Testing the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce diagnostic error in trauma triage: a study protocol for a randomized pilot trial

Abstract

Background Non-compliance with clinical practice guidelines in trauma remains common, in part because physicians make diagnostic errors when triaging injured patients. Deliberate practice, purposeful participation in a training task under the oversight of a coach, effectively changes behavior in procedural domains of medicine but has rarely been used to improve diagnostic skill. We plan a pilot parallel randomized trial to test the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce physician diagnostic errors in trauma triage. Methods We will randomize a national convenience sample of physicians who work at non-trauma centers (n = 60) in a 1:1 ratio to a deliberate practice intervention or to a passive control. We will use a customized, theory-based serious video game as the basis of our training task, selected based on its behavior change techniques and game mechanics, along with a coaching manual to standardize the fidelity of the intervention delivery. The intervention consists of three 30-min sessions with content experts (coaches), conducted remotely, during which physicians (trainees) play the game and receive feedback on their diagnostic processes. We will assess (a) the fidelity with which the intervention is delivered by reviewing video recordings of the coaching sessions; (b) the acceptability of the intervention through surveys and semi-structured interviews, and (c) the effect of the intervention by comparing the performance of trainees and a control group of physicians on a validated virtual simulation. We hypothesize that trainees will make ≥ 25% fewer diagnostic errors on the simulation than control physicians, a large effect size. We additionally hypothesize that ≥ 90% of trainees will receive their intervention as planned. Conclusions The results of the trial will inform the decision to proceed with a future hybrid effectiveness-implementation trial of the intervention. It will also provide a deeper understanding of the challenges of using deliberate practice to modify the diagnostic skill of physicians. Trial registration Clinical trials.gov (NCT05168579); 23 December 2021.

Testing a Novel Deliberate Practice Intervention to Improve Diagnostic Reasoning in Trauma Triage

“…We structured the process evaluation of the intervention using the Proctor framework of outcomes for implementation research and followed the Consolidated Standards of Reporting Trials Extension (CONSORT Extension) reporting guideline (ie, extension for pilot and feasibility trials) in reporting our results . We previously published the trial protocol with a priori hypotheses about criteria for defining success . The University of Pittsburgh Human Research Protection Office approved the study.…”

“… 20 , 21 We previously published the trial protocol with a priori hypotheses about criteria for defining success. 22 The University of Pittsburgh Human Research Protection Office approved the study. Trial participants provided digital written informed consent at the time of enrollment (trial protocol in Supplement 1 ).…”