Assessing the validity of using serious game technology to analyze physician decision making

Background: Physician non-compliance with clinical practice guidelines remains a critical barrier to high quality care. Serious games (using gaming technology for serious purposes) have emerged as a method of studying physician decision making. However, little is known about their validity. Methods: We created a serious game and evaluated its construct validity. We used the decision context of trauma triage in the Emergency Department of non-trauma centers, given widely accepted guidelines that recommend the transfer of severely injured patients to trauma centers. We designed cases with the premise that the representativeness heuristic influences triage (i.e. physicians make transfer decisions based on archetypes of severely injured patients rather than guidelines). We randomized a convenience sample of emergency medicine physicians to a control or cognitive load arm, and compared performance (disposition decisions, number of orders entered, time spent per case). We hypothesized that cognitive load would increase the use of heuristics, increasing the transfer of representative cases and decreasing the transfer of non-representative cases. Findings: We recruited 209 physicians, of whom 168 (79%) began and 142 (68%) completed the task. Physicians transferred 31% of severely injured patients during the game, consistent with rates of transfer for severely injured patients in practice. They entered the same average number of orders in both arms (control (C): 10.9 [SD 4.8] vs. cognitive load (CL):10.7 [SD 5.6], p = 0.74), despite spending less time per case in the control arm (C: 9.7 [SD 7.1] vs. CL: 11.7 [SD 6.7] minutes, p<0.01). Physicians were equally likely to transfer representative cases in the two arms (C: 45% vs. CL: 34%, p = 0.20), but were more likely to transfer non-representative cases in the control arm (C: 38% vs. CL: 26%, p = 0.03). Conclusions: We found that physicians made decisions consistent with actual practice, that we could manipulate cognitive load, and that load increased the use of heuristics, as predicted by cognitive theory. © 2014 Mohan et al

Do closed survey questions over-estimate public perceptions of food risks?

In this paper we show that the widely accepted methodology for the assessment of risk perception – Likert type survey questions featuring a set of risks with fixed response alternatives measuring the extent of worry or concern – may over-estimate food risk perception. Using a European representative sample survey (n=26,961) that included an open-ended question asking about problems and risks with food and eating, followed by a battery of closed questions assessing food risk perception we find a similar ranking of perceived food risks across the two methods. Across Europe the five priority concerns are chronic food related illness; food origins and quality; acute food related illness; chemical contamination, and adulteration of food. However, the discrepancies between mentioning a risk in the open ended question and the expression of worry about risks in the closed question are substantial. Of those who did not mention a specific risk category in the open question, between 60% and 83% (depending on risk category) expressed worry in the closed question. This parallels previous research on the fear of crime, showing that survey responses lead to greatly inflated estimates of the public’s fear of crime than is evidenced by qualitative questioning. It is also consistent with evidence from research on cognitive aspects of survey methodology suggesting that survey questions may frame the respondent’s thinking about an issue. We conclude with recommendations for the use of branched questions in the quantitative elicitation of public perceptions of risk

Initial psychological responses to influenza A, H1N1 ("Swine flu")

