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NCT05284838 Clinical Trial

Facilitating Adaptive Expertise in Learning Computed Tomography

Learning Clinical Trial

— FAIL CT  

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

Clinical Trial Details — Status: Completed

Administrative data
NCT number NCT05284838
Other study ID # 64099
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date July 18, 2022
Est. completion date September 30, 2023

Study information
Verified date March 2024
Source Stanford University
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility
Status Completed
Enrollment 150
Est. completion date September 30, 2023
Est. primary completion date July 31, 2023
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 18 Years and older
Eligibility 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

Study Design

Related Conditions & MeSH terms

Intervention

Other:
• Error Management Training (Difficult)
Error Management Training is used to teach head computed tomography interpretation. Participants encounter difficult questions.
• Error Management Training (Easy)
Error Management Training is used to teach head computed tomography interpretation. Participants encounter easy questions.
• Error Avoidance Training
Error Avoidance Training used to teach head computed tomography interpretation.

Locations
Country Name City State
United States Stanford University Stanford California

Sponsors (8)
Lead Sponsor Collaborator
Stanford University Alameda Health System, Brown University, The University of Texas Health Science Center, Houston, University of California, Los Angeles, University of Chicago, University of Wisconsin, Madison, Vanderbilt University

Country where clinical trial is conducted

United States, 

References & Publications (15)

Aliaga L, Clarke SO. Rethinking Radiology: An Active Learning Curriculum for Head Computed Tomography Interpretation. West J Emerg Med. 2022 Jan 1;23(1):47-51. doi: 10.5811/westjem.2021.10.53665. — View Citation

Dyre L, Tabor A, Ringsted C, Tolsgaard MG. Imperfect practice makes perfect: error management training improves transfer of learning. Med Educ. 2017 Feb;51(2):196-206. doi: 10.1111/medu.13208. Epub 2016 Dec 12. — View Citation

Eva KW. Diagnostic error in medical education: where wrongs can make rights. Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:71-81. doi: 10.1007/s10459-009-9188-9. Epub 2009 Aug 11. — View Citation

Gardner AK, Abdelfattah K, Wiersch J, Ahmed RA, Willis RE. Embracing Errors in Simulation-Based Training: The Effect of Error Training on Retention and Transfer of Central Venous Catheter Skills. J Surg Educ. 2015 Nov-Dec;72(6):e158-62. doi: 10.1016/j.jsurg.2015.08.002. Epub 2015 Sep 8. — View Citation

Keith N, Frese M. Effectiveness of error management training: a meta-analysis. J Appl Psychol. 2008 Jan;93(1):59-69. doi: 10.1037/0021-9010.93.1.59. — View Citation

Keith N, Frese M. Self-regulation in error management training: emotion control and metacognition as mediators of performance effects. J Appl Psychol. 2005 Jul;90(4):677-91. doi: 10.1037/0021-9010.90.4.677. — View Citation

King A, Holder MG Jr, Ahmed RA. Errors as allies: error management training in health professions education. BMJ Qual Saf. 2013 Jun;22(6):516-9. doi: 10.1136/bmjqs-2012-000945. Epub 2013 Jan 3. — View Citation

Kua J, Lim WS, Teo W, Edwards RA. A scoping review of adaptive expertise in education. Med Teach. 2021 Mar;43(3):347-355. doi: 10.1080/0142159X.2020.1851020. Epub 2020 Nov 28. — View Citation

Metcalfe J. Learning from Errors. Annu Rev Psychol. 2017 Jan 3;68:465-489. doi: 10.1146/annurev-psych-010416-044022. Epub 2016 Sep 14. — View Citation

Mylopoulos M, Brydges R, Woods NN, Manzone J, Schwartz DL. Preparation for future learning: a missing competency in health professions education? Med Educ. 2016 Jan;50(1):115-23. doi: 10.1111/medu.12893. — View Citation

Mylopoulos M, Kulasegaram K, Woods NN. Developing the experts we need: Fostering adaptive expertise through education. J Eval Clin Pract. 2018 Jun;24(3):674-677. doi: 10.1111/jep.12905. Epub 2018 Mar 8. — View Citation

Mylopoulos M, Steenhof N, Kaushal A, Woods NN. Twelve tips for designing curricula that support the development of adaptive expertise. Med Teach. 2018 Aug;40(8):850-854. doi: 10.1080/0142159X.2018.1484082. Epub 2018 Jul 15. — View Citation

Pusic MV, Santen SA, Dekhtyar M, Poncelet AN, Roberts NK, Wilson-Delfosse AL, Cutrer WB. Learning to balance efficiency and innovation for optimal adaptive expertise. Med Teach. 2018 Aug;40(8):820-827. doi: 10.1080/0142159X.2018.1485887. Epub 2018 Aug 9. — View Citation

Royce CS, Hayes MM, Schwartzstein RM. Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Acad Med. 2019 Feb;94(2):187-194. doi: 10.1097/ACM.0000000000002518. — View Citation

Soderstrom NC, Bjork RA. Learning versus performance: an integrative review. Perspect Psychol Sci. 2015 Mar;10(2):176-99. doi: 10.1177/1745691615569000. — View Citation

* Note: There are 15 references in all — Click here to view all references

Outcome
Type Measure Description Time frame Safety issue
Primary 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 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)
Secondary 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)
Secondary 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
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