Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.
Background and Objective Healthcare providers require multitasking and multi-patient care skills, and training programs do not formally incorporate curricula specifically for multitasking skills to trainees. The medical education community is in equipoise on whether multitasking ability is a fixed trait. Furthermore, it is unclear whether multitasking ability affects those who gravitate toward careers that demand it, particularly among medical students deciding on a specialty. We sought to define the association between specialty choice, multitasking abilities and multi-patient care delivery among pre-clinical medical students. For this study, we examined both efficiency and accuracy metrics within multitasking and whether they were different between students choosing specialties. Methods This was a planned cross-sectional sub-study focused on 2nd year medical students (MS-IIs) within a parent study evaluating multi-patient care skills using a serious game (VitalSigns:EDTM) depicting a pediatric emergency department. Subjects completed a Multitasking Ability Test (MTAT) and five VitalSigns:ED gameplays. The predictor variable was specialty choice, categorized into multitasking and non-multitasking groups. Outcome variables measuring efficiency and diagnostic accuracy were obtained from the MTAT and the game. The primary analysis was a Mann–Whitney U test, and secondary analyses employed Spearman Rank correlations. Results Twelve students applied to multitasking specialties and 18 applied to others. Those in the multitasking specialties had faster MTAT completions than the other cohort (29.8 vs. 59.7 sec, 95%CI difference -0.9 to -39.8 sec). Differential diagnoses were higher in multitasking specialties in VitalSigns:ED (2.03 vs. 1.06, 95%CI difference +0.05 to +1.54) but efficiency metrics in the game did not differ. Conclusion Multitasking and multi-patient care performance show some association with preferred specialty choices for MS-IIs prior to clinical exposure.
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