Awareness of Medico-Legal Case Management Among Saudi Board Emergency Medicine Physicians in Riyadh: A Multicenter...

Emergency physicians frequently manage cases with legal implications. Accurate documentation, evidence preservation, and compliance with reporting requirements are essential, yet awareness of these duties may be incomplete.

To describe awareness of medico-legal case management among Saudi Board Emergency Medicine physicians in Riyadh and explore associations with demographic and professional characteristics.

This multicenter cross-sectional study included emergency medicine residents, specialists/registrars, and consultants from seven governmental and tertiary hospitals in Riyadh. A 10-item investigator-developed awareness questionnaire and five self-reported confidence items were administered electronically. The instrument was reviewed by five consultant emergency physicians for clarity, relevance, comprehensiveness, and clinical applicability; no pilot study, formal content validity index, Delphi process, or construct validity assessment was performed. For analysis, a "Yes" response to each awareness item was coded 1 and a "No" or "Don't know" response was coded 0, yielding a 0-10 index. Investigator-defined cutoffs of 0-3, 4-7, and 8-10 were used to label poor, moderate, and good awareness, respectively; these cutoffs have not been externally validated. Descriptive statistics, univariable tests, and multivariable linear regression with heteroscedasticity-robust standard errors were used.

Of 576 submitted questionnaires, 276 incomplete submissions were excluded, and 300 complete responses were analyzed. The mean awareness index was 6.31 ± 1.59 (median, 6; observed range, 1-10). Correct responses varied across the 10 awareness items, ranging from 56.3% to 71.3%, with the lowest proportions observed for photographic documentation and legal consequences of failing to report suspected medico-legal cases, and the highest for workplace evidence-collection protocols. Internal consistency was low (Cronbach's alpha = 0.097), indicating that the awareness index should be interpreted as an exploratory summary of heterogeneous medico-legal domains. In the adjusted model, compared with consultants, R4, R3, and R2 residents had lower awareness scores, while managing two to five medico-legal cases per shift was associated with a slightly higher score than managing fewer than two cases. Previous report-writing training was not independently associated with awareness.

Physicians demonstrated variable awareness across different medico-legal knowledge domains. As the investigator-developed awareness index demonstrated very low internal consistency, the overall score should be interpreted cautiously as an exploratory summary rather than a validated measure of a single construct. Future studies should prospectively validate a multidimensional instrument and evaluate competency-based medico-legal education.