Adaptive ExpertiseFAIL CTNCT05284838
Facilitating Adaptive Expertise in Learning Computed Tomography
A study testing Error Management Training (Difficult), Error Management Training (Easy) and Error Avoidance Training in people with Adaptive Expertise and Error Management Training, run by Stanford University at 1 site in United States.
Trial summary
The main objective of this study is to demonstrate that Error Management Training improves adaptive expertise in head computed tomography interpretation. The investigators will conduct a randomized controlled trial comparing two learning strategies, Error Management Training vs Error Avoidance Training, in emergency… Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Adaptive Expertise, Error Management Training, Learning
- What is being tested?
- Error Management Training (Difficult), Error Management Training (Easy) and Error Avoidance Training
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 150 participants
- Where
- 1 siteUnited States
- Study dates
- 18 Jul 2022to 30 Sep 2023
- 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 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Study participation will be available to all current emergency medicine residents at Stanford and at thirteen external sites.
Who cannot join
- Adults unable to consent
- Pregnant women
- Individuals who are not yet adults (infants, children, teenagers)
- Prisoners
- Medical students
- Residents from specialties other than emergency medicine
Trial locations and contacts
1 site in 1 country.
About this study
Official title: The FAIL CT Study: Facilitating Adaptive Expertise in Learning Computed Tomography, a Multi-center Randomized Controlled Trial
The main objective of this study is to demonstrate that Error Management Training improves adaptive expertise in head computed tomography interpretation. The investigators will conduct a randomized controlled trial comparing two learning strategies, Error Management Training vs Error Avoidance Training, in emergency medicine residents. The investigators hypothesize that Error Management Training, as compared to Error Avoidance Training, will improve adaptive expertise, as measured by skills transfer, when used to teach head computed tomography interpretation to emergency medicine residents.
Read the detailed description
Adaptive expertise is the ability to apply existing skills to novel situations. Adaptive expertise enables physicians to reduce preventable medical errors when managing clinical scenarios not encountered during training. However, residency curricula rarely address this learning outcome. Error Management Training improves transfer of skills to new contexts and develops adaptive expertise. Although this methodology has been shown to improve adaptive expertise in procedural skills, its impact on cognitive skills in medical training remains underexplored. Error Management Training promises to improve patient care by developing emergency physicians' adaptive expertise. However, the investigators need further evidence for its efficacy with cognitive skills in residency training. The investigators aim to demonstrate that Error Management Training improves adaptive expertise in a cognitive skill, using head computed tomography interpretation as a model.
- Conditions
- Adaptive Expertise, Error Management Training, Learning
- Being tested
- Error Management Training (Difficult), Error Management Training (Easy), Error Avoidance Training
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Error Management Training (Difficult)Other
Error Management Training is used to teach head computed tomography interpretation. Participants encounter difficult questions.
Error Management Training (Easy)Other
Error Management Training is used to teach head computed tomography interpretation. Participants encounter easy questions.
Error Avoidance TrainingOther
Error Avoidance Training used to teach head computed tomography interpretation.
| Study group | Role | What they receive |
|---|---|---|
| Error Management Training (Difficult) | Experimental | Participants receive the learning strategy Error Management Training and encounter difficult questions. Receives: Other: Error Management Training (Difficult) |
| Error Management Training (Easy) | Experimental | Participants receive the learning strategy Error Management Training and encounter easy questions. Receives: Other: Error Management Training (Easy) |
| Error Avoidance Training | Active comparator | Participants receive the learning strategy Error Avoidance Training. Receives: Other: Error Avoidance Training |
What is being measured
The primary outcome is the main question the study is designed to answer.
Percent correct on an assessment of transfer of skills (adaptive expertise)
Participants will have to demonstrate transfer of head computed tomography interpretation skills by interpreting novel radiology cases different from those used in the instructional session. Performance will be assessed by percent score on a head computed tomography interpretation test using novel radiology content not addressed in the instructional session. Score range is 0-100%.
Measured: Immediately after instructional session (up to 60 minutes to complete the assessment)
Secondary outcomes (3)
Percent correct on an assessment of post-session proficiency for learning objectives (routine expertise)
Participants will have to demonstrate direct application of the intervention's learning objectives by interpreting radiology cases similar to those used in the instructional session. Performance will be assessed by percent score on a head computed tomography interpretation test using radiology content similar to that used in the instructional session. Score range is 0-100%.
