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

Authors

• Kristin L Rising
• Kenzie A Cameron
• David H Salzman
• Dimitrios Papanagnou
• Amanda M B Doty
• Katherine Piserchia
• Benjamin E Leiby
• Ayako Shimada
• William C McGaghie
• Rhea E Powell
• Matthew R Klein
• Xiao Chi Zhang
• John Vozenilek
• Danielle M McCarthy

Publication/Presentation Date

3-1-2023

Abstract

PURPOSE: There are no standardized approaches for communicating with patients discharged from the emergency department with diagnostic uncertainty. This trial tested efficacy of the Uncertainty Communication Education Module, a simulation-based mastery learning curriculum designed to establish competency in communicating diagnostic uncertainty.

METHOD: Resident physicians at 2 sites participated in a 2-arm waitlist randomized controlled trial from September 2019 to June 2020. After baseline (T1) assessment of all participants via a standardized patient encounter using the Uncertainty Communication Checklist (UCC), immediate access physicians received training in the Uncertainty Communication Education Module, which included immediate feedback, online educational modules, a smartphone-based application, and telehealth deliberate practice with standardized patients. All physicians were retested 16-19 weeks later (T2) via in-person standardized patient encounters; delayed access physicians then received the intervention. A final test of all physicians occurred 11-15 weeks after T2 (T3). The primary outcome measured the percentage of physicians in the immediate versus delayed access groups meeting or exceeding the UCC minimum passing standard at T2.

RESULTS: Overall, 109 physicians were randomized, with mean age 29 years (range 25-46). The majority were male (n = 69, 63%), non-Hispanic/Latino (n = 99, 91%), and White (n = 78, 72%). At T2, when only immediate access participants had received the curriculum, immediate access physicians demonstrated increased mastery (n = 29, 52.7%) compared with delayed access physicians (n = 2, 3.7%, P < .001; estimated adjusted odds ratio of mastery for the immediate access participants, 31.1 [95% CI, 6.8-143.1]). There were no significant differences when adjusting for training site or stage of training.

CONCLUSIONS: The Uncertainty Communication Education Module significantly increased mastery in communicating diagnostic uncertainty at the first postintervention test among emergency physicians in standardized patient encounters. Further work should assess the impact of clinical implementation of these communication skills.

Volume

98

Issue

3

First Page

384

Last Page

393

ISSN

1938-808X

Published In/Presented At

Rising, K. L., Cameron, K. A., Salzman, D. H., Papanagnou, D., Doty, A. M. B., Piserchia, K., Leiby, B. E., Shimada, A., McGaghie, W. C., Powell, R. E., Klein, M. R., Zhang, X. C., Vozenilek, J., & McCarthy, D. M. (2023). Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning Randomized Trial. Academic medicine : journal of the Association of American Medical Colleges, 98(3), 384–393. https://doi.org/10.1097/ACM.0000000000004993

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

36205492

Department(s)

Administration and Leadership

Document Type

Article