Virtual Patient Education From Real Cases

NCT04553640 | Completed

• 1 other identifier: IRB00167998
• Study Type: interventional
• Target: 28
• Locations: 1 country
• Sites: 1

Brief Summary

Misdiagnosis of neurological conditions is common in healthcare settings, sometimes with devastating consequences. Most diagnostic errors result from failures in bedside diagnostic reasoning. Dizziness is a symptom that is common, costly, and frequently associated with missed stroke. Too often healthcare providers have misconceptions about diagnostic approaches to dizziness. Current systems of medical education, residency training, and licensure requirements have proven insufficient to prevent harms from diagnostic error. Traditional lectures do not change physician behavior but active learning strategies with the use of simulation do. The investigators built and hope to expand a simulation-based curriculum to improve diagnosis of dizziness (SIDD) that will mirror real-world encounters and clinical practice. Using the tenets of deliberate practice with rapid, real-time feedback, the investigators hope to improve the approach to dizziness of healthcare providers and correct knowledge deficits that contribute to diagnostic errors. Investigators have chosen dizziness as the "model symptom" for this study. Future plans include expanding this approach to other symptoms that are also common, costly, and associated with a high misdiagnosis rate (e.g. abdominal pain, dyspnea, or chest pain).

Conditions

Simulation; Dizziness; Vertigo; Stroke

Keywords

virtual education; medical education

Outcome Measures

Primary Outcomes (1)

• Diagnostic accuracy as determined by the percentage of proportion of correct virtual patient cases from the total number of virtual patient cases

  Diagnostic accuracy on virtual patient cases in a pretest-posttest study and then participants will be exposed to a 2nd posttest after a time delay - evaluated with Phase 1

  6 months

Secondary Outcomes (4)

• Diagnostic process assessed with quality of EHR notes for dizzy patients as assessed by a rubric (intervention vs. control group)

  6 months

• Diagnostic Utilization as determined by percentage of neuroimaging utilization in ED

  6 months

• Self-Confidence as determined by online self assessment survey

  6 months

• Satisfaction as determined by a self assessment score

  6 months

Study Arms (2)

Group A/Intervention Curriculum

EXPERIMENTAL

Virtual patient (VP) cases and feedback available through solving VP cases and participants' self-report on the diagnosis of dizzy patients in the emergency department.

Other: Group A/Intervention Curriculum; Other: Group B/Control Curriculum

Group B/Control curriculum

ACTIVE COMPARATOR

Online articles on dizziness AND regular emergency department clinical rotations

Other: Group A/Intervention Curriculum; Other: Group B/Control Curriculum

Interventions

Group A/Intervention Curriculum OTHER

Virtual patient cases and feedback

Also known as: Simulation-based curriculum to Improve Diagnosis of Dizziness (SIDD)

Group A/Intervention Curriculum; Group B/Control curriculum

Group B/Control Curriculum OTHER

Online articles on dizziness and emergency department clinical experience

Group A/Intervention Curriculum; Group B/Control curriculum

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• All internal medicine interns (PGY 1) and residents (PGY 2 and 3) at Johns Hopkins Hospital (JHH) and Johns Hopkins Bayview Medical Center (JHBMC) will be invited to participate voluntarily.
• JHBMC and JHH Hospitalists, Physician Assistants, Nurse Practitioners, Emergency Medicine Residents.

You may not qualify if:

• Interns and residents not associated with the internal medicine or emergency medicine residency programs at JHH and JHBMC.
• Hospitalists, Physician Assistants, Nurse Practitioners not associated with JHBMC or JHH.

Sponsors & Collaborators

• Johns Hopkins University: lead

Study Sites (1)

Johns Hopkins University School of Medicine

Baltimore, Maryland, 21224, United States

Location

MeSH Terms

Conditions

Dizziness; Vertigo; Stroke

Condition Hierarchy (Ancestors)

Sensation Disorders; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Vestibular Diseases; Labyrinth Diseases; Ear Diseases; Otorhinolaryngologic Diseases; Nervous System Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Study Officials

• Susrutha Kotwal, MD

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Phase 1: A stratified randomized controlled delayed intervention trial to assess the effectiveness of the "intervention" relative to a "control" condition. Participants will undergo a pretest \& then stratified randomization to groups A or B (depending on clinical experience). Participants in group A will be exposed to the intervention (virtual patient curriculum + Feedback) and participants in group B will be exposed to the control (Online articles on dizziness and traditional ED residency training). The groups will then reverse so that now group B is exposed to the intervention. Outcomes will be measured for all participants at T0 (pretest), T1 (crossover point), and T2 (intervention end). Phase 2: This will be a non-randomized study between intervention group (those ED providers who participated in our curriculum) vs. new control group (matched ED providers who did not participate in our curriculum).

Study Record Dates

• First Submitted: September 11, 2020
• First Posted: September 17, 2020
• Study Start: May 15, 2021
• Primary Completion: June 30, 2023
• Study Completion: June 30, 2023
• Last Updated: July 12, 2023

Record last verified: 2023-07

Locations

US (1)