Clinical medicine (London, England)
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BackgroundWe sought to establish to what extent decision certainty has been measured in real time and whether high or low levels of certainty correlate with clinical outcomes. MethodsOur pre-specified study protocol is published on PROSPERO, CRD42019128112. We identified prospective studies from Medline, Embase and PsycINFO up to February 2019 that measured real time self-rating of the certainty of a medical decision by a clinician. ⋯ One other study demonstrated the danger of extreme diagnostic confidence - 7% of cases (24/341) labelled as having either 0% or 100% diagnostic likelihood of heart failure were made in error. ConclusionsThe literature on real time self-rated certainty of clinician decisions is sparse and only relates to diagnostic decisions. Further prospective research with a view to generating hypotheses for testable interventions that can better calibrate clinician certainty with accuracy of decision making could be valuable in reducing diagnostic error and improving outcomes.