Journal Article

Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial

Salzman, David H., Papanagnou, Dimitrios, Leiby, Benjamin E., McCarthy, Danielle M., Piserchia, Katherine, Zhang, Xiao C., Rising, Kristin L., McGaghie, William C., Powell, Rhea E., Klein, Matthew R., Doty, Amanda MB, Cameron, Kenzie A.

2020

Overview

Background Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications. Methods The trial is a multicenter, two-arm randomized controlled trial designed to teach communication skills using simulation-based mastery learning (SBML). Resident emergency physicians from two training programs will be randomly assigned to immediate or delayed receipt of the two-part UCEM intervention after completing a baseline standardized patient encounter. The two UCEM components are: 1) a web-based interactive module, and 2) a smart-phone-based game. Both formats teach and reinforce communication skills for patient cases involving diagnostic uncertainty. Following baseline testing, participants in the immediate intervention arm will complete a remote deliberate practice session via a video platform and subsequently return for a second study visit to assess if they have achieved mastery. Participants in the delayed intervention arm will receive access to UCEM and remote deliberate practice after the second study visit. The primary outcome of interest is the proportion of residents in the immediate intervention arm who achieve mastery at the second study visit. Discussion Patients’ understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. Although use of SBML is a resource intensive educational approach, this trial has been deliberately designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake. Trial registration The trial was registered at clinicaltrials.gov ( NCT04021771 ). Registration date: July 16, 2019.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Academic Achievement / Approaches to teaching and learning / Check Lists / Clinical Competence / Communication / Communication Skills / Comparative analysis / Computer simulation / Curricula / Diagnostic Tests, Routine - methods / Education / Education, Medical, Graduate - methods / Emergency department / Emergency medical care / Emergency medicine / Emergency Medicine - education / Emergency Service, Hospital - statistics & numerical data / Female / Hospital emergency services / Humans / Internship and Residency - methods / Interpersonal Competence / Machine Learning / Male / Mastery Learning / Medical diagnosis / Medical Education / Medical personnel training / Patient safety / Patient satisfaction / Patient-centered care / Patients / Physical Health / Physician-Patient Relations / Physicians / Randomized Controlled Trials / Simulation based mastery learning / Simulation Training - methods / Skill Development / Skills / Study Protocol / Teaching Methods / Test Construction / Theory of Medicine/Bioethics / Trainees / Uncertainty / United States