Facilitating Adaptive Expertise in Learning Computed Tomography

Study Overview
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Brief Summary
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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
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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.

Official Title
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The FAIL CT Study: Facilitating Adaptive Expertise in Learning Computed Tomography, a Multi-center Randomized Controlled Trial

Conditions
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Adaptive Expertise, Error Management Training, Learning

Intervention / Treatment
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* Other: Error Management Training (Difficult)
* Other: Error Management Training (Easy)
* Other: Error Avoidance Training


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Error Management Training (Difficult)<br>Participants receive the learning strategy Error Management Training and encounter difficult questions. | Other: Error Management Training (Difficult)<br>* Error Management Training is used to teach head computed tomography interpretation. Participants encounter difficult questions.<br>|
| Experimental: Error Management Training (Easy)<br>Participants receive the learning strategy Error Management Training and encounter easy questions. | Other: Error Management Training (Easy)<br>* Error Management Training is used to teach head computed tomography interpretation. Participants encounter easy questions.<br>|
| Active Comparator: Error Avoidance Training<br>Participants receive the learning strategy Error Avoidance Training. | Other: Error Avoidance Training<br>* Error Avoidance Training used to teach head computed tomography interpretation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent correct on an assessment of transfer of skills (adaptive expertise) | 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%. | Immediately after instructional session (up to 60 minutes to complete the assessment) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent correct on an assessment of post-session proficiency for learning objectives (routine expertise) | 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%. | Immediately after instructional session (up to 60 minutes to complete the assessment) | 
| Percent correct on an assessment of transfer of skills (adaptive expertise) | 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%. | Three months after instructional session (up to 60 minutes to complete the assessment) | 
| Percent correct on an assessment of post-session proficiency for learning objectives (routine expertise) | 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%. | Three months after instructional session (up to 60 minutes to complete the assessment) | 
| Effect of post-graduate year level on post-test performance | 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%. | Immediately after instructional session (up to 60 minutes to complete the assessment) | 
| Mediation effect of errors on performance on the adaptive expertise cases | 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. | Number of errors will be measured during the educational intervention |