Measured: Immediately after instructional session (up to 60 minutes to complete the assessment)
Effect of post-graduate year level on post-test performance
Performance on a head computed tomography interpretation test (both adaptive expertise and routine expertise cases) will be assessed by percent score, stratified by post-graduate year level to show differences across residency training stage. Score range is 0-100%.
Measured: Immediately after instructional session (up to 60 minutes to complete the assessment)
Mediation effect of errors on performance on the adaptive expertise cases
The number of errors made during the educational intervention will be measured for both the Error Management Training (Difficult) arm and the Error Management Training (Easy) arm. A mediation analysis will be conducted to assess the effect of committing errors during learning on subsequent performance in the cases measuring adaptive expertise.
Measured: Number of errors will be measured during the educational intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 Mar 2022
- Study start18 Jul 2022
- Primary completion31 Jul 2023
- Study completion30 Sep 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (16)Papers the sponsor has linked to this study.
- Other trials for Adaptive ExpertiseStudies of the same condition, open and under way.
- More trials run by Stanford UniversityThe 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
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 150 participants (actual)
Sponsor and investigators
- Lead sponsor
- Stanford University
- Sponsor type
- University, hospital or other
- Collaborators
- Brown University, Alameda Health System, University of California, Los Angeles, University of Chicago, The University of Texas Health Science Center, Houston, University of Wisconsin, Madison, Vanderbilt University
- Responsible party
- Principal investigator, Leonardo Aliaga, Stanford University
- Investigators
- Leonardo Aliaga, MD, Principal investigator, Stanford University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05284838
- Sponsor's protocol ID
- 64099
- Acronym
- FAIL CT
- Status last verified
- Mar 2024
- First submitted
- 10 Mar 2022
- Last updated
- 2 Apr 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: No current plan to share data.
Publications
Aliaga L, Clarke SO. Rethinking Radiology: An Active Learning Curriculum for Head Computed Tomography Interpretation. West J Emerg Med. 2022 Jan 1;23(1):47-51. doi: 10.5811/westjem.2021.10.53665.
PubMed 35060860Pusic MV, Santen SA, Dekhtyar M, Poncelet AN, Roberts NK, Wilson-Delfosse AL, Cutrer WB. Learning to balance efficiency and innovation for optimal adaptive expertise. Med Teach. 2018 Aug;40(8):820-827. doi: 10.1080/0142159X.2018.1485887. Epub 2018 Aug 9.
PubMed 30091659Royce CS, Hayes MM, Schwartzstein RM. Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Acad Med. 2019 Feb;94(2):187-194. doi: 10.1097/ACM.0000000000002518.
PubMed 30398993King A, Holder MG Jr, Ahmed RA. Errors as allies: error management training in health professions education. BMJ Qual Saf. 2013 Jun;22(6):516-9. doi: 10.1136/bmjqs-2012-000945. Epub 2013 Jan 3.
PubMed 23293120Dyre L, Tabor A, Ringsted C, Tolsgaard MG. Imperfect practice makes perfect: error management training improves transfer of learning. Med Educ. 2017 Feb;51(2):196-206. doi: 10.1111/medu.13208. Epub 2016 Dec 12.
PubMed 27943372Gardner AK, Abdelfattah K, Wiersch J, Ahmed RA, Willis RE. Embracing Errors in Simulation-Based Training: The Effect of Error Training on Retention and Transfer of Central Venous Catheter Skills. J Surg Educ. 2015 Nov-Dec;72(6):e158-62. doi: 10.1016/j.jsurg.2015.08.002. Epub 2015 Sep 8.
PubMed 26362712Mylopoulos M, Brydges R, Woods NN, Manzone J, Schwartz DL. Preparation for future learning: a missing competency in health professions education? Med Educ. 2016 Jan;50(1):115-23. doi: 10.1111/medu.12893.
PubMed 26695471Keith N, Frese M. Effectiveness of error management training: a meta-analysis. J Appl Psychol. 2008 Jan;93(1):59-69. doi: 10.1037/0021-9010.93.1.59.
PubMed 18211135Keith N, Frese M. Self-regulation in error management training: emotion control and metacognition as mediators of performance effects. J Appl Psychol. 2005 Jul;90(4):677-91. doi: 10.1037/0021-9010.90.4.677.
PubMed 16060786Kua J, Lim WS, Teo W, Edwards RA. A scoping review of adaptive expertise in education. Med Teach. 2021 Mar;43(3):347-355. doi: 10.1080/0142159X.2020.1851020. Epub 2020 Nov 28.
PubMed 33251895Eva KW. Diagnostic error in medical education: where wrongs can make rights. Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:71-81. doi: 10.1007/s10459-009-9188-9. Epub 2009 Aug 11.
