Developing a Deliberate Practice Intervention to Recalibrate Physician Heuristics in Trauma Triage
Condition: Trauma Injury
MeSH terms: Wounds and Injuries
Study type: Interventional

Summary: 
      The objective of this study is to test the feasibility of using deliberate practice -
      goal-oriented training in the presence of a coach who can provide personalized, immediate
      feedback - to increase engagement. The research design involves recruitment of a national
      convenience sample of board-certified emergency physicians who will serve as trainees (n=30),
      pairing of the trainees with a coach, delivery of three 30-minute coaching sessions using the
      existing games as the training task, and assessment of the effect of the combined
      intervention on performance in the laboratory. The specific aims are:

        1. To assess the fidelity of intervention delivery by measuring coaching skill acquisition,
           coaching skill drift and protocol adherence.

        2. To assess the potential effect size of the intervention by comparing trainee performance
           on a validated virtual simulation with a control group of physicians (n=30).

        3. To assess the acceptability of the intervention by using a mixture of validated
           instruments and semi-structured debriefing interviews with trainees to assess their
           engagement with the intervention.
    

Detailed description: 
      Deliberate practice - goal-oriented training in the presence of a coach who can provide
      personalized, immediate feedback - has successfully improved performance across multiple
      domains, including sports, music, and combat. When used in conjunction with simulation to
      improve surgical skill, it has a large effect on educational outcomes. It has characteristics
      that make its application in this context potentially powerful (e.g. personalized
      feedback/relationship with coach increase engagement) but also potentially challenging (e.g.
      the diagnostic process does not lend itself easily to assessment). The objective of this
      study is to test the feasibility of using deliberate practice to amplify the effect of a
      video game intervention. The team will recruit a national sample of board-certified emergency
      physicians (n=30) to serve as trainees, with members of the team (n=3) serving as coaches.
      Trainee-coach dyads will meet for 30 minutes/week for 3 weeks, by video-conferencing, to play
      one of the existing video games and to use it to practice pattern recognition. Aims are:

        1. To assess the fidelity of intervention delivery. Approach: the team will standardize
           coaching skill during an 'on-boarding session,' measure skill drift over the course of
           training sessions, and measure protocol adherence (primary outcome). Hypothesis: >90% of
           dyads will complete three training sessions.

        2. To assess the potential effect size of the intervention. Approach: the team will compare
           performance of trainees (n=30) with a control group of physicians (n=30) on a validated
           virtual simulation. Hypothesis: Trainees will make ≥25% fewer diagnostic errors than
           control physicians (large effect size).

        3. To assess the acceptability of the intervention. Approach: the team will conduct
           semi-structured debriefing interviews with trainees, assessing elements of the
           intervention that promote engagement.

      This proposal will inform a future Stage III trial to compare the effect of different
      interventions on diagnostic error in trauma triage. If successful, this program of research
      will have an impact on patients by reducing the burden imposed by injury and by addressing
      the refractory problem of diagnostic error. It is novel conceptually in its effort to make
      heuristics a source of power, methodologically in its use of deliberate practice to improve
      diagnosis, and translationally in its use of video game technology. It is feasible because
      the investigative team has clinical and behavioral science expertise, experience developing
      deliberate practice interventions, and a track record of successfully building video games
      that can transform physician behavior. It responds to two national research priorities: 1)
      improving the diagnostic process; 2) maintaining health and independent living among the
      aging.
    

Intervention name(s): Deliberate practice
Intervention type(s): Behavioral
Intervention description(s): As above
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: two arm randomized trial
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment