Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial
Abstract 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...
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doaj-33cedb33b8f0421b9ccc20efff3bd7b12020-11-25T03:40:09ZengBMCBMC Medical Education1472-69202020-02-0120111210.1186/s12909-020-1926-ySimulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trialDanielle M. McCarthy0Rhea E. Powell1Kenzie A. Cameron2David H. Salzman3Dimitrios Papanagnou4Amanda MB. Doty5Benjamin E. Leiby6Katherine Piserchia7Matthew R. Klein8Xiao C. Zhang9William C. McGaghie10Kristin L. Rising11Department of Emergency Medicine, Northwestern University Feinberg School of MedicineDivision of General Internal Medicine and Geriatrics, Northwestern UniversityDivision of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineDepartment of Emergency Medicine, Northwestern University Feinberg School of MedicineDepartment of Emergency Medicine, Thomas Jefferson UniversityDepartment of Emergency Medicine, Thomas Jefferson UniversityDivision of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson UniversityDepartment of Emergency Medicine, Northwestern University Feinberg School of MedicineDepartment of Emergency Medicine, Northwestern University Feinberg School of MedicineDepartment of Emergency Medicine, Thomas Jefferson UniversityDepartment of Medical Education, Northwestern University Feinberg School of MedicineDepartment of Emergency Medicine, Thomas Jefferson UniversityAbstract 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.http://link.springer.com/article/10.1186/s12909-020-1926-yUncertaintyMedical educationSimulation based mastery learningEmergency medicineCommunicationEmergency department |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Danielle M. McCarthy Rhea E. Powell Kenzie A. Cameron David H. Salzman Dimitrios Papanagnou Amanda MB. Doty Benjamin E. Leiby Katherine Piserchia Matthew R. Klein Xiao C. Zhang William C. McGaghie Kristin L. Rising |
spellingShingle |
Danielle M. McCarthy Rhea E. Powell Kenzie A. Cameron David H. Salzman Dimitrios Papanagnou Amanda MB. Doty Benjamin E. Leiby Katherine Piserchia Matthew R. Klein Xiao C. Zhang William C. McGaghie Kristin L. Rising Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial BMC Medical Education Uncertainty Medical education Simulation based mastery learning Emergency medicine Communication Emergency department |
author_facet |
Danielle M. McCarthy Rhea E. Powell Kenzie A. Cameron David H. Salzman Dimitrios Papanagnou Amanda MB. Doty Benjamin E. Leiby Katherine Piserchia Matthew R. Klein Xiao C. Zhang William C. McGaghie Kristin L. Rising |
author_sort |
Danielle M. McCarthy |
title |
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial |
title_short |
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial |
title_full |
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial |
title_fullStr |
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial |
title_full_unstemmed |
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial |
title_sort |
simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial |
publisher |
BMC |
series |
BMC Medical Education |
issn |
1472-6920 |
publishDate |
2020-02-01 |
description |
Abstract 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. |
topic |
Uncertainty Medical education Simulation based mastery learning Emergency medicine Communication Emergency department |
url |
http://link.springer.com/article/10.1186/s12909-020-1926-y |
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