Facilitating Adaptive Expertise in Learning Computed Tomography

NCT05284838 | Completed

• 1 other identifier: 64099
• Study Type: interventional
• Target: 150
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Adaptive Expertise; Error Management Training; Learning

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (3)

• Percent correct on an assessment of post-session proficiency for learning objectives (routine expertise)

  Immediately after instructional session (up to 60 minutes to complete the assessment)

• Effect of post-graduate year level on post-test performance

  Immediately after instructional session (up to 60 minutes to complete the assessment)

• Mediation effect of errors on performance on the adaptive expertise cases

  Number of errors will be measured during the educational intervention

Study Arms (3)

Error Management Training (Difficult)

EXPERIMENTAL

Participants receive the learning strategy Error Management Training and encounter difficult questions.

Other: Error Management Training (Difficult)

Error Management Training (Easy)

EXPERIMENTAL

Participants receive the learning strategy Error Management Training and encounter easy questions.

Other: Error Management Training (Easy)

Error Avoidance Training

ACTIVE COMPARATOR

Participants receive the learning strategy Error Avoidance Training.

Other: Error Avoidance Training

Interventions

Error Management Training (Difficult) OTHER

Error Management Training is used to teach head computed tomography interpretation. Participants encounter difficult questions.

Error Management Training (Difficult)

Error Management Training (Easy) OTHER

Error Management Training is used to teach head computed tomography interpretation. Participants encounter easy questions.

Error Management Training (Easy)

Error Avoidance Training OTHER

Error Avoidance Training used to teach head computed tomography interpretation.

Error Avoidance Training

Eligibility Criteria

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

You may qualify if:

• Study participation will be available to all current emergency medicine residents at Stanford and at thirteen external sites.

You may not qualify if:

• 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

Sponsors & Collaborators

• Stanford University: lead
• Brown University: collaborator
• Alameda Health System: collaborator
• University of California, Los Angeles: collaborator
• University of Chicago: collaborator
• The University of Texas Health Science Center, Houston: collaborator
• University of Wisconsin, Madison: collaborator
• Vanderbilt University: collaborator

Study Sites (1)

Stanford University

Stanford, California, 94305, United States

Location

Related Publications (16)

• 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.

  PMID: 35060860 BACKGROUND

• 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.

  PMID: 30091659 BACKGROUND

• 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.

  PMID: 30398993 BACKGROUND

• 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.

  PMID: 23293120 BACKGROUND

• 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.

  PMID: 27943372 BACKGROUND

• 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.

  PMID: 26362712 BACKGROUND

• 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.

  PMID: 26695471 BACKGROUND

• 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.

  PMID: 18211135 BACKGROUND

• 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.

  PMID: 16060786 BACKGROUND

• 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.

  PMID: 33251895 BACKGROUND

• 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.

  PMID: 19669913 BACKGROUND

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

  PMID: 25910388 BACKGROUND

• 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.

  PMID: 27648988 BACKGROUND

• 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.

  PMID: 29516651 BACKGROUND

• 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.

  PMID: 30009648 BACKGROUND

• Aliaga L, Bavolek RA, Cooper B, Mariorenzi A, Ahn J, Kraut A, Duong D, Burger C, Gisondi MA. Error Management Training and Adaptive Expertise in Learning Computed Tomography Interpretation: A Randomized Clinical Trial. JAMA Netw Open. 2024 Sep 3;7(9):e2431600. doi: 10.1001/jamanetworkopen.2024.31600.

  PMID: 39250155 DERIVED

Study Officials

• Leonardo Aliaga, MD

  Stanford University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Instructor, Department of Emergency Medicine

Study Record Dates

• First Submitted: March 10, 2022
• First Posted: March 17, 2022
• Study Start: July 18, 2022
• Primary Completion: July 31, 2023
• Study Completion: September 30, 2023
• Last Updated: April 2, 2024

Record last verified: 2024-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)