A Trial of a Video Game Intervention to Recalibrate Physician Heuristics
Primary Purpose
Wounds and Injuries
Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Night Shift
Educational Module
Sponsored by
About this trial
This is an interventional treatment trial for Wounds and Injuries focused on measuring decision making, heuristics
Eligibility Criteria
Inclusion Criteria:
- Physicians who care for adult patients in the Emergency Department.
- Physicians who work at a non-trauma center.
- Physicians who work at a Level III/IV trauma center.
Exclusion Criteria:
- Physicians who work at a Level I/II trauma center.
- Physicians who do not practice in the US.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Adventure video game
Educational Module
Arm Description
Physicians in this arm of the trial will be asked to play Night Shift, an adventure video game, for one hour.
Physicians in this arm of the trial will be asked to use myATLS, an app designed by the American College of Surgeons to serve as an adjunct to the ATLS course, and Trauma Life Support MCQ Review, an app designed to help students prepare for the ATLS exam. They will be asked to spend at least one hour on the combined tasks.
Outcomes
Primary Outcome Measures
Under-triage rate
Physicians in both arms of the study will be randomized to complete one of two versions of a virtual simulation: a control version and a cognitive load version. They will complete the simulation upon completion of the intervention, ideally within one month of enrollment.
The virtual simulation replicates the environment of the ED. Physicians have to manage 10 patients that appear concurrently, while also responding to a series of audio-visual distractors. Specifically, they must provide information on whether they will admit, transfer, or discharge the patients home. The investigators will calculate an under-triage rate for each physician (the number of simulated patients with severe injuries not transferred to a trauma center), summarize the under-triage rate by group (Night Shift v. educational control), and will compare the difference in those rates.
Secondary Outcome Measures
The effect of cognitive load on the under-triage rate
As described above, participants will complete either a control or cognitive load version of the virtual simulation upon completion of the intervention, ideally within one month of the enrollment. As a secondary outcome measure, the investigators will assess the difference in under-triage rates of physicians who complete the simulation under control and cognitive load conditions, by intervention type.
Full Information
NCT ID
NCT02857348
First Posted
July 28, 2016
Last Updated
August 22, 2017
Sponsor
University of Pittsburgh
Collaborators
Carnegie Mellon University
1. Study Identification
Unique Protocol Identification Number
NCT02857348
Brief Title
A Trial of a Video Game Intervention to Recalibrate Physician Heuristics
Official Title
A Randomized Controlled Trial of a Video Game Intervention to Recalibrate Physician Heuristics
Study Type
Interventional
2. Study Status
Record Verification Date
August 2017
Overall Recruitment Status
Completed
Study Start Date
October 2016 (undefined)
Primary Completion Date
November 2016 (Actual)
Study Completion Date
November 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Pittsburgh
Collaborators
Carnegie Mellon University
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
The objective of this study is to compare the efficacy of a video game designed to recalibrate physician heuristics in trauma triage with a standard educational program.
Detailed Description
Treatment at trauma centers improves outcomes for patients with moderate-to-severe injuries. Accordingly, professional organizations, state authorities, and the federal government have endorsed the systematic triage and transfer of these patients to trauma centers either directly from the field or after evaluation at a non-trauma center. Nonetheless, between 30 to 40% of patients with moderate-to-severe injuries still only receive treatment at non-trauma centers, so-called under-triage. Most of this under-triage occurs because of physician decisions (rather than first-responder decisions). Existing efforts to change physician decision making focus primarily on knowledge of clinical practice guidelines and attitudes towards the guidelines. These strategies ignores the growing consensus that decision making reflects both knowledge as well as intuitive judgments (heuristics). Heuristics, mental short cuts based on pattern recognition, drive the majority of decision making. The investigators have developed an adventure video game (Night Shift) to serve as a novel method of recalibrating physician heuristics in trauma triage and will compare its efficacy with a standard educational program.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Wounds and Injuries
Keywords
decision making, heuristics
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
368 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Adventure video game
Arm Type
Experimental
Arm Description
Physicians in this arm of the trial will be asked to play Night Shift, an adventure video game, for one hour.