PubMed 19669913Soderstrom NC, Bjork RA. Learning versus performance: an integrative review. Perspect Psychol Sci. 2015 Mar;10(2):176-99. doi: 10.1177/1745691615569000.
PubMed 25910388Metcalfe J. Learning from Errors. Annu Rev Psychol. 2017 Jan 3;68:465-489. doi: 10.1146/annurev-psych-010416-044022. Epub 2016 Sep 14.
PubMed 27648988Mylopoulos M, Kulasegaram K, Woods NN. Developing the experts we need: Fostering adaptive expertise through education. J Eval Clin Pract. 2018 Jun;24(3):674-677. doi: 10.1111/jep.12905. Epub 2018 Mar 8.
PubMed 29516651Mylopoulos M, Steenhof N, Kaushal A, Woods NN. Twelve tips for designing curricula that support the development of adaptive expertise. Med Teach. 2018 Aug;40(8):850-854. doi: 10.1080/0142159X.2018.1484082. Epub 2018 Jul 15.
PubMed 30009648
Study at a glance
From the registry record, last updated by the sponsor on 2 Apr 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The FAIL CT Study: Facilitating Adaptive Expertise in Learning Computed Tomography, a Multi-center Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT05284838
- Acronym / sponsor ID
- FAIL CT / 64099
- Conditions
- Adaptive Expertise, Error Management Training, Learning
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 150 participants (actual)
- Lead sponsor
- Stanford UniversityUniversity, hospital or other
- Collaborators
- Brown University, Alameda Health System, University of California, Los Angeles, University of Chicago, The University of Texas Health Science Center, Houston, University of Wisconsin, Madison, Vanderbilt University
- Study start
- 18 Jul 2022 (actual)
- Primary completion
- 31 Jul 2023 (actual)
- Study completion
- 30 Sep 2023 (actual)
- First posted
- 17 Mar 2022 (actual)
- 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 main objective of this study is to demonstrate that Error Management Training improves adaptive expertise in head computed tomography interpretation. The investigators will conduct a randomized controlled trial comparing two learning strategies, Error Management Training vs Error Avoidance Training, in emergency medicine residents. The investigators hypothesize that Error Management Training, as compared to Error Avoidance Training, will improve adaptive expertise, as measured by skills transfer, when used to teach head computed tomography interpretation to emergency medicine residents.
Detailed description
Adaptive expertise is the ability to apply existing skills to novel situations. Adaptive expertise enables physicians to reduce preventable medical errors when managing clinical scenarios not encountered during training. However, residency curricula rarely address this learning outcome. Error Management Training improves transfer of skills to new contexts and develops adaptive expertise. Although this methodology has been shown to improve adaptive expertise in procedural skills, its impact on cognitive skills in medical training remains underexplored. Error Management Training promises to improve patient care by developing emergency physicians' adaptive expertise. However, the investigators need further evidence for its efficacy with cognitive skills in residency training. The investigators aim to demonstrate that Error Management Training improves adaptive expertise in a cognitive skill, using head computed tomography interpretation as a model.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Error Management Training (Difficult) | Experimental | Other: Error Management Training (Difficult)Participants receive the learning strategy Error Management Training and encounter difficult questions. |
| Error Management Training (Easy) | Experimental | Other: Error Management Training (Easy)Participants receive the learning strategy Error Management Training and encounter easy questions. |
| Error Avoidance Training | Active comparator | Other: Error Avoidance TrainingParticipants receive the learning strategy Error Avoidance Training. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Study participation will be available to all current emergency medicine residents at Stanford and at thirteen external sites.
Key exclusion criteria (6 listed)
- Adults unable to consent
- Pregnant women
- Individuals who are not yet adults (infants, children, teenagers)
- Prisoners
- Medical students
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 |
|---|---|---|
| Error Management Training (Difficult)Error Management Training is used to teach head computed tomography interpretation. Participants encounter difficult questions. | Other | Error Management Training (Difficult) |
| Error Management Training (Easy)Error Management Training is used to teach head computed tomography interpretation. Participants encounter easy questions. | Other | Error Management Training (Easy) |
| Error Avoidance TrainingError Avoidance Training used to teach head computed tomography interpretation. | Other | Error Avoidance Training |
Primary outcome
Percent correct on an assessment of transfer of skills (adaptive expertise)
Time frame: Immediately after instructional session (up to 60 minutes to complete the assessment)
Participants will have to demonstrate transfer of head computed tomography interpretation skills by interpreting novel radiology cases different from those used in the instructional session. Performance will be assessed by percent score on a head computed tomography interpretation test using novel radiology content not addressed in the instructional session. Score range is 0-100%.
