Developing a Deliberate Practice Intervention to Recalibrate Physician Heuristics in Trauma Triage

NCT ID: NCT05168579

Last Updated: 2023-04-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 72 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-12-15
• Study Completion Date: 2022-12-01

Brief Summary

The objective of this study is to test the feasibility of using deliberate practice - goal-oriented training in the presence of a coach who can provide personalized, immediate feedback - to increase engagement. The research design involves recruitment of a national convenience sample of board-certified emergency physicians who will serve as trainees (n=30), pairing of the trainees with a coach, delivery of three 30-minute coaching sessions using the existing games as the training task, and assessment of the effect of the combined intervention on performance in the laboratory. The specific aims are:

1. To assess the fidelity of intervention delivery by measuring coaching skill acquisition, coaching skill drift and protocol adherence.

2. To assess the potential effect size of the intervention by comparing trainee performance on a validated virtual simulation with a control group of physicians (n=30).

3. To assess the acceptability of the intervention by using a mixture of validated instruments and semi-structured debriefing interviews with trainees to assess their engagement with the intervention.

Detailed Description

Deliberate practice - goal-oriented training in the presence of a coach who can provide personalized, immediate feedback - has successfully improved performance across multiple domains, including sports, music, and combat. When used in conjunction with simulation to improve surgical skill, it has a large effect on educational outcomes. It has characteristics that make its application in this context potentially powerful (e.g. personalized feedback/relationship with coach increase engagement) but also potentially challenging (e.g. the diagnostic process does not lend itself easily to assessment). The objective of this study is to test the feasibility of using deliberate practice to amplify the effect of a video game intervention. The team will recruit a national sample of board-certified emergency physicians (n=30) to serve as trainees, with members of the team (n=3) serving as coaches. Trainee-coach dyads will meet for 30 minutes/week for 3 weeks, by video-conferencing, to play one of the existing video games and to use it to practice pattern recognition. Aims are:

1. To assess the fidelity of intervention delivery. Approach: the team will standardize coaching skill during an 'on-boarding session,' measure skill drift over the course of training sessions, and measure protocol adherence (primary outcome). Hypothesis: >90% of dyads will complete three training sessions.

2. To assess the potential effect size of the intervention. Approach: the team will compare performance of trainees (n=30) with a control group of physicians (n=30) on a validated virtual simulation. Hypothesis: Trainees will make ≥25% fewer diagnostic errors than control physicians (large effect size).

3. To assess the acceptability of the intervention. Approach: the team will conduct semi-structured debriefing interviews with trainees, assessing elements of the intervention that promote engagement.

This proposal will inform a future Stage III trial to compare the effect of different interventions on diagnostic error in trauma triage. If successful, this program of research will have an impact on patients by reducing the burden imposed by injury and by addressing the refractory problem of diagnostic error. It is novel conceptually in its effort to make heuristics a source of power, methodologically in its use of deliberate practice to improve diagnosis, and translationally in its use of video game technology. It is feasible because the investigative team has clinical and behavioral science expertise, experience developing deliberate practice interventions, and a track record of successfully building video games that can transform physician behavior. It responds to two national research priorities: 1) improving the diagnostic process; 2) maintaining health and independent living among the aging.

Conditions

Trauma Injury

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Deliberate practice

Trainees will be paired with a coach, and will meet, once per week for thirty minutes, over a three week period. During the training session, coach-trainee dyads will play a puzzle video game, and will discuss contextual cues that should inform triage decisions. At the completion of the three weeks, trainees will complete a semi-structured, debriefing interview and a virtual simulation to assess triage performance.

Group Type: EXPERIMENTAL

Deliberate practice

Intervention Type: BEHAVIORAL

As above

Control

Participants in the control group will complete a virtual simulation.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Deliberate practice

As above

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

Board certified physicians who work at non-trauma centers in the United States

Exclusion Criteria

Physicians without board certification (i.e., residents). Physicians who work only at trauma centers in the US.

• Minimum Eligible Age: 25 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

National Institute on Aging (NIA)

NIH

Sponsor Role: collaborator

University of Pittsburgh

OTHER

Sponsor Role: lead

Responsible Party

Deepika Mohan

Associate Professor of Surgery

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Deepika Mohan, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Countries

United States

References

Mohan D, Elmer J, Arnold RM, Forsythe RM, Fischhoff B, Rak K, Barnes JL, White DB. Testing a Novel Deliberate Practice Intervention to Improve Diagnostic Reasoning in Trauma Triage: A Pilot Randomized Clinical Trial. JAMA Netw Open. 2023 May 1;6(5):e2313569. doi: 10.1001/jamanetworkopen.2023.13569.

Reference Type: DERIVED

PMID: 37195666 (View on PubMed)

Mohan D, Elmer J, Arnold RM, Forsythe RM, Fischhoff B, Rak K, Barnes JL, White DB. Testing the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce diagnostic error in trauma triage: a study protocol for a randomized pilot trial. Pilot Feasibility Stud. 2022 Dec 12;8(1):253. doi: 10.1186/s40814-022-01212-y.

Reference Type: DERIVED

PMID: 36510328 (View on PubMed)

Provided Documents

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

R21AG072072

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY20120026

Identifier Type: -

Identifier Source: org_study_id