Testing the Efficacy of Two Behavioral Interventions at Recalibrating Physician Heuristics in Trauma Triage

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

320 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-10-29

Study Completion Date

2017-12-11

Brief Summary

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The objective of this study is to compare the efficacy of two behavioral interventions at recalibrating physician heuristics.

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Detailed Description

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Treatment at trauma centers improves outcomes for patients with moderate-to-severe injuries. Accordingly, professional organizations, state authorities, and the federal government have endorsed the systematic triage and transfer of these patients to trauma centers either directly from the field or after evaluation at a non-trauma center. Nonetheless, between 30 to 40% of patients with moderate-to-severe injuries still only receive treatment at non-trauma centers, so-called under-triage. Most of this under-triage occurs because of physician decisions (rather than first-responder decisions). Existing efforts to change physician decision making focus primarily on knowledge of clinical practice guidelines and attitudes towards the guidelines. These strategies ignores the growing consensus that decision making reflects both knowledge as well as intuitive judgments (heuristics). Heuristics, mental short cuts based on pattern recognition, drive the majority of decision making. The investigators have developed two separate behavioral interventions to recalibrate physician heuristics in trauma triage, and will compare the effect of these interventions, an educational program, and no intervention on physician performance on a virtual simulation.

Conditions

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Wounds and Injuries

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

1:1:1:1 allocation

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

We will mask the intervention status of participants when analyzing the data.

Study Groups

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Night Shift

Night Shift is an adventure video game with the transformational goal of teaching physicians key characteristics of patients with non-representative severe injuries - injuries classified by the American College of Surgeons as life-threatening or critical but that do not fit the archetype of injuries typically requiring treatment at a trauma center. Players take on the persona of Andy Jordan, a young emergency physician who moves home after the disappearance of his estranged grandfather (Robert Jordan) and takes up a job in the local Emergency Department (ED). In the preamble, players learn they have two explicit objectives. First, they must diagnose and treat patients who present to their ED. Second they must solve the mystery of Robert's disappearance: was he murdered or has he simply chosen to disappear?

Group Type EXPERIMENTAL

Night Shift

Intervention Type BEHAVIORAL

Physicians in this arm of the trial will be asked to play Night Shift, an adventure video game, for two hours.

Graveyard Shift

Graveyard Shift is a puzzle video game with the transformational goal of helping physicians derive key triage decision principles for themselves. They complete a three-step game loop to obtain case information, compare cases to determine similarities and differences between cases, and then explicitly state the decision principle that should drive decision making.

Group Type EXPERIMENTAL

Graveyard Shift

Intervention Type BEHAVIORAL

Physicians in this arm of the trial will be asked to play Graveyard Shift, a puzzle video game, for two hours.

Educational program

The educational module consists of two separate apps, both commercially available. myATLS includes a review of each chapter of the Advanced Trauma Life Support (ATLS) textbook, a series of videos demonstrating common trauma procedures, and clinical resources including checklists for use at the bedside. Trauma Life Support MCQ Review includes 550 multiple-choice questions with correct answers and explanations. The investigators will ask physicians to review the myATLS app and then com

Group Type ACTIVE_COMPARATOR

Educational program

Intervention Type BEHAVIORAL

Physicians in this arm of the trial will be asked to use myATLS, an app designed by the American College of Surgeons to serve as an adjunct to the ATLS course, and Trauma Life Support MCQ Review, an app designed to help students prepare for the ATLS exam. They will be asked to spend at least two hours on the combined tasks.

Control

Physicians in this arm will not be asked to complete any intervention.

Group Type PLACEBO_COMPARATOR

Control

Intervention Type BEHAVIORAL

Physicians in this arm will serve as a no-contact control group.

Interventions

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Night Shift

Physicians in this arm of the trial will be asked to play Night Shift, an adventure video game, for two hours.

Intervention Type BEHAVIORAL

Graveyard Shift

Physicians in this arm of the trial will be asked to play Graveyard Shift, a puzzle video game, for two hours.

Intervention Type BEHAVIORAL

Educational program

Physicians in this arm of the trial will be asked to use myATLS, an app designed by the American College of Surgeons to serve as an adjunct to the ATLS course, and Trauma Life Support MCQ Review, an app designed to help students prepare for the ATLS exam. They will be asked to spend at least two hours on the combined tasks.

Intervention Type BEHAVIORAL