Wounds and InjuriesNCT02857348
A Trial of a Video Game Intervention to Recalibrate Physician Heuristics
A study testing Night Shift and Educational Module in people with Wounds and Injuries, run by University of Pittsburgh.
Trial 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. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Wounds and Injuries
- What is being tested?
- Night Shift and Educational Module
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 368 participants
- Where
- No sites listed yet
- Study dates
- Oct 2016to Nov 2016
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- 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.
Who cannot join
- Physicians who work at a Level I/II trauma center.
- Physicians who do not practice in the US.
About this study
Official title: A Randomized Controlled Trial of a Video Game Intervention to Recalibrate Physician Heuristics
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.
Read the 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.
- Conditions
- Wounds and Injuries
- Being tested
- Night Shift, Educational Module
- Keywords
- decision making, heuristics
- Medical subject headings
- Wounds and Injuries
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Night ShiftBehavioural
Night Shift is an adventure video game with the transformational goal of teaching physicians key characteristics of patients with non-representative severe injuries - injuries classified by the American College of Surgeons as life-threatening or critical but that do not fit the archetype of injuries typically requiring treatment at a trauma center. Players take on the persona of Andy Jordan, a young emergency physician who moves home after the disappearance of his estranged grandfather (Robert Jordan) and takes up a job in the local Emergency Department (ED). In the preamble, players learn they have two explicit objectives. First, they must diagnose and treat patients who present to their ED. Second they must solve the mystery of Robert's disappearance: was he murdered or has he simply chosen to disappear?
Educational ModuleBehavioural
The educational module consists of two separate apps, both commercially available. myATLS includes a review of each chapter of the Advanced Trauma Life Support (ATLS) textbook, a series of videos demonstrating common trauma procedures, and clinical resources including checklists for use at the bedside. Trauma Life Support MCQ Review includes 550 multiple-choice questions with correct answers and explanations. The investigators will ask physicians to review the myATLS app and then complete questions in the Trauma Life Support MCQ Review, spending at least 1 hour on the combined tasks.
| Study group | Role | What they receive |
|---|---|---|
| Adventure video game | Experimental | Physicians in this arm of the trial will be asked to play Night Shift, an adventure video game, for one hour. Receives: Behavioral: Night Shift |
| Educational Module | Active comparator | 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. Receives: Behavioral: Educational Module |
What is being measured
The primary outcome is the main question the study is designed to answer.
Under-triage rate
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.
Measured: After completion of the intervention
Secondary outcomes (1)
The effect of cognitive load on the under-triage rate
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.
Measured: After completion of the intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Aug 2016 (estimated)
- Study startOct 2016
- Primary completionNov 2016
- Study completionNov 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Wounds and InjuriesStudies of the same condition, open and under way.
- More trials run by University of PittsburghThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 368 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Pittsburgh
- Sponsor type
- University, hospital or other
- Collaborators
- Carnegie Mellon University
- Responsible party
- Principal investigator, Deepika Mohan, University of Pittsburgh
- Investigators
- Deepika Mohan, MD, Principal investigator, University of Pittsburgh
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02857348
- Sponsor's protocol ID
- PRO16070572
- Status last verified
- Aug 2017
- First submitted
- 28 Jul 2016
- Last updated
- 24 Aug 2017
- Results posted
- No
- Data monitoring committee
- No
- Individual data sharing
- Yes: De-identified data will be made available on application to the investigator team.
Publications
Mohan D, Rosengart MR, Fischhoff B, Angus DC, Wallace DJ, Farris C, Yealy DM, Barnato AE. Using incentives to recruit physicians into behavioral trials: lessons learned from four studies. BMC Res Notes. 2017 Dec 28;10(1):776. doi: 10.1186/s13104-017-3101-z.
PubMed 29282154Mohan D, Farris C, Fischhoff B, Rosengart MR, Angus DC, Yealy DM, Wallace DJ, Barnato AE. Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial. BMJ. 2017 Dec 12;359:j5416. doi: 10.1136/bmj.j5416.
PubMed 29233854Mohan D, Rosengart MR, Fischhoff B, Angus DC, Farris C, Yealy DM, Wallace DJ, Barnato AE. Testing a videogame intervention to recalibrate physician heuristics in trauma triage: study protocol for a randomized controlled trial. BMC Emerg Med. 2016 Nov 11;16(1):44. doi: 10.1186/s12873-016-0108-z.
PubMed 27835981
Study at a glance
From the registry record, last updated by the sponsor on 24 Aug 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Controlled Trial of a Video Game Intervention to Recalibrate Physician Heuristics
- ClinicalTrials.gov ID
- NCT02857348
- Acronym / sponsor ID
- PRO16070572
- Conditions
- Wounds and Injuries
- Keywords
- decision making, heuristics
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 368 participants (actual)
- Lead sponsor
- University of PittsburghUniversity, hospital or other
- Collaborators
- Carnegie Mellon University
- Study start
- Oct 2016
- Primary completion
- Nov 2016 (actual)
- Study completion
- Nov 2016 (actual)
- First posted
- 5 Aug 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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 design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Adventure video game | Experimental | Behavioral: Night ShiftPhysicians in this arm of the trial will be asked to play Night Shift, an adventure video game, for one hour. |
| Educational Module | Active comparator | Behavioral: Educational ModulePhysicians 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. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (3 listed)
- 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.
Key exclusion criteria (2 listed)
- Physicians who work at a Level I/II trauma center.
- Physicians who do not practice in the US.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Night ShiftNight Shift is an adventure video game with the transformational goal of teaching physicians key characteristics of patients with non-representative severe injuries - injuries classified by the American College of Surgeons as life-threatening or critical but that do not fit the archetype of injuries typically requiring treatment at a trauma center. Players take on the persona of Andy Jordan, a young emergency physician who moves home after the disappearance of his estranged grandfather (Robert Jordan) and takes up a job in the local Emergency Department (ED). In the preamble, players learn they have two explicit objectives. First, they must diagnose and treat patients who present to their ED. Second they must solve the mystery of Robert's disappearance: was he murdered or has he simply chosen to disappear? | Behavioural | Adventure video game |
| Educational ModuleThe educational module consists of two separate apps, both commercially available. myATLS includes a review of each chapter of the Advanced Trauma Life Support (ATLS) textbook, a series of videos demonstrating common trauma procedures, and clinical resources including checklists for use at the bedside. Trauma Life Support MCQ Review includes 550 multiple-choice questions with correct answers and explanations. The investigators will ask physicians to review the myATLS app and then complete questions in the Trauma Life Support MCQ Review, spending at least 1 hour on the combined tasks. | Behavioural | Educational Module |
Primary outcome
Under-triage rate
Time frame: 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.
1 secondary outcome
The effect of cognitive load on the under-triage rate
Time frame: After completion of the intervention
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Aug 2017.
- Derived from this study: PubMed 29282154Mohan D, Rosengart MR, Fischhoff B, Angus DC, Wallace DJ, Farris C, Yealy DM, Barnato AE. Using incentives to recruit physicians into behavioral trials: lessons learned from four studies. BMC Res Notes. 2017 Dec 28;10(1):776. doi: 10.1186/s13104-017-3101-z.
- Derived from this study: PubMed 29233854Mohan D, Farris C, Fischhoff B, Rosengart MR, Angus DC, Yealy DM, Wallace DJ, Barnato AE. Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial. BMJ. 2017 Dec 12;359:j5416. doi: 10.1136/bmj.j5416.
- Derived from this study: PubMed 27835981Mohan D, Rosengart MR, Fischhoff B, Angus DC, Farris C, Yealy DM, Wallace DJ, Barnato AE. Testing a videogame intervention to recalibrate physician heuristics in trauma triage: study protocol for a randomized controlled trial. BMC Emerg Med. 2016 Nov 11;16(1):44. doi: 10.1186/s12873-016-0108-z.
- Individual participant dataSharing planned: Yes. De-identified data will be made available on application to the investigator team.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Deepika Mohan, MD principal investigator
University of Pittsburgh
Questions about this trial
What is this clinical trial studying?
A study testing Night Shift and Educational Module in people with Wounds and Injuries, run by University of Pittsburgh.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 24 Aug 2017. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Under-triage rate (time frame: After completion of the intervention). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02857348, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Aug 2017.