The Influence of Time Pressure and Case Complexity on Physicians׳ Diagnostic Performance

Dalal A. ALQahtani, Jerome I. Rotgans, Nasr Eldin Ahmed, Ibrahim A. Alalwan, Mohi Eldin M. Magzoub

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Purpose Practicing medicine is a cognitively demanding task that consists of the ability to assess the patient, judge the nature of his or her complaints, and make an appropriate diagnosis. A number of factors have the potential to affect the physician׳s diagnostic performance negatively. Two of these factors are time pressure and case complexity. However, the empirical evidence that supports this negative influence is scant. This study experimentally investigated the effect of time pressure and the complexity of clinical cases on diagnostic accuracy. Method Thirty-seven senior internal medicine residents participated in this study. These residents were randomly allocated to two experimental groups (with time pressure vs. without time pressure). These residents were instructed to diagnose 8 case scenarios (4 straightforward and 4 complex cases) presented on a computer by using E-Prime® 2.0. The time pressure group received feedback after each case that they were behind schedule, whereas the control group did not receive such information. The dependent variables were the mean diagnostic accuracy and the mean processing time spent on each case during diagnosis. Results Participants under time pressure spent nearly the same time as the group without time pressure in diagnosing the clinical cases. The diagnostic accuracy scores did not differ significantly between the experimental and control group (F(1,35)=0.07, P=0.79, and η2=0.002). Conversely, a main effect of case complexity was found (F(1,35)=203.19, P<0.001, and η2=0.85). Participants processed straightforward cases faster and more accurately compared with complex cases. No interaction was found between time pressure and case complexity on diagnostic accuracy (F(1,35)=0.003, P=0.96, and η2<0.001). Conclusions Time pressure did not impact the diagnostic performance, whereas the complexity of the clinical case negatively influenced the diagnostic accuracy. Further studies with the enhanced experimental manipulation of time pressure are needed to reveal the effect of time pressure, if any, on a physician׳s diagnostic performance.

Original languageEnglish
Pages (from-to)99-105
Number of pages7
JournalHealth Professions Education
Issue number2
Publication statusPublished - Dec 1 2016
Externally publishedYes


  • Case complexity
  • Clinical reasoning
  • Diagnostic error
  • Physicians
  • Time pressure

ASJC Scopus subject areas

  • General Medicine
  • General Nursing
  • Education


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