title: Thoracic surgeons' perception of frail behavior in videos of standardized patients.
abstract: BACKGROUND
  Frailty is a predictor of poor outcomes following many types of operations. We measured thoracic surgeons' accuracy in assessing patient frailty using videos of standardized patients demonstrating signs of physical frailty. We compared their performance to that of geriatrics specialists.
  
  
  METHODS
  We developed an anchored scale for rating degree of frailty. Reference categories were assigned to 31 videos of standardized patients trained to exhibit five levels of activity ranging from "vigorous" to "frail." Following an explanation of frailty, thoracic surgeons and geriatrics specialists rated the videos. We evaluated inter-rater agreement and tested differences between ratings and reference categories. The influences of clinical specialty, clinical experience, and self-rated expertise were examined.
  
  
  RESULTS
  Inter-rater rank correlation among all participants was high (Kendall's W 0.85) whereas exact agreement (Fleiss' kappa) was only moderate (0.47). Better inter-rater agreement was demonstrated for videos exhibiting extremes of behavior. Exact agreement was better for thoracic surgeons (n = 32) than geriatrics specialists (n = 9; p = 0.045), whereas rank correlation was similar for both groups. More clinical years of experience and self-reported expertise were not associated with better inter-rater agreement.
  
  
  CONCLUSIONS
  Videos of standardized patients exhibiting varying degrees of frailty are rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition.
authors.affiliation: Department of Surgery, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Ferguson
authors.affiliation: Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Katherine
authors.initials: K
authors.lastname: Thompson
authors.affiliation: Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Megan
authors.initials: M
authors.lastname: Huisingh-Scheetz
authors.affiliation: Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Farnan
authors.affiliation: Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Josh A
authors.initials: JA
authors.lastname: Hemmerich
authors.affiliation: Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Kris
authors.initials: K
authors.lastname: Slawinski
authors.affiliation: Center for Research Informatics, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Julissa
authors.initials: J
authors.lastname: Acevedo
authors.affiliation: Department of Health Studies, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Sang Mee
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Surgery, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Marko
authors.initials: M
authors.lastname: Rojnica
authors.affiliation: Department of Anesthesiology and Critical Care, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Small
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D010465:Perception / Q000502:physiology*; D010820:Physicians; D066231:Surgeons; D014743:Videotape Recording