Issue 3

Abstract

Objectives

Rudeness exposure has been shown to inhibit diagnostic performance. The effects of rudeness on challenging a handed-off diagnostic error has not been studied.

Methods

This was a randomized controlled 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.

Results

Among 41 simulations (16 residents, 14 fellows, and 11 attendings), the neutral group challenged the diagnostic error more than the rude group (neutral: 71%, rude: 55%, p=0.28). The magnitude of this trend was larger among resident physicians only, although not statistically significant (neutral: 50%, rude: 12.5%, p=0.11). Experience was associated with a higher percentage of challenging diagnostic error (residents: 31%, fellows: 86%, attendings: 82%, p=0.003). Experienced physicians were faster to challenge diagnostic error (p<0.0003), and experience was associated with a greater frequency of diagnostic error challenges (p<0.0001). High perspective taking scores were also associated with 1.63 times more diagnostic error challenges (p=0.007).

Conclusions

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.

Keywords: critical care; diagnostic error; medical education; pediatrics; rudeness; simulation
Corresponding author: Michael Avesar, MD, Assistant Professor of Pediatrics, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Loma Linda University Children’s Hospital, Suite A1117, 11175 Campus St., Loma Linda CA 92354, USA, E-mail:

Funding source: Children’s Hospital Los Angeles

Award Identifier / Grant number: Critical Care Medicine Department

  1. Research funding: Interdepartmental Funds at Children’s Hospital Los Angeles.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The research was IRB approved at the location of the study, Children’s Hospital Los Angeles/University of Southern California.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2020-0083).

Received: 2020-06-11
Accepted: 2020-09-30
Published Online: 2020-11-13
Published in Print: 2021-08-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2020-0083
Keywords for this article
critical care; diagnostic error; medical education; pediatrics; rudeness; simulation

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Chest pain management and biomarkers: the lack of trust in cardiac troponins measurement
  4. Reviews
  5. Bringing the clinical laboratory into the strategy to advance diagnostic excellence
  6. Atrial fibrillation: is there a role for cardiac troponin?
  7. Opinion Papers
  8. Towards better metainterpretation: improving the clinician’s interpretation of the radiology report
  9. The challenges of diagnosing diabetes in childhood
  10. Guidelines and Recommendations
  11. Measuring patient experience of diagnostic care and acceptability of testing
  12. Original Articles
  13. Clinical assessment of the Roche SARS-CoV-2 rapid antigen test
  14. Delayed treatment of bacteremia during the COVID-19 pandemic
  15. Strengths and weaknesses in the diagnostic process of endometriosis from the patients’ perspective: a focus group study
  16. Identifying trigger concepts to screen emergency department visits for diagnostic errors
  17. Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors
  18. Uncertain diagnoses in a children’s hospital: patient characteristics and outcomes
  19. The effects of rudeness, experience, and perspective-taking on challenging premature closure after pediatric ICU physicians receive hand-off with the wrong diagnosis: a randomized controlled simulation trial
  20. Resident-faculty overnight discrepancy rates as a function of number of consecutive nights during a week of night float
  21. CONUT: a tool to assess nutritional status. First application in a primary care population
  22. Is there a real need for sputum culture for community-acquired pneumonia diagnostics? Results from a retrospective study in Russia
  23. Differentiating solid breast masses: comparison of the diagnostic efficacy of shear wave elastography and magnetic resonance imaging
  24. Short Communication
  25. Chest pain management: use of troponins in internal medicine wards
  26. Case Report
  27. Learning from tragedy – The Jessica Barnett story: challenges in the diagnosis of long QT syndrome
  28. Letters to the Editor
  29. Usability of non-medicinal swabs for SARS-CoV-2 detection to circumvent supply shortages
  30. Medical decision making during the COVID-19 epidemic: an opportunity to think how we think
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