时间压力是否会对诊断准确性产生负面影响？

Does Time Pressure Have a Negative Effect on Diagnostic Accuracy?

作者信息

ALQahtani Dalal A, Rotgans Jerome I, Mamede Silvia, ALAlwan Ibrahim, Magzoub Mohi Eldin M, Altayeb Fatheya M, Mohamedani Manahil A, Schmidt Henk G

机构信息

D.A. ALQahtani is lecturer and medical education specialist, Department of Oral Medicine and Diagnostic Sciences (DDS), College of Dentistry-King Saud University, Riyadh, Saudi Arabia. J.I. Rotgans is assistant professor, National Institute of Education, Nanyang Technological University, Singapore. S. Mamede is associate professor, Institute of Medical Education Research Rotterdam, Erasmus Medical Center, and Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands. I. ALAlwan is professor and assistant vice president for educational affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. M.E.M. Magzoub is professor, Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. F.M. Altayeb is research assistant, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. M.A. Mohamedani is research coordinator, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. H.G. Schmidt is professor, Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.

出版信息

Acad Med. 2016 May;91(5):710-6. doi: 10.1097/ACM.0000000000001098.

DOI:10.1097/ACM.0000000000001098

PMID:26826069

Abstract

PURPOSE

Studies suggest time pressure has negative effects on physicians' working conditions and may lead to suboptimal patient care and medical errors. Experimental evidence supporting this is lacking, however. This study investigated the effect of time pressure on diagnostic accuracy.

METHOD

In 2013, senior internal medicine residents at three hospitals in Saudi Arabia were divided randomly into two groups: a time-pressure condition and a control condition without time pressure. Both groups diagnosed eight written clinical cases presented on computers. In the time-pressure condition, after completing each case, participants received information that they were behind schedule. Response time was recorded, and diagnostic accuracy was scored.

RESULTS

The 23 participants in the time-pressure condition spent significantly less time diagnosing the cases (mean = 96.00 seconds) than the 19 control participants (mean = 151.97 seconds) (P < .001). Participants under time pressure had a significantly lower diagnostic accuracy score (mean = 0.33; 95% CI, 0.23-0.43) than participants without time pressure (mean = 0.51; 95% CI, 0.42-0.60) (F[1, 41] = 6.90, P = .012, η = 0.15). This suggests participants in the time-pressure condition made on average 37% more errors than control participants.

CONCLUSIONS

Time pressure has a negative impact on diagnostic performance. The authors propose that the effect of time pressure on diagnostic accuracy is moderated by both the case difficulty level and the physician's level of experience. Post hoc analyses demonstrated that time pressure affects diagnostic accuracy only if cases are not too difficult and physicians' expertise level is intermediate.

摘要

目的

研究表明时间压力会对医生的工作条件产生负面影响，并可能导致患者护理欠佳和医疗失误。然而，缺乏支持这一观点的实验证据。本研究调查了时间压力对诊断准确性的影响。

方法

2013年，沙特阿拉伯三家医院的内科住院医师被随机分为两组：时间压力组和无时间压力的对照组。两组均对电脑上呈现的8个书面临床病例进行诊断。在时间压力组中，完成每个病例后，参与者会收到他们落后于进度的信息。记录反应时间，并对诊断准确性进行评分。

结果

时间压力组的23名参与者诊断病例所花的时间（平均=96.00秒）明显少于19名对照组参与者（平均=151.97秒）（P<.001）。处于时间压力下的参与者的诊断准确性得分（平均=0.33；95%CI，0.23 - 0.43）明显低于无时间压力的参与者（平均=0.51；95%CI，0.42 - 0.60）（F[1, 41]=6.90，P=.012，η=0.15）。这表明时间压力组的参与者平均比对照组参与者多犯37%的错误。