BACKGROUND Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications. METHODS The trial is a multicenter, two-arm randomized controlled trial designed to teach communication skills using simulation-based mastery learning (SBML). Resident emergency physicians from two training programs will be randomly assigned to immediate or delayed receipt of the two-part UCEM intervention after completing a baseline standardized patient encounter. The two UCEM components are: 1) a web-based interactive module, and 2) a smart-phone-based game. Both formats teach and reinforce communication skills for patient cases involving diagnostic uncertainty. Following baseline testing, participants in the immediate intervention arm will complete a remote deliberate practice session via a video platform and subsequently return for a second study visit to assess if they have achieved mastery. Participants in the delayed intervention arm will receive access to UCEM and remote deliberate practice after the second study visit. The primary outcome of interest is the proportion of residents in the immediate intervention arm who achieve mastery at the second study visit. DISCUSSION Patients' understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. Although use of SBML is a resource intensive educational approach, this trial has been deliberately designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake. TRIAL REGISTRATION The trial was registered at clinicaltrials.gov (NCT04021771). Registration date: July 16, 2019.

中文翻译：

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基于模拟的掌握学习与标准教育相比，用于与急诊科患者讨论诊断不确定性：一项随机对照试验。


背景诊断不确定性在紧急医疗护理中经常发生，超过三分之一的患者在没有明确诊断的情况下离开急诊室（ED）。尽管这种频率很高，但急诊科提供者并未接受过如何与这些患者讨论诊断不确定性的充分培训，这些患者常常让急诊科感到困惑和担忧。为了满足这一培训需求，我们开发了不确定性沟通教育模块 (UCEM) 来教医生如何讨论诊断不确定性。该研究的目的是评估 UCEM 在改善医生沟通方面的有效性。方法 该试验是一项多中心、双臂随机对照试验，旨在使用基于模拟的掌握学习 (SBML) 来教授沟通技能。来自两个培训项目的住院急诊医生将在完成基线标准化患者就诊后被随机分配立即或延迟接受两部分 UCEM 干预。两个 UCEM 组件是：1) 基于网络的交互模块，2) 基于智能手机的游戏。这两种形式都教授和强化涉及诊断不确定性的患者病例的沟通技巧。在基线测试之后，立即干预组的参与者将通过视频平台完成远程刻意练习课程，然后返回进行第二次研究访问，以评估他们是否已经掌握。延迟干预组的参与者将在第二次研究访视后获得 UCEM 和远程刻意练习的机会。感兴趣的主要结果是立即干预组中在第二次研究访问中达到掌握的居民的比例。 讨论 患者对他们接受的护理的理解对护理质量、安全性和患者满意度具有影响，特别是当他们在没有明确诊断的情况下出院时。制定以患者为中心的诊断不确定性沟通策略将提高急症护理出院的安全性。尽管 SBML 的使用是一种资源密集型教育方法，但该试验经过精心设计，旨在提供低资源、可扩展的干预措施，以便广泛传播和采用。试验注册 该试验在 ClinicalTrials.gov 上注册 (NCT04021771)。报名日期：2019年7月16日。