Arm Title
Educational Module
Arm Type
Active Comparator
Arm Description
Physicians in this arm of the trial will be asked to use myATLS, an app designed by the American College of Surgeons to serve as an adjunct to the ATLS course, and Trauma Life Support MCQ Review, an app designed to help students prepare for the ATLS exam. They will be asked to spend at least one hour on the combined tasks.
Intervention Type
Behavioral
Intervention Name(s)
Night Shift
Intervention Description
Night Shift is an adventure video game with the transformational goal of teaching physicians key characteristics of patients with non-representative severe injuries - injuries classified by the American College of Surgeons as life-threatening or critical but that do not fit the archetype of injuries typically requiring treatment at a trauma center. Players take on the persona of Andy Jordan, a young emergency physician who moves home after the disappearance of his estranged grandfather (Robert Jordan) and takes up a job in the local Emergency Department (ED). In the preamble, players learn they have two explicit objectives. First, they must diagnose and treat patients who present to their ED. Second they must solve the mystery of Robert's disappearance: was he murdered or has he simply chosen to disappear?
Intervention Type
Behavioral
Intervention Name(s)
Educational Module
Intervention Description
The educational module consists of two separate apps, both commercially available. myATLS includes a review of each chapter of the Advanced Trauma Life Support (ATLS) textbook, a series of videos demonstrating common trauma procedures, and clinical resources including checklists for use at the bedside. Trauma Life Support MCQ Review includes 550 multiple-choice questions with correct answers and explanations. The investigators will ask physicians to review the myATLS app and then complete questions in the Trauma Life Support MCQ Review, spending at least 1 hour on the combined tasks.
Primary Outcome Measure Information:
Title
Under-triage rate
Description
Physicians in both arms of the study will be randomized to complete one of two versions of a virtual simulation: a control version and a cognitive load version. They will complete the simulation upon completion of the intervention, ideally within one month of enrollment.
The virtual simulation replicates the environment of the ED. Physicians have to manage 10 patients that appear concurrently, while also responding to a series of audio-visual distractors. Specifically, they must provide information on whether they will admit, transfer, or discharge the patients home. The investigators will calculate an under-triage rate for each physician (the number of simulated patients with severe injuries not transferred to a trauma center), summarize the under-triage rate by group (Night Shift v. educational control), and will compare the difference in those rates.
Time Frame
After completion of the intervention
Secondary Outcome Measure Information:
Title
The effect of cognitive load on the under-triage rate
Description
As described above, participants will complete either a control or cognitive load version of the virtual simulation upon completion of the intervention, ideally within one month of the enrollment. As a secondary outcome measure, the investigators will assess the difference in under-triage rates of physicians who complete the simulation under control and cognitive load conditions, by intervention type.
Time Frame
After completion of the intervention
10. Eligibility
Sex
All
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Physicians who care for adult patients in the Emergency Department.
Physicians who work at a non-trauma center.
Physicians who work at a Level III/IV trauma center.
Exclusion Criteria:
Physicians who work at a Level I/II trauma center.
Physicians who do not practice in the US.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Deepika Mohan, MD
Organizational Affiliation
University of Pittsburgh
Official's Role
Principal Investigator
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
De-identified data will be made available on application to the investigator team.
Citations:
PubMed Identifier
29282154
Citation
Mohan D, Rosengart MR, Fischhoff B, Angus DC, Wallace DJ, Farris C, Yealy DM, Barnato AE. Using incentives to recruit physicians into behavioral trials: lessons learned from four studies. BMC Res Notes. 2017 Dec 28;10(1):776. doi: 10.1186/s13104-017-3101-z.
Results Reference
derived
PubMed Identifier
29233854
Citation
Mohan D, Farris C, Fischhoff B, Rosengart MR, Angus DC, Yealy DM, Wallace DJ, Barnato AE. Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial. BMJ. 2017 Dec 12;359:j5416. doi: 10.1136/bmj.j5416.
Results Reference
derived
PubMed Identifier
27835981
Citation
Mohan D, Rosengart MR, Fischhoff B, Angus DC, Farris C, Yealy DM, Wallace DJ, Barnato AE. Testing a videogame intervention to recalibrate physician heuristics in trauma triage: study protocol for a randomized controlled trial. BMC Emerg Med. 2016 Nov 11;16(1):44. doi: 10.1186/s12873-016-0108-z.
Results Reference
derived
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A Trial of a Video Game Intervention to Recalibrate Physician Heuristics
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