Background The outbreak of the pandemic flu, Influenza A H1N1 (Swine Flu) in early 2009, provided a major challenge to health services around the world. Previous pandemics have led to stockpiling of goods, the victimisation of particular population groups, and the cancellation of travel and the boycotting of particular foods (e.g. pork). We examined initial behavioural and attitudinal responses towards Influenza A, H1N1 ("Swine flu") in the six days following the WHO pandemic alert level 5, and regional differences in these responses. Methods 328 respondents completed a cross-sectional Internet or paper-based questionnaire study in Malaysia (N = 180) or Europe (N = 148). Measures assessed changes in transport usage, purchase of preparatory goods for a pandemic, perceived risk groups, indicators of anxiety, assessed estimated mortality rates for seasonal flu, effectiveness of seasonal flu vaccination, and changes in pork consumption Results 26% of the respondents were 'very concerned' about being a flu victim (42% Malaysians, 5% Europeans, p < .001). 36% reported reduced public transport use (48% Malaysia, 22% Europe, p < .001), 39% flight cancellations (56% Malaysia, 17% Europe, p < .001). 8% had purchased preparatory materials (e.g. face masks: 8% Malaysia, 7% Europe), 41% Malaysia (15% Europe) intended to do so (p < .001). 63% of Europeans, 19% of Malaysians had discussed the pandemic with friends (p < .001). Groups seen as at 'high risk' of infection included the immune compromised (mentioned by 87% respondents), pig farmers (70%), elderly (57%), prostitutes/highly sexually active (53%), and the homeless (53%). In data collected only in Europe, 64% greatly underestimated the mortality rates of seasonal flu, 26% believed seasonal flu vaccination gave protection against swine flu. 7% had reduced/stopped eating pork. 3% had purchased anti-viral drugs for use at home, while 32% intended to do so if the pandemic worsened. Conclusion Initial responses to Influenza A show large regional differences in anxiety, with Malaysians more anxious and more likely to reduce travel and to buy masks and food. Discussions with family and friends may reinforce existing anxiety levels. Particular groups (homosexuals, prostitutes, the homeless) are perceived as at greater risk, potentially leading to increased prejudice during a pandemic. Europeans underestimated mortality of seasonal flu, and require more information about the protection given by seasonal flu inoculation

Communicating foodborne disease risk.

The food industry, like many others, has a risk communication problem. That problem is manifested in the public's desire to know the truth about outbreaks of foodborne diseases; ongoing concern about the safety of foods, additives, and food-processing procedures; and continued apathy regarding aspects of routine food hygiene. If these concerns are addressed in a coherent and trustworthy way, the public will have better and cheaper food. However, sloppy risk communication can itself cause public health damage. Because citizens are ill-equipped to discriminate among information sources, the food industry as a whole bears responsibility for the successes and failures of its individual members. We review risk communication research and practice for their application to the food industry

Tearing Out the Income Tax by the (Grass)Roots

Landscapes are increasingly fragmented, and conservation programs have started to look at network approaches for maintaining populations at a larger scale. We present an agent-based model of predator–prey dynamics where the agents (i.e. the individuals of either the predator or prey population) are able to move between different patches in a landscaped network. We then analyze population level and coexistence probability given node-centrality measures that characterize specific patches. We show that both predator and prey species benefit from living in globally well-connected patches (i.e. with high closeness centrality). However, the maximum number of prey species is reached, on average, at lower closeness centrality levels than for predator species. Hence, prey species benefit from constraints imposed on species movement in fragmented landscapes since they can reproduce with a lesser risk of predation, and their need for using anti-predatory strategies decreases.authorCount :

The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study

BACKGROUND Since 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. This study examined when doctors in this new system make specialty choices, which factors influence choices, and whether doctors who choose a specialty they were interested in at medical school are more confident in their choice than those doctors whose interests change post-graduation. METHODS Two cohorts of students in their penultimate year at one medical school (n = 227/239) were asked which specialty interested them as a career. Two years later, 210/227 were sent a questionnaire measuring actual specialty chosen, confidence, influence of perceptions of the specialty and experiences on choice, satisfaction with medicine, personality, self-efficacy, and demographics. Medical school and post-graduation choices in the same category were deemed 'stable'. Predictors of stability, and of not having chosen a specialty, were calculated using bootstrapped logistic regression. Differences between specialties on questionnaire factors were analysed. RESULTS 50% responded (n = 105/277; 44% of the 239 Year 4 students). 65% specialty choices were 'stable'. Factors univariately associated with stability were specialty chosen, having enjoyed the specialty at medical school or since starting work, having first considered the specialty earlier. A regression found doctors who chose psychiatry were more likely to have changed choice than those who chose general practice. Confidence in the choice was not associated with stability. Those who chose general practice valued lifestyle factors. A psychiatry choice was associated with needing a job and using one's intellect to help others. The decision to choose surgical training tended to be made early. Not having applied for specialty training was associated with being lower on agreeableness and conscientiousness. CONCLUSION Medical school experiences are important in specialty choice but experiences post-graduation remain significant, particularly in some specialties (psychiatry in our sample). Career guidance is important at medical school and should be continued post-graduation, with senior clinicians supported in advising juniors. Careers advice in the first year post-graduation may be particularly important, especially for specialties which have difficulty recruiting or are poorly represented at medical school

