Serious games may improve physician heuristics in trauma triage

Fischhoff, Baruch; Angus, Derek C.; Rosengart, Matthew R.; Wallace, David J.; Yealy, Donald M.; Farris, Coreen; Chang, Chung‐Chou H.; Kerti, Samantha J.; Barnato, Amber E.

doi:10.1073/pnas.1805450115

Cited by 38 publications

(40 citation statements)

References 35 publications

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“…All studies investigating the impact of training or experience found that, regardless of whether CDM was operationalized as either cognitive processes (83)(84)(85) or dispositional decisions (86,87), experience and re ective learning had a positive impact on the clinicians' con dence, effectively improving skills, and possibly leading to more accurate decisions.…”

Section: The Effects Of Training or Experiencementioning

confidence: 99%

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

Gamborg

Mehlsen

Paltved

et al. 2020

Preprint

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Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by a vague conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalisations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

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Section: The Effects Of Training or Experiencementioning

confidence: 99%

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

Gamborg

Mehlsen

Paltved

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…The second, Shift: The Next Generation, used analogical reasoning delivered via a puzzle video game. 13,14 Both games included cases of representative and nonrepresentative patients and incorporated mechanisms to provide feedback based on triage decisions.…”

Section: Overview Of Prior Studies and Present Analysismentioning

confidence: 99%

“…13 In the second trial, we compared the effect of exposure to either one of the two video games, a text-based educational training program, or nothing at all. 14 In both trials, all physicians were required to complete the same simulation within 4 wk of completing their designated intervention. The main results from these studies have been previously reported.…”

Section: Overview Of Prior Studies and Present Analysismentioning

confidence: 99%

“…The main results from these studies have been previously reported. 13,14 In the current effort, we performed a post hoc secondary analysis by linking physician data from our previous trials to claims records acquired from the Centers for Medicare and Medicaid Services (CMS). The elderly experience high undertriage and mortality after injury, allowing insight into the determinants of variation in triage practices.…”

Section: Overview Of Prior Studies and Present Analysismentioning

confidence: 99%

“…Enrollment occurred at two separate meetings of the American College of Emergency Physicians in 2016 (Study 1) and 2017 (Study 2). 13,14 We obtained information about physicians including age, sex, race, years of experience, and work environment. Subjects received a wage-based incentive ($100/ h) for participating.…”

Section: Subjectsmentioning

confidence: 99%

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Does Preexisting Practice Modify How Video Games Recalibrate Physician Heuristics in Trauma Triage?

Kulkarni

Barnato

Rosengart

et al. 2019

Journal of Surgical Research

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Triage Heuristics Behavioral interventionSerious video game a b s t r a c t Background: A majority of severely injured patients fail to receive care at trauma centers (undertriage), in part, because of physician judgment. We previously developed two educational video games that reduced physicians' undertriage compared with control in two clinical trials. In this secondary analysis, we investigated heterogeneity of treatment effect of the interventions by assessing physicians' preexisting practice patterns in claims data. We hypothesized that physicians with high preexisting undertriage would benefit most from game-based training.Methods: Using Medicare claims records from 2010 to 2015, we measured physicians' preexisting triage practices before their participation in one of two trials conducted in 2016 and 2017. We categorized physicians as having received game-based training versus control and noted their postintervention simulation triage performance in the trials. We used multivariable linear regression models to assess the heterogeneity of game-based training effect among physicians with high and low preexisting undertriage.Results: Of the 394 eligible physicians from our trials, we identified 275 (70%) with claims for Medicare fee-for-service beneficiaries suffering severe injury between 2010 and 2015. On average, the physicians were 44 y old (SD 8.4) with 12 y (SD 8.2) of experience. We found significant interaction between preexisting practice and intervention efficacy (P ¼ 0.04).Physicians with high undertriage before enrollment improved significantly with gamebased training compared with the control (46% versus 63%, P < 0.001). Those with low preexisting undertriage did not (58% versus 56%, P ¼ 0.76).Conclusions: Using claims-based data, we found heterogeneity of treatment effect of interventions designed to recalibrate physician heuristics. Physicians with high preexisting undertriage benefited most from game-based training.

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Testing a Novel Deliberate Practice Intervention to Improve Diagnostic Reasoning in Trauma Triage

et al. 2023

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ImportanceDiagnostic errors made during triage at nontrauma centers contribute to preventable morbidity and mortality after injury.ObjectiveTo test the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to improve diagnostic reasoning in trauma triage.Design, Setting, and ParticipantsThis pilot randomized clinical trial was conducted online in a national convenience sample of 72 emergency physicians between January 1 and March 31, 2022, without follow-up.InterventionsParticipants were randomly assigned to receive either usual care (ie, passive control) or a deliberate practice intervention, consisting of 3 weekly, 30-minute, video-conferenced sessions during which physicians played a customized, theory-based video game while being observed by content experts (coaches) who provided immediate, personalized feedback on diagnostic reasoning.Main Outcomes and MeasuresUsing the Proctor framework of outcomes for implementation research, the feasibility, fidelity, acceptability, adoption, and appropriateness of the intervention was assessed by reviewing videos of the coaching sessions and conducting debriefing interviews with participants. A validated online simulation was used to assess the intervention’s effect on behavior, and triage among control and intervention physicians was compared using mixed-effects logistic regression. Implementation outcomes were analyzed using an intention-to-treat approach, but participants who did not use the simulation were excluded from the efficacy analysis.ResultsThe study enrolled 72 physicians (mean [SD] age, 43.3 [9.4] years; 44 men [61%]) but limited registration of physicians in the intervention group to 30 because of the availability of the coaches. Physicians worked in 20 states; 62 (86%) were board certified in emergency medicine. The intervention was delivered with high fidelity, with 28 of 30 physicians (93%) completing 3 coaching sessions and with coaches delivering 95% of session components (642 of 674). A total of 21 of 36 physicians (58%) in the control group participated in outcome assessment; 28 of 30 physicians (93%) in the intervention group participated in semistructured interviews, and 26 of 30 physicians (87%) in the intervention group participated in outcome assessment. Most physicians in the intervention group (93% [26 of 28]) described the sessions as entertaining and valuable; most (88% [22 of 25]) affirmed the intention to adopt the principles discussed. Suggestions for refinement included providing more time with the coach and addressing contextual barriers to triage. During the simulation, the triage decisions of physicians in the intervention group were more likely to adhere to clinical practice guidelines than those in the control group (odds ratio; 13.8, 95% CI, 2.8-69.6; P = .001).Conclusions and RelevanceIn this pilot randomized clinical trial, coaching was feasible and acceptable and had a large effect on simulated trauma triage decisions, setting the stage for a phase 3 trial.Trial RegistrationClinicalTrials.gov Identifier: NCT05168579

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Serious games may improve physician heuristics in trauma triage

Cited by 38 publications

References 35 publications

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

Does Preexisting Practice Modify How Video Games Recalibrate Physician Heuristics in Trauma Triage?

Testing a Novel Deliberate Practice Intervention to Improve Diagnostic Reasoning in Trauma Triage

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