Time pressure in diagnosing written clinical cases: An experimental study on time constraints and perceived time pressure

Objectives: Time pressure and time constraints have been shown to affect diagnostic accuracy, but how they interact is not clear. The current study aims to investigate the effects of both perceived time pressure (sufficient vs. insufficient time) and actual time constraints (lenient vs. restricted time limit) with regard to diagnostic accuracy. Methods: Residents from two university-affiliated training programs in the USA participated in this online within-subjects experiment. They diagnosed cases under two perceived time pressure conditions: one where they were told they had sufficient time to diagnose the cases and one where they were told they had insufficient time. The actual time limit was either restricted or lenient (± one standard deviation from the mean time to diagnose). Participants provided their most likely diagnosis and a differential diagnosis for each case, and rated their confidence in their most likely diagnosis. Results: A restricted time limit was associated with lower accuracy scores (p=0.044) but no effects of perceived time pressure on diagnostic accuracy were found. However, participants self-reported feeling more time pressure when they thought they had insufficient time (p<0.001). In addition, there was an effect of the actual time limit (p=0.012) and perceived time pressure (p=0.048) on confidence. Conclusions: This study showed that a restricted time limit can negatively affect diagnostic accuracy. Although participants felt more time pressure and were less confident when they thought they had insufficient time, perceived time pressure did not affect diagnostic accuracy. More research is needed to further investigate the effects of time pressure and time limits on diagnostic accuracy.