Mark K Ferguson1, Jeanne Farnan2, Josh A Hemmerich2, Kris Slawinski3, Julissa Acevedo4, Stephen Small5. 1. Department of Surgery, University of Chicago, Chicago, Illinois. Electronic address: mferguso@surgery.bsd.uchicago.edu. 2. Department of Medicine, University of Chicago, Chicago, Illinois. 3. Pritzker School of Medicine, University of Chicago, Chicago, Illinois. 4. Center for Research Informatics, University of Chicago, Chicago, Illinois. 5. Department of Anesthesiology and Critical Care, University of Chicago, Chicago, Illinois.
Abstract
BACKGROUND: Physicians are only moderately accurate in estimating surgical risk based on clinical vignettes. We assessed the impact of perceived frailty by measuring the influence of a short video of a standardized patient on surgical risk estimates. METHODS: Thoracic surgeons and cardiothoracic trainees estimated the risk of major complications for lobectomy based on clinical vignettes of varied risk categories (low, average, high). After each vignette, subjects viewed a randomly selected video of a standardized patient exhibiting either vigorous or frail behavior, then reestimated risk. Subjects were asked to rate 5 vignettes paired with 5 different standardized patients. RESULTS: Seventy-one physicians participated. Initial risk estimates varied according to the vignette risk category: low 15.2%±11.2% risk; average 23.7%±16.1%; high 37.3%±18.9% (p<0.001 by analysis of variance). Concordant information in vignettes and videos moderately altered estimates (high risk vignette, frail video 10.6%±27.5% increase in estimate, p=0.006; low risk vignette, vigorous video 14.5%±45.0% decrease, p=0.009). Discordant findings influenced risk estimates more substantially (high risk vignette, vigorous video 21.2%±23.5% decrease in second risk estimate, p<0.001; low risk vignette, frail video 151.9%±209.8% increase, p<0.001). CONCLUSIONS: Surgeons differentiated relative risk of lobectomy based on clinical vignettes. The effect of viewing videos was small when vignettes and videos were concordant; the effect was more substantial when vignettes and videos were discordant. The information will be helpful in training future surgeons in frailty recognition and risk estimation.
BACKGROUND: Physicians are only moderately accurate in estimating surgical risk based on clinical vignettes. We assessed the impact of perceived frailty by measuring the influence of a short video of a standardized patient on surgical risk estimates. METHODS: Thoracic surgeons and cardiothoracic trainees estimated the risk of major complications for lobectomy based on clinical vignettes of varied risk categories (low, average, high). After each vignette, subjects viewed a randomly selected video of a standardized patient exhibiting either vigorous or frail behavior, then reestimated risk. Subjects were asked to rate 5 vignettes paired with 5 different standardized patients. RESULTS: Seventy-one physicians participated. Initial risk estimates varied according to the vignette risk category: low 15.2%±11.2% risk; average 23.7%±16.1%; high 37.3%±18.9% (p<0.001 by analysis of variance). Concordant information in vignettes and videos moderately altered estimates (high risk vignette, frail video 10.6%±27.5% increase in estimate, p=0.006; low risk vignette, vigorous video 14.5%±45.0% decrease, p=0.009). Discordant findings influenced risk estimates more substantially (high risk vignette, vigorous video 21.2%±23.5% decrease in second risk estimate, p<0.001; low risk vignette, frail video 151.9%±209.8% increase, p<0.001). CONCLUSIONS: Surgeons differentiated relative risk of lobectomy based on clinical vignettes. The effect of viewing videos was small when vignettes and videos were concordant; the effect was more substantial when vignettes and videos were discordant. The information will be helpful in training future surgeons in frailty recognition and risk estimation.
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