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.
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.
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DOI：
10.1186/s40814-022-01212-y
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发表时间：
2022-12-12
影响因子：
1.7
通讯作者：
White, Douglas B.
中科院分区：
文献类型：
--
作者：
Mohan, Deepika;Elmer, Jonathan;Arnold, Robert M.;Forsythe, Raquel M.;Fischhoff, Baruch;Rak, Kimberly;Barnes, Jacqueline L.;White, Douglas B.
关键词：
在创伤中，不遵守临床实践指南的情况仍然很常见，部分原因是医生在对受伤患者进行分诊时会犯诊断错误。有意识的练习，在教练的监督下有目的地参与训练任务，有效地改变了医学程序领域的行为，但很少被用来提高诊断技能。我们计划进行一项试点平行随机试验，以测试一种新型的刻意实践干预措施的可行性、可接受性和初步效果，以减少创伤分类中的医生诊断错误。我们将在全国范围内随机抽取在非创伤中心工作的医生(n=60)，按1：1的比例随机分为有意识的实践干预或被动对照。我们将使用一款定制的、基于理论的严肃视频游戏作为我们的培训任务的基础，根据其行为改变技术和游戏机制进行选择，并附上一份教练手册，以标准化干预交付的保真度。干预包括与内容专家(教练)远程进行的三次30分钟的会议，在此期间，医生(实习生)玩游戏并接收关于他们诊断过程的反馈。我们将评估(A)通过审查辅导课程的录像来实施干预的保真度；(B)通过调查和半结构化访谈来评估干预的可接受性；以及(C)通过比较受训者和对照组医生在经过验证的虚拟模拟上的表现来评估干预的效果。我们假设受训者将使≥在模拟中的诊断错误比对照医生少25%，这是一个很大的影响规模。我们还假设≥90%的受训者将按计划接受干预。试验的结果将为今后继续进行干预措施的混合有效性-实施试验的决定提供依据。它还将使人们更深入地了解使用刻意练习来修改医生的诊断技能所面临的挑战。临床试验.gov(NCT05168579)；2021年12月23日。网上版载有补充材料，可在10.1186/s40814-022-01212-y查阅。
Non-compliance with clinical practice guidelines in trauma remains common, in part because physicians make diagnostic errors when triaging injured patients. Deliberate practice, purposeful participation in a training task under the oversight of a coach, effectively changes behavior in procedural domains of medicine but has rarely been used to improve diagnostic skill. We plan a pilot parallel randomized trial to test the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce physician diagnostic errors in trauma triage. We will randomize a national convenience sample of physicians who work at non-trauma centers (n = 60) in a 1:1 ratio to a deliberate practice intervention or to a passive control. We will use a customized, theory-based serious video game as the basis of our training task, selected based on its behavior change techniques and game mechanics, along with a coaching manual to standardize the fidelity of the intervention delivery. The intervention consists of three 30-min sessions with content experts (coaches), conducted remotely, during which physicians (trainees) play the game and receive feedback on their diagnostic processes. We will assess (a) the fidelity with which the intervention is delivered by reviewing video recordings of the coaching sessions; (b) the acceptability of the intervention through surveys and semi-structured interviews, and (c) the effect of the intervention by comparing the performance of trainees and a control group of physicians on a validated virtual simulation. We hypothesize that trainees will make ≥ 25% fewer diagnostic errors on the simulation than control physicians, a large effect size. We additionally hypothesize that ≥ 90% of trainees will receive their intervention as planned. The results of the trial will inform the decision to proceed with a future hybrid effectiveness-implementation trial of the intervention. It will also provide a deeper understanding of the challenges of using deliberate practice to modify the diagnostic skill of physicians. Clinical trials.gov (NCT05168579); 23 December 2021. The online version contains supplementary material available at 10.1186/s40814-022-01212-y.
DOI：
10.1016/j.jss.2021.07.029
发表时间：
2021-12
期刊：
The Journal of surgical research
影响因子：
--
作者：
Mohan D;Chang CC;Fischhoff B;Rosengart MR;Angus DC;Yealy DM;Barnato AE
通讯作者：
Barnato AE