CONFIDENCE IN DECISION MAKING OF PARAMEDIC CREW LEADERS: ITS LEVEL, ROOTS AND POSSIBLE CONSEQUENCES

Purpose: The aim of this study was to probe the validity of confidence in medical decision making of paramedic crew commanders in simulated task and to identify their more or less successful decision-making strategies.

Method(s): Presented data consisted of short interviews and performance analysis of 54 leaders of emergency medical services teams (EMS, 14 medics, 21 paramedics, 19 physicians) who participated in the international competition Rallye Rejviz 2015 (Czech Republic).  The level of a) the confidence in medical decision making in general together with b) the confidence in specific diagnosis and c) the confidence in the solution of one of 13 simulated competition tasks designed as regular emergency interventions were compared with d) expert-based rating of the team performance in selected task and e) the team performance in the whole competition.

Result(s): No significant correlation between leaders confidence in medical decision making and expert-based ratings of team performance was found. However, the cluster analysis of cases based on the level of subjective confidence in decision making and expert-based rating of performance divided EMS team leaders into three prototypical categories. Qualitative analysis of interviews related to solution of one selected task revealed specific decision-making strategies dominating in each cluster. Type A – “active searcher” - shows high confidence in decision making as a result of high quality performance. He has strong motivation to follow prescribed rules and to check alternative possibilities. On the other hand, type B – “believer” – shows high confidence which often results in lower quality of performance. He relies more on assumptions based on his own experience and invests less energy into checking other explanations. Type C – “careful thinker” – shows mediocre level of performance and lowest confidence in own decision making. He knows his own limitations and tries to compensate them by following prescribed rules. His point of view is frequently enriched by another kind of professional experience from the hospital or ambulance.

Conclusion(s): Specific types of participants and situation suggest that this typology may not be complete and should be verified in the next research. It represents some prototypes of preferred medical decision-making style in paramedic crew leaders. Anyway, depending on situation the same person may prefer different styles.

Supported by the scientific grant agency VEGA 2/0080/14