Overconfidence, Time-on-Task, and Medical Errors: Is There a Relationship?

Mohsin Al-Maghrabi,1 Silvia Mamede,2 Henk G Schmidt,3 Aamir Omair,4– 6 Sami Al-Nasser,4– 6 Nouf Sulaiman Alharbi,4– 6 Mohi Eldin Mohammed Ali Magzoub7 1Department of Pediatrics, Imam Abdulrahman Alfaisal Hospital, Riyadh, Saudi Arabia; 2Institute of Medical Education Research Rotterdam, Erasmus University Rotterdam, Rotterdam, the Netherlands; 3Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands; 4Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 6Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; 7Department of Medical Education, United Arab Emirates University, Al Ain, United Arab EmiratesCorrespondence: Nouf Sulaiman Alharbi, Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Email [email protected]: Literature suggest that physicians’ high level of confidence has a negative impact on medical decisions, and this may lead to medical errors. Experimental research is lacking; however, this study investigated the effects of high confidence on diagnostic accuracy.Methods: Forty internal medicine residents from different hospitals in Saudi Arabia were divided randomly into two groups: A high-confidence group as an experimental and a low-confidence group acting as a control. Both groups solved each of eight written complex clinical vignettes. Before diagnosing these cases, the high-confidence group was led to believe that the task was easy, while the low-confidence group was presented with information from which it could deduce that the diagnostic task was difficult. Level of confidence, response time, and diagnostic accuracy were recorded.Results: The participants in the high-confidence group had a significantly higher confidence level than those in the control group: 0.75 compared to 0.61 (maximum 1.00). However, neither time on task nor diagnostic accuracy significantly differed between the two groups.Conclusion: In the literature, high confidence as one of common cognitive biases has a strong association with medical error. Even though the high-confidence group spent somewhat less time on the cases, suggesting potential premature decision-making, we failed to find differences in diagnostic accuracy. It is suggested that overconfidence should be studied as a personality trait rather than as a malleable characteristic.Keywords: overconfidence, diagnostic accuracy, medical errors, premature closur

Reliability and validity of student peer assessment in medical education: a systematic review

Background: Peer assessment has been demonstrated to be an effective educational intervention for health science students.\ud \ud Aims: This study aims to give an overview of all instruments or questionnaires for peer assessments used in medical and allied health professional educational settings and their psychometric characteristics as described in literature.\ud \ud Methods: A systematic literature search was carried out using the electronic databases Pubmed, Embase, ERIC, PsycINFO and Web of Science, including all available inclusion dates up to May 2010.\ud \ud Results: Out of 2899 hits, 28 studies were included, describing 22 different instruments for peer assessment in mainly medical educational settings. Although most studies considered professional behaviour as a main subject of assessment and described peer assessment usually as an assessment tool, great diversity was found in educational settings and application of peer assessment, dimensions or constructs as well as number of items and scoring system per questionnaire, and in psychometric characteristics.\ud \ud Conclusions: Although quite a few instruments of peer assessment have been identified, many questionnaires did not provide sufficient psychometric data. Still, the final choice of an instrument for educational purposes can only be justified by its sufficient reliability and validity as well as the discriminative and evaluative purposes of the assessment