Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Nov 13;8(3):358-367.
doi: 10.1515/dx-2020-0083. Print 2021 Aug 26.

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  1 , Amir Erez  2 , Jenna Essakow  3 , Caulette Young  3 , Binyamin Cooper  4 , Denizhan Akan  3 , Margaret J Klein  3 , Todd P Chang  3 , Alyssa Rake  3
Affiliations
Randomized Controlled Trial

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 et al. Diagnosis (Berl). .

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.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Havens, DH, Boroughs, L. “To err is human”: a report from the Institute of Medicine. J Pediatr Health Care 2000;14:77–80. https://doi.org/10.1067/mph.2000.105383.
    1. Aspden, P, Wolcott, J, Bootman, JL, Cronenwett, LR, editors. Institute of Medicine (U.S.). Committee on Identifying and Preventing Medication Errors. Preventing medication errors. Washington, DC: National Academies Press; 2007.
    1. Bates, DW, Singh, H. Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Aff 2018;37:1736–43. https://doi.org/10.1377/hlthaff.2018.0738.
    1. James, JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf 2013;9:122–8. https://doi.org/10.1097/pts.0b013e3182948a69.
    1. Newman-Toker, DE, Pronovost, PJ. Diagnostic errors–the next Frontier for patient safety. J Am Med Assoc 2009;301:1060–2. https://doi.org/10.1001/jama.2009.249.

Publication types

LinkOut - more resources