The impact of the framing effect on performance in a simulated emergency anaesthetic scenario in medical officers: A prospective, randomised, double-blinded study

Abstract

Background: Cognitive errors in anaesthesia may contribute significantly to medical error in the perioperative environment, but few studies have been conducted in this area. The framing effect is a cognitive bias that occurs when a problem is presented in different ways, potentially leading to changes in clinical decision-making.
Methods: The authors conducted a single-centre, prospective, randomised, double-blinded study with the aim of determining the impact of the framing effect in medical officers who have recently passed their Diploma in Anaesthesia examination in the Pietermaritzburg Anaesthetic Department. All participants underwent the same simulated emergency scenario related to high airway pressures (because of a bronchial plug) in a ventilated patient under anaesthesia. Participants were allocated either to a control group (receiving a neutral handover) or to an experiment group (receiving a handover that included additional information relating to asthma). The authors also collected quantitative data related to clinical performance and qualitative data related to participants’ experience of the scenario.
Results: The study included a total of 34 medical officers, with 17 in each group. There was no difference in median times to diagnosis (control group 240 [interquartile range {IQR} 195–240] vs experimental group 240 [IQR 162−240] s; z = −0.433, p = 0.6648). There were no differences in secondary outcomes. Participants reported a positive learning experience that may influence future training methods.
Conclusion: The study was unable to demonstrate objective evidence for the framing effect in this simulation study. Future studies can use these findings to perform sample size calculations for larger studies to investigate this important area.
Contribution: This study offers insight into the relationship between cognitive bias and clinical decision-making within anaesthesia simulation training. The findings contribute to a better understanding of how framing effects may influence trainee responses in simulated clinical scenarios. This work aligns with the JCMSA’s focus on medical education and training.