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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基于模拟的精通学习与标准教育相比，可以与急诊科的患者讨论诊断不确定性：一项随机对照试验。

背景技术诊断不确定性在急诊医疗中经常发生，超过三分之一的患者在没有明确诊断的情况下离开急诊科（ED）。尽管频率如此之高，但急诊服务提供者并未与如何与这些患者讨论诊断不确定性的问题进行充分的培训，这些患者常常使急诊医生感到困惑和担忧。为了满足这种培训需求，我们开发了不确定性交流教育模块（UCEM），教医生如何讨论诊断不确定性。这项研究的目的是评估UCEM在改善医师沟通方面的有效性。方法该试验是一项多中心，两臂随机对照试验，旨在使用基于模拟的精通学习（SBML）来教授沟通技巧。来自两个培训计划的住院急诊医师将在完成基线标准化患者治疗后被随机分配为立即或延迟接受由两部分组成的UCEM干预。UCEM的两个组件是：1）基于Web的交互模块，以及2）基于智能手机的游戏。两种格式都针对涉及诊断不确定性的患者案例教授和加强沟通技巧。在进行基线测试之后，即时干预部门的参与者将通过视频平台完成远程故意练习，然后返回进行第二次研究访问，以评估他们是否已掌握。在第二次研究访问之后，延迟干预部门的参与者将可以使用UCEM和远程故意练习。感兴趣的主要结果是立即干预部门中在第二次研究访问中达到精通的居民比例。讨论患者对他们所接受护理的理解会影响护理质量，安全性和患者满意度，尤其是当他们没有明确诊断出院时。制定以患者为中心的诊断不确定性沟通策略将提高急诊出院的安全性。尽管SBML的使用是一种资源密集型的教育方法，但该试验的设计目的是要进行资源贫乏，可扩展的干预，以允许广泛传播和吸收。试验注册该试验已在Clinicaltrials.gov（NCT04021771）上进行了注册。报名日期：2019年7月16日。