Failure to demonstrate effects of interruptions on diagnostic reasoning: three experiments

Mai Alajaji; Nada Saleh; Ali Hassan AlKhulaif; Silvia Mamede; Jerome I Rotgans; Hatouf Sukkarieh; Nouf AlHarbi; Mohi Eldin Magzoub; Henk G Schmidt

doi:10.1186/s12909-022-03212-1

Failure to demonstrate effects of interruptions on diagnostic reasoning: three experiments

BMC Med Educ. 2022 Mar 16;22(1):182. doi: 10.1186/s12909-022-03212-1.

Authors

Mai Alajaji¹, Nada Saleh², Ali Hassan AlKhulaif³, Silvia Mamede⁴, Jerome I Rotgans⁵, Hatouf Sukkarieh⁶, Nouf AlHarbi², Mohi Eldin Magzoub⁷, Henk G Schmidt⁸

Affiliations

¹ College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
² College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ar Rimayah, Riyadh, 14611, Saudi Arabia.
³ Emergency Medicine Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, 11564, Saudi Arabia.
⁴ Erasmus University, Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, and Department of Psychology, Erasmus University Rotterdam, Rotterdam, P.O. Box 1738, 3000, DR, The Netherlands.
⁵ Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, 308232, Singapore.
⁶ College of Medicine, Alfaisal University, Takhassusi St, Riyadh, 11533, Saudi Arabia.
⁷ College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates.
⁸ Department of Psychology, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands. schmidt@fsw.eur.nl.

Abstract

Background: Diagnostic error is a major source of patient suffering. Researchshows that physicians experience frequent interruptions while being engaged with patients and indicate that diagnostic accuracy may be impaired as a result. Since most studies in the field are observational, there is as yet no evidence suggesting a direct causal link between being interrupted and diagnostic error. Theexperiments reported in this article were intended to assess this hypothesis.

Methods: Three experiments were conducted to test the hypothesis that interruptions hurt diagnostic reasoning and increase time on task. In the first experiment (N = 42), internal medicine residents, while diagnosing vignettes of actual clinical cases were interrupted halfway with a task unrelated to medicine, solving word-spotting puzzles and anagrams. In the second experiment (N = 78), the interruptions were medically relevant ones. In the third experiment (N = 30), we put additional time pressure on the participants. In all these experiments, a control group diagnosed the cases without interruption. Dependent variables were diagnostic accuracy and amount of time spent on the vignettes.

Results: In none of the experiments interruptions were demonstrated to influence diagnostic accuracy. In Experiment 1: Mean of interrupted group was 0.88 (SD = 0.37) versus non- interrupted group 0.91 (SD = 0.32). In Experiment 2: Mean of interrupted group was 0.95 (SD = 0.32) versus non-interrupted group 0.94 (SD = 0.38). In Experiment 3: Mean of interrupted group was 0.42 (SD = 0.12) versus non-interrupted group 0.37 (SD = 0.08). Although interrupted residents in all experiments needed more time to complete the diagnostic task, only in Experiment 2, this effect was statistically significant.

Conclusions: These three experiments, taken together, failed to demonstrate negative effects of interruptions on diagnostic reasoning. Perhaps physicians who are interrupted may still have sufficient cognitive resources available to recover from it most of the time.

Keywords: Cognition; Diagnostic error; Emergency medicine; Internal medicine.

MeSH terms

Diagnostic Errors
Humans
Physicians*