Does time pressure impact on dentists' diagnostic performance?

Design A randomised blinded crossover trial.Sample selection Forty local primary care dentists in the south west of England were recruited using a variety of methods. Dentists from NHS, mixed practice, private practice and community services were included. Participants were allocated to four balanced experimental test groups of equal numbers. Block randomisation was used for allocation. The principle researcher was blind to which group a participant was from. The trial was completed using a purpose-made weblink which contained a clinical decision-making exercise. The participants repeated the exercise under increasing time pressure.Data analysis Data analysis was performed independently by the principle researcher. The diagnostic sensitivity and specificity of the decisions made were calculated and statistical analysis preformed. This included paired t-tests to assess differences in self-reported stress and difficulty when the exercise was performed under different time constraints. Mann-Whitney U tests were used to compare differences in the sensitivity and specificity values achieved under the varying time constraints.Results One hundred percent (n = 40) of GDPs who responded to the invitation were eligible and included in the study. Results showed a statistical difference (p <0.001) of both perceived difficulty of the task, and stress experienced when under time pressure. Results showed diagnostic sensitivity to pathological features was significantly worse (p <0.001) under time pressure. Conversely, the specificity of identification of pathology free sites were not affected by the different circumstances.Conclusions Time pressure negatively impacted diagnostic performance and decreased diagnostic sensitivity for all pathological features. Sensitivity to caries-related pathology and periodontal disease-related pathology deteriorated by 40% and 67%, retrospectively.