A review of current approaches for evaluating impaired performance in around-the-clock medical professionals

Huizinga, Coen R.H.; Tummers, Fokkedien H.M.P.; Mheen, Perla J Marang-van de; Cohen, Adam F.; Bogt, Koen E.A. van der

doi:10.1016/j.smrv.2019.04.007

Cited by 7 publications

(2 citation statements)

References 126 publications

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“…A relevant alignment of confidence on accuracy stands as a key parameter in bridging the gap between uncertainty, confidence and clinical challenges (Zwaan & Hautz, 2019). Indeed, clinicians sometimes seem unable to accurately self-assess their fitness-to-perform (Davis et al, 2006;Huizinga et al, 2019) and more likely than other professionals to underestimate the impact of stress and fatigue on their own practice, and their risks of committing errors (Klein, 2005;Sexton et al, 2000).…”

Section: Metacognition Confidence and (Mis)calibration In Clinical De...mentioning

confidence: 99%

Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey

et al. 2023

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Healthcare professionals’ statistical illiteracy can impair medical decision quality and compromise patient safety. Previous studies have documented clinicians’ insufficient proficiency in statistics and a tendency in overconfidence. However, an underexplored aspect is clinicians’ awareness of their lack of statistical knowledge that precludes any corrective intervention attempt. Here, we investigated physicians’, residents’ and medical students’ alignment between subjective confidence judgments and objective accuracy in basic medical statistics. We also examined how gender, profile of experience and practice of research activity affect this alignment, and the influence of problem framing (conditional probabilities, CP vs. natural frequencies, NF). Eight hundred ninety-eight clinicians completed an online survey assessing skill and confidence on three topics: vaccine efficacy, p value and diagnostic test results interpretation. Results evidenced an overall consistent poor proficiency in statistics often combined with high confidence, even in incorrect answers. We also demonstrate that despite overconfidence bias, clinicians show a degree of metacognitive sensitivity, as their confidence judgments discriminate between their correct and incorrect answers. Finally, we confirm the positive impact of the more intuitive NF framing on accuracy. Together, our results pave the way for the development of teaching recommendations and pedagogical interventions such as promoting metacognition on basic knowledge and statistical reasoning as well as the use of NF to tackle statistical illiteracy in the medical context.

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Section: Metacognition Confidence and (Mis)calibration In Clinical De...mentioning

confidence: 99%

Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey

et al. 2023

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“…Doctors that regularly work at night are more prone to chronic diseases [ 2 ], sleeping disorders [ 3 ], and burnout [ 5 ]. Due to sleep loss and circadian misalignment, shift work also associates with fatigue, reduced alertness and impaired psychomotor and cognitive performance [ 6 – 11 ]. Consequently, doctors that regularly work night shifts are more likely to make significant medical errors due to the effects of these shifts [ 5 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Doctors’ alertness, contentedness and calmness before and after night shifts: a latent profile analysis

Debets,

Tummers,

Silkens

et al. 2023

Hum Resour Health

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Background While night shifts are crucial for patient care, they threaten doctors’ well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate the adverse effects of night shifts. This study aimed to obtain more precise insight into doctors’ feelings surrounding night shift by: identifying profiles based on doctors’ alertness, contentedness and calmness scores before and after night shifts (research question (RQ) 1); assessing how doctors’ pre- and post-shift profiles change (RQ2); and determining associations of doctors’ demographics and shift circumstances with alertness, contentedness and calmness change (RQ3). Methods Latent Profile Analysis using doctors’ pre- and post-shift self-rated alertness, contentedness and calmness scores was employed to identify pre- and post-shift profiles (RQ1). A cross-tabulation revealed pre- and post-shift profile changes (RQ2). Multiple regressions determined associations of demographics (i.e. age, sex, specialty) and night shift circumstances (i.e. hours worked pre-call, hours awake pre-call, shift duration, number of consecutive shifts, total hours of sleep) with alertness, contentedness and calmness change (RQ3). Results In total, 211 doctors participated with a mean age of 39.8 ± 10 years; 47.4% was male. The participants included consultants (46.4%) and trainees (53.6%) of the specialties surgery (64.5%) and obstetrics/gynaecology (35.5%). Three pre-shift (Indifferent, Ready, Engaged) and four post-shift profiles (Lethargic, Tired but satisfied, Excited, Mindful) were found. Most doctors changed from Ready to Tired but satisfied, with alertness reducing most. Age, specialty, sleep, shift duration and the number of consecutive shifts associated with alertness, contentedness and calmness changes. Conclusions The results provided nuanced insight into doctors’ feelings before and after night shifts. Future research may assess whether specific subgroups benefit from tailored interventions.

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Use of Simulation Methods in Social Work Research on Clinical Decision-Making

Regehr

Birze

2020

Clin Soc Work J

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A review of current approaches for evaluating impaired performance in around-the-clock medical professionals

Cited by 7 publications

References 126 publications

Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey

Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey

Doctors’ alertness, contentedness and calmness before and after night shifts: a latent profile analysis

Use of Simulation Methods in Social Work Research on Clinical Decision-Making

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