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

Abstract

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 closure

Keywords

• overconfidence
• diagnostic accuracy
• medical errors
• premature closure.