Thoracic Surgeons' Perception of Frail Behavior in Videos of Standardized Patients

Ferguson, Mark K.; Thompson, Katherine; Huisingh-Scheetz, Megan; Farnan, Jeanne M.; Hemmerich, Josh A.; Slawinski, Kris; Acevedo, Julissa; Lee, Sang Mee; Rojnica, Marko; Small, Stephen D.

doi:10.1371/journal.pone.0098654

Cited by 10 publications

(12 citation statements)

References 21 publications

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“…Training of raters on how to use the assessment tool improves the agreement generally and is recommended for this new tool as well. The Fleiss Kappa of 42% and Kendall’s value of 50% obtained in this study are consistent with findings of other studies: that assessed agreement between thoracic surgeons rating frail behavior of patient and obtained a Fleiss Kappa of 47% and Kendall’s value of 85% [ 21 ]; and another that assessed the reliability of an injury scoring system for horses and obtained a Fleiss Kappa of 66% and Kendall’s value of 88% [ 22 ]. The Kendall’s value represents a robust measurement of agreement compared to the value generated by traditional Kappa.…”

Section: Discussionsupporting

confidence: 91%

Development and Validation of a Standardized Tool for Prioritization of Information Sources

Akwar¹,

Kloeze

Mukhi

2016

OJPHI

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Purpose: To validate the utility and effectiveness of a standardized tool for prioritization of information sources for early detection of diseases. Methods: The tool was developed with input from diverse public health experts garnered through survey. Ten raters used the tool to evaluate ten information sources and reliability among raters was computed. The Proc mixed procedure with random effect statement and SAS Macros were used to compute multiple raters’ Fleiss Kappa agreement and Kendall's Coefficient of Concordance. Results: Ten disparate information sources evaluated obtained the following composite scores: ProMed 91%; WAHID 90%; Eurosurv 87%; MediSys 85%; SciDaily 84%; EurekAl 83%; CSHB 78%; GermTrax 75%; Google 74%; and CBC 70%. A Fleiss Kappa agreement of 50.7% was obtained for ten information sources and 72.5% for a sub-set of five sources rated, which is substantial agreement validating the utility and effectiveness of the tool. Conclusion: This study validated the utility and effectiveness of a standardized criteria tool developed to prioritize information sources. The new tool was used to identify five information sources suited for use by the KIWI system in the CEZD-IIR project to improve surveillance of infectious diseases. The tool can be generalized to situations when prioritization of numerous information sources is necessary.

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Section: Discussionsupporting

confidence: 91%

Development and Validation of a Standardized Tool for Prioritization of Information Sources

Akwar¹,

Kloeze

Mukhi

2016

OJPHI

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“…A group of geriatric specialists, using an iterative process, had previously developed a set of physical characteristics based on the phenotypic criteria developed by Fried and colleagues [18] that could be portrayed in a short, silent video, including weight loss, gait speed, strength, and fatigue [19]. Three levels of physical performance (“somewhat vigorous,” “neither vigorous nor frail,” and “somewhat frail”) were assigned performance characteristics with standard metrics (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…We have previously shown that risk estimates for surgical treatment change considerably when vignette and video pairings are discordant [19]. Risk estimates decrease somewhat after subjects view a vigorous video paired with a high-risk vignette.…”

Section: Commentmentioning

confidence: 99%

The Influence of Physician and Patient Gender on Risk Assessment for Lung Cancer Resection

Ferguson

Huisingh-Scheetz

Thompson

et al. 2017

The Annals of Thoracic Surgery

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Background Women do not receive appropriate surgical therapy for lung cancer as often as men. Patient gender may influence treatment recommendations; less is known about the effect of physician gender on recommendations. Methods Gender-neutral vignettes representing low-risk, average-risk, and high-risk candidates for lung resection were paired with concordant videos of standardized patients (SPs). Cardiothoracic trainees and practicing thoracic surgeons read a vignette, provided an initial estimate of the percentage risk of major adverse events after lung resection, viewed a video (randomized to male or female SP), provided a final estimate of risk, and ranked the importance of the video in the final risk estimate. Results Overall, 107 surgeons participated, of whom 90 were men. Initial estimated risks mirrored actual vignette risks: 10.4% ± 9.9 for low risk, 17.6% ± 13.2 for average risk, and 21.0% ± 14.7 for high risk (p < 0.001). After SP videos were viewed and final risk estimates were rendered, there was a significant difference between male and female physicians in the absolute change in estimated risk (p = 0.002), with male physicians having larger changes than female physicians. There was also an effect of SP gender that varied by vignette type (p < 0.001). Increasing video importance scores were directly associated with increasing change in risk scores for average-risk and high-risk vignette/video combinations (p < 0.001 for each). Conclusions Differences in estimating complication risk for lung resection candidates are related to physician and patient gender. This may influence recommendations for surgical treatment. Understanding such differences may help reduce inequities in treatment recommendations.

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“…Videos of standardized patients were created to portray “somewhat vigorous” and “somewhat frail” behavior, hereafter referred to as “vigorous” and “frail” videos, as previously described [10,11]. The videos were silent, and depicted the standardized patient walking into an exam room, sitting in a chair, rising from the chair, walking to an exam table, and climbing onto the table.…”

Section: Methodsmentioning

confidence: 99%

“…Experienced thoracic surgeons, on visual inspection, have an ability to recognize frail characteristics similar to that of geriatricians [10]. Surgeons in practice are better than surgical residents at recognizing frailty and at incorporating factors associated with frailty in their surgical risk estimates [11].…”

Section: Introductionmentioning

confidence: 99%

The Impact of a Frailty Education Module on Surgical Resident Estimates of Lobectomy Risk

Ferguson

Thompson

Huisingh-Scheetz

et al. 2015

The Annals of Thoracic Surgery

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Background Frailty is a risk factor for adverse events after surgery. Residents’ ability to recognize frailty is underdeveloped. We assessed the influence of a frailty education module on surgical residents’ estimates of lobectomy risk. Methods Traditional track cardiothoracic surgery residents were randomized to take an on-line short course on frailty (experimental group) or to receive no training (control group). Residents read a clinical vignette, made an initial risk estimate of major complications for lobectomy, and rated clinical factors on their importance to their estimates. They viewed a video of a standardized patient portraying the patient in the vignette, randomly selected to exhibit either vigorous or frail behavior, and provided a final risk estimate. After rating 5 vignettes, they completed a test on their frailty knowledge. Results Forty-one residents participated (20 in the experimental group). Initial risk estimates were similar between the groups. The experimental group rated clinical factors as “very important” in their initial risk estimates more often than did the control group (47.6% vs 38.5%; p<0.001). Viewing videos resulted in a significant change from initial to final risk estimates (frail: 50±75% increase, p=0.008; vigorous: 14±32% decrease, p=0.043). The magnitude of change in risk estimates was greater for the experimental group (10.0±8.1 vs 5.1±7.7; p<0.001). The experimental group answered more frailty test questions correctly (93.7% vs 75.2%; p<0.001). Conclusions A frailty education module improved resident knowledge of frailty and influenced surgical risk estimates. Training in frailty may help educate residents in frailty recognition and surgical risk assessment.

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Thoracic Surgeons' Perception of Frail Behavior in Videos of Standardized Patients

Cited by 10 publications

References 21 publications

Development and Validation of a Standardized Tool for Prioritization of Information Sources

Development and Validation of a Standardized Tool for Prioritization of Information Sources

The Influence of Physician and Patient Gender on Risk Assessment for Lung Cancer Resection

The Impact of a Frailty Education Module on Surgical Resident Estimates of Lobectomy Risk

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