title: The impact of perceived frailty on surgeons' estimates of surgical risk.
abstract: BACKGROUND
  Physicians are only moderately accurate in estimating surgical risk based on clinical vignettes. We assessed the impact of perceived frailty by measuring the influence of a short video of a standardized patient on surgical risk estimates.
  
  
  METHODS
  Thoracic surgeons and cardiothoracic trainees estimated the risk of major complications for lobectomy based on clinical vignettes of varied risk categories (low, average, high). After each vignette, subjects viewed a randomly selected video of a standardized patient exhibiting either vigorous or frail behavior, then reestimated risk. Subjects were asked to rate 5 vignettes paired with 5 different standardized patients.
  
  
  RESULTS
  Seventy-one physicians participated. Initial risk estimates varied according to the vignette risk category: low 15.2%±11.2% risk; average 23.7%±16.1%; high 37.3%±18.9% (p<0.001 by analysis of variance). Concordant information in vignettes and videos moderately altered estimates (high risk vignette, frail video 10.6%±27.5% increase in estimate, p=0.006; low risk vignette, vigorous video 14.5%±45.0% decrease, p=0.009). Discordant findings influenced risk estimates more substantially (high risk vignette, vigorous video 21.2%±23.5% decrease in second risk estimate, p<0.001; low risk vignette, frail video 151.9%±209.8% increase, p<0.001).
  
  
  CONCLUSIONS
  Surgeons differentiated relative risk of lobectomy based on clinical vignettes. The effect of viewing videos was small when vignettes and videos were concordant; the effect was more substantial when vignettes and videos were discordant. The information will be helpful in training future surgeons in frailty recognition and risk estimation.
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois. Electronic address: mferguso@surgery.bsd.uchicago.edu.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Ferguson
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Farnan
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Josh A
authors.initials: JA
authors.lastname: Hemmerich
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Kris
authors.initials: K
authors.lastname: Slawinski
authors.affiliation: Center for Research Informatics, University of Chicago, Chicago, Illinois.
authors.forename: Julissa
authors.initials: J
authors.lastname: Acevedo
authors.affiliation: Department of Anesthesiology and Critical Care, University of Chicago, Chicago, Illinois.
authors.forename: Stephen
authors.initials: S
authors.lastname: Small
mesh_terms: D000328:Adult; D003657:Decision Making; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D011013:Pneumonectomy / Q000193:education*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires