■适应性专业知识可帮助医生将其技能应用于新的临床病例,并减少可预防的错误。错误管理培训(EMT)已被证明可以通过程序技能提高适应性专业知识;但是,其在医学教育中的认知技能应用尚不清楚。
■在学习头部计算机断层扫描(CT)解释的认知技能时,评估EMT是否提高了适应性专业知识。
■这项三臂随机临床试验于2022年7月8日至2023年3月30日在7个地理上不同的急诊医学住院医师计划中进行。参与者是1至4年级的急诊医学居民,掩盖了这一假设。
■参与者以1:1:1随机分配给困难的EMT,容易EMT,或错误避免训练(EAT)控制学习策略,以完成在线头部CT课程。在滚动通过头部CT病例之前,两个EMT队列都没有收到任何教学指导,而EAT组做到了。困难的EMT队列回答了有关教学案例的难题,导致错误,而简单的EMT队列回答了简单的问题,导致更少的错误。所有3个队列使用相同的病例。
■主要结果是3个队列中适应性专业知识的差异,使用头部CT后测测量。次要结果是(1)常规专业知识的差异,(2)培训过程中的错误数量是否介导了适应性专业知识的差异,(3)前期住院医师培训与学习策略之间的相互作用。
■在212名随机参与者中(平均[SD]年龄,28.8[2.0]年;107名男性[50.5%]),70个被分配给困难的EMT,71到容易的EMT,EAT对照组71人;150名参与者(70.8%)完成了后验。困难的EMT队列在适应性专业知识案例中的表现优于容易的EMT和EAT队列(60.6%[95%CI,56.1%-65.1%]vs45.2%[95%CI,39.9%-50.6%],vs40.9%[95%CI,36.0%-45.7%],分别;P<.001),具有较大的效应大小(η2=0.19)。常规专业知识没有显着差异。困难的EMT队列在训练期间比容易的EMT队列犯了更多的错误。中介分析表明,训练过程中的错误数解释了困难的EMT学习策略对提高适应性专业知识的影响的87.2%(P=0.01)。困难的EMT学习策略在早期培训中更有效地提高居民的适应性专业知识,具有较大的效应大小(η2=0.25;P=0.002)。
■在这项随机临床试验中,研究结果表明,EMT是培养具有认知技能的医师适应性专业知识的有效方法。
■ClinicalTrials.gov标识符:NCT05284838。
UNASSIGNED: Adaptive expertise helps physicians apply their skills to novel clinical cases and reduce preventable errors. Error management training (EMT) has been shown to improve adaptive expertise with procedural skills; however, its application to cognitive skills in medical education is unclear.
UNASSIGNED: To evaluate whether EMT improves adaptive expertise when learning the cognitive skill of head computed tomography (CT) interpretation.
UNASSIGNED: This 3-arm randomized clinical trial was conducted from July 8, 2022, to March 30, 2023, in 7 geographically diverse emergency medicine residency programs. Participants were postgraduate year 1 through 4 emergency medicine residents masked to the hypothesis.
UNASSIGNED: Participants were randomized 1:1:1 to a difficult EMT, easy EMT, or error avoidance training (EAT) control learning strategy for completing an online head CT curriculum. Both EMT cohorts received no didactic instruction before scrolling through head CT cases, whereas the EAT group did. The difficult EMT cohort answered difficult questions about the teaching cases, leading to errors, whereas the easy EMT cohort answered easy questions, leading to fewer errors. All 3 cohorts used the same cases.
UNASSIGNED: The primary outcome was a difference in adaptive expertise among the 3 cohorts, as measured using a head CT posttest. Secondary outcomes were (1) differences in routine expertise, (2) whether the quantity of errors during training mediated differences in adaptive expertise, and (3) the interaction between prior residency training and the learning strategies.
UNASSIGNED: Among 212 randomized participants (mean [SD] age, 28.8 [2.0] years; 107 men [50.5%]), 70 were allocated to the difficult EMT, 71 to the easy EMT, and 71 to the EAT control cohorts; 150 participants (70.8%) completed the posttest. The difficult EMT cohort outperformed both the easy EMT and EAT cohorts on adaptive expertise cases (60.6% [95% CI, 56.1%-65.1%] vs 45.2% [95% CI, 39.9%-50.6%], vs 40.9% [95% CI, 36.0%-45.7%], respectively; P < .001), with a large effect size (η2 = 0.19). There was no significant difference in routine expertise. The difficult EMT cohort made more errors during training than the easy EMT cohort. Mediation analysis showed that the number of errors during training explained 87.2% of the difficult EMT learning strategy\'s effect on improving adaptive expertise (P = .01). The difficult EMT learning strategy was more effective in improving adaptive expertise for residents earlier in training, with a large effect size (η2 = 0.25; P = .002).
UNASSIGNED: In this randomized clinical trial, the findings show that EMT is an effective method to develop physicians\' adaptive expertise with cognitive skills.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT05284838.