Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial

Abstract

Background: Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications. Methods: The trial is a multicenter, two-arm randomized controlled trial designed to teach communication skills using simulation-based mastery learning (SBML). Resident emergency physicians from two training programs will be randomly assigned to immediate or delayed receipt of the two-part UCEM intervention after completing a baseline standardized patient encounter. The two UCEM components are: 1) a web-based interactive module, and 2) a smart-phone-based game. Both formats teach and reinforce communication skills for patient cases involving diagnostic uncertainty. Following baseline testing, participants in the immediate intervention arm will complete a remote deliberate practice session via a video platform and subsequently return for a second study visit to assess if they have achieved mastery. Participants in the delayed intervention arm will receive access to UCEM and remote deliberate practice after the second study visit. The primary outcome of interest is the proportion of residents in the immediate intervention arm who achieve mastery at the second study visit. Discussion: Patients' understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. Although use of SBML is a resource intensive educational approach, this trial has been deliberately designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake. Trial registration: The trial was registered at clinicaltrials.gov (NCT04021771). Registration date: July 16, 2019.

Emergency Medicine Clinician Experiences Addressing Uncertainty in First-Trimester Bleeding

“…There is overlap with general uncertainty communication, and existing educational materials related to other, non-obstetric situations could be leveraged and adapted to the FTB scenario. These might include, for instance, the Uncertainty Communication Checklist or simulation-based mastery learning geared towards uncertainty ( 25 , 26 ).…”

Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning Randomized Trial

“…The trial methods are described in detail in the published trials protocol manuscript. 18 In brief, we conducted a randomized controlled waitlist trial from September 2021 to June 2022 across 2 urban academic residency training sites: Thomas Jefferson University (TJU) and Northwestern University (NU). TJU Hospital, the main TJU clinical site, is an urban academic hospital located in Philadelphia, Pennsylvania, with approximately 100,000 ED visits annually.…”

“…In this article, we report results from a randomized controlled waitlist trial testing UCEM efficacy for teaching physicians to achieve mastery as assessed by the UCC. 18 We hypothesized that physicians who received immediate access to the UCEM intervention would be significantly more likely to achieve mastery (i.e., meeting or exceeding the minimum passing standard set for the UCC) on their first attempt at the initial posttest compared with physicians whose access was delayed.…”

Language and culture in health communication in an emergency context: do health practitioners and patients talk differently about uncertainty and risk?

“…One of the possible explanations is that HPs may have been trained in how to discuss diagnostic uncertainty with their patients. Although there are no standard instructions and approaches to discussing uncertainty for patients discharged from the ED with diagnostic uncertainty (McCarthy et al, 2020), recent studies have reported on the inclusion of training in how to discuss diagnostic uncertainty with patients in medical degree programs (McCarthy et al, 2020;Poluch et al, 2022). Specifically, medical students are instructed to explicitly tell patients that there is no confirmed explanation (diagnosis) for what the patient has been experiencing (McCarthy et al, 2020;Poluch et al, 2022).…”