The Visualization of Uncertainty in Clinical Diagnostic Reasoning for Pulmonary Embolism

Study Overview
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Brief Summary
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Medical reasoning is a form of inquiry that examines the thought processes involved in making medical decisions. When physicians are faced with patients' symptoms or signs, their thought processes follow either direct shortcuts to suspect a diagnosis or go into a deeper and more analytic process to reach a diagnosis. The second pathway is less prone to biases and errors. This study explores whether the use of an interactive visual display of probabilities of pulmonary embolism generated from positive or negative test results will increase the adherence to evidence based guidelines in the diagnosis of pulmonary embolism.

Official Title
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The Visualization of Uncertainty in Clinical Diagnostic Reasoning for Pulmonary Embolism: a Randomized Controlled Trial.

Conditions
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Pulmonary Embolism, Diagnostic Uncertainty, Clinical Reasoning, Evidence Based Medicine, Visualization of Uncertainty

Intervention / Treatment
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* Other: Visualized pulmonary embolism computer task model
* Other: Didactic review lecture


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Medical students, University of Calgary, in clerkship who finished at least 4 weeks of a block of medicine rotation at any hospital site. First year subspecialty or Internal Medicine residents. Practicing physicians in the subspecialties of Internal Medicine or Emergency Medicine. Exclusion Criteria: Physicians in the subspecialty of Haematology or Respiratory

Ages Eligible for Study
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Minimum Age: 24 Years
Maximum Age: 65 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

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Visualized pulmonary embolism computer task model<br>This group of participants was presented and trained to use a visual representation of diagnostic pathway for pulmonary embolism. The design of this visual representation is based on Bayes theorem and cognition enhancing visual design principles. | Other: Visualized pulmonary embolism computer task model<br>* This group of participants was presented and trained to use a visual representation of diagnostic pathway for pulmonary embolism. The design of this visual representation is based on Bayes theorem and cognition enhancing visual design principles.<br>|
| Active Comparator: Didactic review pulmonary embolism lecture<br>This group of participants was presented with a didactic lecture covering the diagnostic approach of pulmonary embolism. | Other: Didactic review lecture<br>* This group of participants was presented with a didactic lecture covering the diagnostic approach of pulmonary embolism.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Concordance with medical diagnostic reasoning pathway for pulmonary embolism. | Concordance with medical diagnostic reasoning pathway for a case presentation suggestive of pulmonary embolism will be reflected by whether participants are stopping prematurely or proceeding with diagnostic steps inappropriately. | Paper-based clinical case scenarios were completed within 2 hour after either intervention. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time. | The overall time taken to solve each clinical scenario may give insight to which decision making process was predominant to solve each clinical scenario. | Paper-based clinical case scenarios were completed within 2 hour after either intervention. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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randomized controlled study