COP21 climate negotiators' responses to climate model forecasts

Policymakers involved in climate change negotiations are key users of climate science. It is therefore vital to understand how to communicate scientific information most effectively to this group. We tested how a unique sample of policymakers and negotiators at the Paris COP21 conference update their beliefs on year 2100 global mean temperature increases in response to a statistical summary of climate models' forecasts. We randomized the way information was provided across participants using three different formats similar to those used in Intergovernmental Panel on Climate Change reports. In spite of having received all available relevant scientific information, policymakers adopted such information very conservatively, assigning it less weight than their own prior beliefs. However, providing individual model estimates in addition to the statistical range was more effective in mitigating such inertia. The experiment was repeated with a population of European MBA students who, despite starting from similar priors, reported conditional probabilities closer to the provided models' forecasts than policymakers. There was also no effect of presentation format in the MBA sample. These results highlight the importance of testing visualization tools directly on the population of interest

‘Perceptions of non-accidental child deaths as preventable events: The impact of probability heuristics and biases on child protection work'

Anxiety about the possibility of non-accidental deaths of children has had a major influence on child care policy and practice over the last 40 years. The formal inquiry reports and media coverage of these rare events serve to maintain the perception that these are regular incidents that happen far too often and that they could have been prevented. This focus on individual events tends to distort a clear view of the actual probability of non-accidental deaths and serves to reinforce the notion that potentially all child care cases are risky and that any social work practitioner could be involved in such a case. As a result, work with children has become highly risk averse. However, in statistical terms, the probability of non-accidental child deaths is very low and recently has averaged about 55 deaths a year. Children are at considerably higher risk of being killed on the roads. This paper examines the way in which perceptions of the ‘high’ level of risk of possible child deaths are maintained despite the very low statistical probability of such incidents. It draws on thinking from behavioural psychology and, in particular the work of Kahneman and Tversky, to consider some of the biases in probability reasoning affecting people’s perception of risk and explores how inquiry reports into single past events reconfirm risk perceptions. It is suggested that recognition of the essentially unpredictable nature of future non-accidental child deaths would free up childcare professionals to work in a more positive and less risk-averse manner in the present

Risk reduction through community-based monitoring:the vigías of Tungurahua, Ecuador

Since 2000, a network of volunteers known as vigías has been engaged in community-based volcano monitoring, which involves local citizens in the collection of scientific data, around volcán Tungurahua, Ecuador. This paper provides the first detailed description and analysis of this well-established initiative, drawing implications for volcanic risk reduction elsewhere. Based on 32 semi-structured interviews and other qualitative data collected in June and July 2013 with institutional actors and with vigías themselves, the paper documents the origins and development of the network, identifies factors that have sustained it, and analyses the ways in which it contributes to disaster risk reduction. Importantly, the case highlights how this community-based network performs multiple functions in reducing volcanic risk. The vigías network functions simultaneously as a source of observational data for scientists; as a communication channel for increasing community awareness, understanding of hazard processes and for enhancing preparedness; and as an early warning system for civil protection. Less tangible benefits with nonetheless material consequences include enhanced social capital – through the relationships and capabilities that are fostered – and improved trust between partners. Establishing trust-based relationships between citizens, the vigías, scientists and civil protection authorities is one important factor in the effectiveness and resilience of the network. Other factors discussed in the paper that have contributed to the longevity of the network include the motivations of the vigías, a clear and regular communication protocol, persistent volcanic activity, the efforts of key individuals, and examples of successful risk reduction attributable to the activities of the network. Lessons that can be learned about the potential of community-based monitoring for disaster risk reduction in other contexts are identified, including what the case tells us about the conditions that can affect the effectiveness of such initiatives and their resilience to changing circumstances