Adaptive Expertise, Error Management Training, Learning
Conditions
Brief summary
The main objective of this study is to demonstrate that Error Management Training improves adaptive expertise in head computed tomography interpretation. The investigators will conduct a randomized controlled trial comparing two learning strategies, Error Management Training vs Error Avoidance Training, in emergency medicine residents. The investigators hypothesize that Error Management Training, as compared to Error Avoidance Training, will improve adaptive expertise, as measured by skills transfer, when used to teach head computed tomography interpretation to emergency medicine residents.
Detailed description
Adaptive expertise is the ability to apply existing skills to novel situations. Adaptive expertise enables physicians to reduce preventable medical errors when managing clinical scenarios not encountered during training. However, residency curricula rarely address this learning outcome. Error Management Training improves transfer of skills to new contexts and develops adaptive expertise. Although this methodology has been shown to improve adaptive expertise in procedural skills, its impact on cognitive skills in medical training remains underexplored. Error Management Training promises to improve patient care by developing emergency physicians' adaptive expertise. However, the investigators need further evidence for its efficacy with cognitive skills in residency training. The investigators aim to demonstrate that Error Management Training improves adaptive expertise in a cognitive skill, using head computed tomography interpretation as a model.
Interventions
OTHERError Management Training (Difficult)
Error Management Training is used to teach head computed tomography interpretation. Participants encounter difficult questions.
OTHERError Management Training (Easy)
Error Management Training is used to teach head computed tomography interpretation. Participants encounter easy questions.
Error Avoidance Training used to teach head computed tomography interpretation.
Sponsors
Brown University
Alameda Health System
University of California, Los Angeles
University of Chicago
The University of Texas Health Science Center, Houston
University of Wisconsin, Madison
Vanderbilt University
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Study participation will be available to all current emergency medicine residents at Stanford and at thirteen external sites.
Exclusion criteria
* Adults unable to consent * Pregnant women * Individuals who are not yet adults (infants, children, teenagers) * Prisoners * Medical students * Residents from specialties other than emergency medicine
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent correct on an assessment of transfer of skills (adaptive expertise) | Immediately after instructional session (up to 60 minutes to complete the assessment) | Participants will have to demonstrate transfer of head computed tomography interpretation skills by interpreting novel radiology cases different from those used in the instructional session. Performance will be assessed by percent score on a head computed tomography interpretation test using novel radiology content not addressed in the instructional session. Score range is 0-100%. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent correct on an assessment of post-session proficiency for learning objectives (routine expertise) | Immediately after instructional session (up to 60 minutes to complete the assessment) | Participants will have to demonstrate direct application of the intervention's learning objectives by interpreting radiology cases similar to those used in the instructional session. Performance will be assessed by percent score on a head computed tomography interpretation test using radiology content similar to that used in the instructional session. Score range is 0-100%. |
| Effect of post-graduate year level on post-test performance | Immediately after instructional session (up to 60 minutes to complete the assessment) | Performance on a head computed tomography interpretation test (both adaptive expertise and routine expertise cases) will be assessed by percent score, stratified by post-graduate year level to show differences across residency training stage. Score range is 0-100%. |
| Mediation effect of errors on performance on the adaptive expertise cases | Number of errors will be measured during the educational intervention | The number of errors made during the educational intervention will be measured for both the Error Management Training (Difficult) arm and the Error Management Training (Easy) arm. A mediation analysis will be conducted to assess the effect of committing errors during learning on subsequent performance in the cases measuring adaptive expertise. |
Countries
United States
Outcome results
None listed