A Trial of a Video Game Intervention to Recalibrate Physician Heuristics

Not Applicable

Completed

• Conditions: Wounds and Injuries
• Interventions: Behavioral: Educational Module; Behavioral: Night Shift

• Registration Number: NCT02857348
• Lead Sponsor: University of Pittsburgh

Brief Summary

The objective of this study is to compare the efficacy of a video game designed to recalibrate physician heuristics in trauma triage with a standard educational program.

Detailed Description

Treatment at trauma centers improves outcomes for patients with moderate-to-severe injuries. Accordingly, professional organizations, state authorities, and the federal government have endorsed the systematic triage and transfer of these patients to trauma centers either directly from the field or after evaluation at a non-trauma center. Nonetheless, between 30 to 40% of patients with moderate-to-severe injuries still only receive treatment at non-trauma centers, so-called under-triage. Most of this under-triage occurs because of physician decisions (rather than first-responder decisions). Existing efforts to change physician decision making focus primarily on knowledge of clinical practice guidelines and attitudes towards the guidelines. These strategies ignores the growing consensus that decision making reflects both knowledge as well as intuitive judgments (heuristics). Heuristics, mental short cuts based on pattern recognition, drive the majority of decision making. The investigators have developed an adventure video game (Night Shift) to serve as a novel method of recalibrating physician heuristics in trauma triage and will compare its efficacy with a standard educational program.

Study Timeline

• Study First Submitted: 2016-07-28
• Study First Submitted QC: 2016-08-02
• Study First Posted: 2016-08-05
• Study Start: 2016-10
• Primary Completion: 2016-11
• Study Completion: 2016-11
• Status Verified: 2017-08
• Last Update Submitted: 2017-08-22
• Last Update Posted: 2017-08-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 368

Inclusion Criteria

• Physicians who care for adult patients in the Emergency Department.
• Physicians who work at a non-trauma center.
• Physicians who work at a Level III/IV trauma center.

Read More

Exclusion Criteria

• Physicians who work at a Level I/II trauma center.
• Physicians who do not practice in the US.

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Educational Module	Educational Module	Physicians in this arm of the trial will be asked to use myATLS, an app designed by the American College of Surgeons to serve as an adjunct to the ATLS course, and Trauma Life Support MCQ Review, an app designed to help students prepare for the ATLS exam. They will be asked to spend at least one hour on the combined tasks.
Adventure video game	Night Shift	Physicians in this arm of the trial will be asked to play Night Shift, an adventure video game, for one hour.

Primary Outcome Measures

Name	Time	Method
Under-triage rate	After completion of the intervention	Physicians in both arms of the study will be randomized to complete one of two versions of a virtual simulation: a control version and a cognitive load version. They will complete the simulation upon completion of the intervention, ideally within one month of enrollment.; The virtual simulation replicates the environment of the ED. Physicians have to manage 10 patients that appear concurrently, while also responding to a series of audio-visual distractors. Specifically, they must provide information on whether they will admit, transfer, or discharge the patients home. The investigators will calculate an under-triage rate for each physician (the number of simulated patients with severe injuries not transferred to a trauma center), summarize the under-triage rate by group (Night Shift v. educational control), and will compare the difference in those rates.

Secondary Outcome Measures

Name	Time	Method
The effect of cognitive load on the under-triage rate	After completion of the intervention	As described above, participants will complete either a control or cognitive load version of the virtual simulation upon completion of the intervention, ideally within one month of the enrollment. As a secondary outcome measure, the investigators will assess the difference in under-triage rates of physicians who complete the simulation under control and cognitive load conditions, by intervention type.