Medical decision-making in the physician hierarchy: A pilot pedagogical evaluation

Title

Medical decision-making in the physician hierarchy: A pilot pedagogical evaluation

Creator

Rosasco J; McCarroll ML; Gothard MD; Myers Jerry; Hughes P; Schwartz A; George RL; Ahmed RA

Publisher

Journal of Medical Education and Curricular Development

Date

2020
2020-07

Description

Purpose: Recently, the American College of Graduate Medical Education included medical decision-making as a core competency in several specialties. To date, the ability to demonstrate and measure a pedagogical evolution of medical judgment in a medical education program has been limited. In this study, we aim to examine differences in medical decision-making of physician groups in distinctly different stages of their postgraduate career. Methods: The study recruited physicians with a wide spectrum of disciplines and levels of experience to take part in 4 medical simulations divided into 2 categories, abdominal pain (biliary colic [BC] and renal colic [RC]) or chest pain (cardiac ischemia with ST-segment elevation myocardial infarction [STEMI] and pneumothorax [PTX]). Evaluation of medical decision-making used the Medical Judgment Metric (MJM). The targeted selection criteria for the physician groups are administrative physicians (APs), representing those with the most experience but whose current duties are largely administrative; resident physicians (RPs), those enrolled in postgraduate medical or surgical training; and mastery level physicians (MPs), those deemed to have mastery level experience. The study measured participant demographics, physiological responses, medical judgment scores, and simulation time to case resolution. Outcome differences were analyzed using Fisher exact tests with post hoc Bonferroni-adjustedztests and single-factor analysis of variance F tests with post hoc Tukey honestly significant difference, as appropriate. The significance threshold was set atP < .05. Effect sizes were determined and reported to inform future studies. Results: A total of n = 30 physicians were recruited for the study with n = 10 participants in each physician group. No significant differences were found in baseline demographics between groups. Analysis of simulations showed a significant (P = .002) interaction for total simulation time between groups RP: 6.2 minutes (+/- 1.58); MP: 8.7 minutes (+/- 2.46); and AP: 10.3 minutes (+/- 2.78). The AP MJM scores, 12.3 (+/- 2.66), for the RC simulation were significantly (P = .010) lower than the RP 14.7 (+/- 1.15) and MP 14.7 (+/- 1.15) MJM scores. Analysis of simulated patient outcomes showed that the AP group was significantly less likely to stabilize the participant in the RC simulation than MP and RP groups (P = .040). While not significant, all MJM scores for the AP group were lower in the BC, STEMI, and PTX simulations compared with the RP and MP groups. Conclusions: Physicians in distinctly different stages of their respective postgraduate career differed in several domains when assessed through a consistent high-fidelity medical simulation program. Further studies are warranted to accurately assess pedagogical differences over the medical judgment lifespan of a physician.

Subject

education; clinical judgment; medical judgment; simulation; care; decision-making; medical education; students; improve; knowledge retention; medical judgment; Skill retention

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Format

journalArticle

Search for Full-text

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Pages

2382120520925061

Volume

7

ISSN

2382-1205

NEOMED College

NEOMED College of Medicine

NEOMED Department

Department of General Surgery

Update Year & Number

August 2020 List

Affiliated Hospital

Summa Health System Akron City Hospital

Citation

Rosasco J; McCarroll ML; Gothard MD; Myers Jerry; Hughes P; Schwartz A; George RL; Ahmed RA, “Medical decision-making in the physician hierarchy: A pilot pedagogical evaluation,” NEOMED Bibliography Database, accessed July 27, 2021, https://neomed.omeka.net/items/show/11213.

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