Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial.
Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial.
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DOI：
10.1136/bmj.j5416
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发表时间：
2017-12-12
期刊：
影响因子：
--
通讯作者：
Barnato AE
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文献类型：
--
作者：
Mohan D;Farris C;Fischhoff B;Rosengart MR;Angus DC;Yealy DM;Wallace DJ;Barnato AE
确定通过视频游戏进行的行为干预是否可以提高非创伤中心急诊科创伤分诊决策的适当性。随机临床试验。在线干预在美国医院做出分诊决定的急诊医学医生的国家样本。368名急诊医生主要在非创伤中心工作。在6个月时，对具有主要结局数据的随机样本（n=200）进行重新评估。医生以1：1的比例随机分配到一个小时的冒险视频游戏（夜班）或基于传统教学教育的应用程序（myATLS和创伤生命支持MCQ评论），两者都在iPad上。开发Night Shift是为了重新校准使用模式识别的过程，通过使用故事来促进行为改变（叙事参与）来识别中度至重度伤害（代表性认知）。医生被随机分为2×2析因设计进行干预（游戏与传统教育应用程序），然后进入他们完成结果评估工具的实验条件（低认知负荷与高认知负荷）。分配后无法保持设盲，但在分析阶段对组分配设盲。包括10例病例的虚拟模拟结果;其中4例患者严重受伤。参与者在干预后四周内完成了模拟。对入院、出院或转院的决定进行了衡量。然后（主要结果）计算未分类的患者比例（严重损伤患者未转移到创伤中心），并在6个月后再次计算不同病例组的比例（随访研究的主要结果）。次要结局是认知负荷对分诊不足的影响。149名（81%）游戏组医生和148名（80%）传统教育组医生完成了试验。其中，64/100（64%）和58/100（58%）分别在6个月时完成了重新评估。平均年龄为40岁（SD 8.9），283人（96%）接受过急诊医学培训，207人（70%）获得ATLS（高级创伤生命支持）认证。与接受教学教育的医生相比，接触游戏的医生对严重受伤的患者进行分类的次数较少（316/596（0.53）v 377/592（0.64），估计差异0.11，95%置信区间0.05至0.16; P<0.001）。认知负荷没有影响分类不足（游戏组161/308（0.53）vs 155/288（0.54）;传统教育应用程序组197/300（0.66）vs 180/292（0.62）; P=0.66）。在六个月时，接触游戏的医生仍然不太可能对患者进行分类（146/256（0.57）v172/232（0.74），估计差异为0.17，0.09至0.25; P<0.001）。没有医生报告副作用。样本可能不能反映所有急诊医生，一小部分病例用于评估绩效。与基于传统教学式教育的应用程序相比，医生接触理论基础的视频游戏可以在经过验证的虚拟模拟中改善分类决策。虽然观察到的效果很大，但广泛的置信区间包括了小受益的可能性，并且这种干预的真实的世界疗效仍然不确定。clinicaltrials.gov; NCT 02857348（初始研究）/NCT 03138304（随访）。
To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. Randomized clinical trial. Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively, completed reassessment at six months. The mean age was 40 (SD 8.9), 283 (96%) were trained in emergency medicine, and 207 (70%) were ATLS (advanced trauma life support) certified. Physicians exposed to the game under-triaged fewer severely injured patients than those exposed to didactic education (316/596 (0.53) v 377/592 (0.64), estimated difference 0.11, 95% confidence interval 0.05 to 0.16; P<0.001). Cognitive load did not influence under-triage (161/308 (0.53) v 155/288 (0.54) in the game arm; 197/300 (0.66) v 180/292 (0.62) in the traditional educational apps arm; P=0.66). At six months, physicians exposed to the game remained less likely to under-triage patients (146/256 (0.57) v 172/232 (0.74), estimated difference 0.17, 0.09 to 0.25; P<0.001). No physician reported side effects. The sample might not reflect all emergency medicine physicians, and a small set of cases was used to assess performance. Compared with apps based on traditional didactic education, exposure of physicians to a theoretically grounded video game improved triage decision making in a validated virtual simulation. Though the observed effect was large, the wide confidence intervals include the possibility of a small benefit, and the real world efficacy of this intervention remains uncertain. clinicaltrials.gov; NCT02857348 (initial study)/NCT03138304 (follow-up).
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影响因子：
2
作者：
Idson, LC;Chugh, D;Bazerman, M
通讯作者：
Bazerman, M
影响因子：
158.5
作者：
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通讯作者：
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DOI：
10.1097/ta.0b013e3181e03a21
发表时间：
2010-07-01
影响因子：
--
作者：
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通讯作者：
Salkever, David S.
DOI：
10.1016/0030-5073(80)90052-5
发表时间：
1980-01-01
期刊：
ORGANIZATIONAL BEHAVIOR AND HUMAN PERFORMANCE
影响因子：
--
作者：
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通讯作者：
FISCHHOFF, B
影响因子：
16.9
作者：
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通讯作者：
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