3 secondary outcomes
Percent correct on an assessment of post-session proficiency for learning objectives (routine expertise)
Time frame: Immediately after instructional session (up to 60 minutes to complete the assessment)
Effect of post-graduate year level on post-test performance
Time frame: Immediately after instructional session (up to 60 minutes to complete the assessment)
Mediation effect of errors on performance on the adaptive expertise cases
Time frame: Number of errors will be measured during the educational 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 2 Apr 2024.
- Background: PubMed 35060860Aliaga L, Clarke SO. Rethinking Radiology: An Active Learning Curriculum for Head Computed Tomography Interpretation. West J Emerg Med. 2022 Jan 1;23(1):47-51. doi: 10.5811/westjem.2021.10.53665.
- Background: PubMed 30091659Pusic MV, Santen SA, Dekhtyar M, Poncelet AN, Roberts NK, Wilson-Delfosse AL, Cutrer WB. Learning to balance efficiency and innovation for optimal adaptive expertise. Med Teach. 2018 Aug;40(8):820-827. doi: 10.1080/0142159X.2018.1485887. Epub 2018 Aug 9.
- Background: PubMed 30398993Royce CS, Hayes MM, Schwartzstein RM. Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Acad Med. 2019 Feb;94(2):187-194. doi: 10.1097/ACM.0000000000002518.
- Background: PubMed 23293120King A, Holder MG Jr, Ahmed RA. Errors as allies: error management training in health professions education. BMJ Qual Saf. 2013 Jun;22(6):516-9. doi: 10.1136/bmjqs-2012-000945. Epub 2013 Jan 3.
- Background: PubMed 27943372Dyre L, Tabor A, Ringsted C, Tolsgaard MG. Imperfect practice makes perfect: error management training improves transfer of learning. Med Educ. 2017 Feb;51(2):196-206. doi: 10.1111/medu.13208. Epub 2016 Dec 12.
- Background: PubMed 26362712Gardner AK, Abdelfattah K, Wiersch J, Ahmed RA, Willis RE. Embracing Errors in Simulation-Based Training: The Effect of Error Training on Retention and Transfer of Central Venous Catheter Skills. J Surg Educ. 2015 Nov-Dec;72(6):e158-62. doi: 10.1016/j.jsurg.2015.08.002. Epub 2015 Sep 8.
- Background: PubMed 26695471Mylopoulos M, Brydges R, Woods NN, Manzone J, Schwartz DL. Preparation for future learning: a missing competency in health professions education? Med Educ. 2016 Jan;50(1):115-23. doi: 10.1111/medu.12893.
- Background: PubMed 18211135Keith N, Frese M. Effectiveness of error management training: a meta-analysis. J Appl Psychol. 2008 Jan;93(1):59-69. doi: 10.1037/0021-9010.93.1.59.
- Background: PubMed 16060786Keith N, Frese M. Self-regulation in error management training: emotion control and metacognition as mediators of performance effects. J Appl Psychol. 2005 Jul;90(4):677-91. doi: 10.1037/0021-9010.90.4.677.
- Background: PubMed 33251895Kua J, Lim WS, Teo W, Edwards RA. A scoping review of adaptive expertise in education. Med Teach. 2021 Mar;43(3):347-355. doi: 10.1080/0142159X.2020.1851020. Epub 2020 Nov 28.
- Background: PubMed 19669913Eva KW. Diagnostic error in medical education: where wrongs can make rights. Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:71-81. doi: 10.1007/s10459-009-9188-9. Epub 2009 Aug 11.
- Background: PubMed 25910388Soderstrom NC, Bjork RA. Learning versus performance: an integrative review. Perspect Psychol Sci. 2015 Mar;10(2):176-99. doi: 10.1177/1745691615569000.
- Individual participant dataSharing planned: No. No current plan to share data.
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.
Leonardo Aliaga, MD principal investigator
Stanford University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Error Management Training (Difficult), Error Management Training (Easy) and Error Avoidance Training in people with Adaptive Expertise and Error Management Training, run by Stanford University at 1 site in United States.
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 1 inclusion and 6 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 2 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
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?
Percent correct on an assessment of transfer of skills (adaptive expertise) (time frame: Immediately after instructional session (up to 60 minutes to complete the assessment)). 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 NCT05284838, which also lists 16 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 2 Apr 2024.