## Protocol Section
### Identification Module
**NCT ID:** NCT05168579

**Brief Title:** Developing a Deliberate Practice Intervention to Recalibrate Physician Heuristics in Trauma Triage

**Official Title:** Developing a Deliberate Practice Intervention to Recalibrate Physician Heuristics in Trauma Triage

#### Organization Study ID Info
**ID:** STUDY20120026
#### Organization
**Class:** OTHER
**Full Name:** University of Pittsburgh
#### Secondary ID Infos
**ID:** R21AG072072
**Link:** https://reporter.nih.gov/quickSearch/R21AG072072
**Type:** NIH
### Status Module
#### Completion Date
**Date:** 2022-12-01

**Type:** ACTUAL

#### Expanded Access Info
#### Last Update Post Date
**Date:** 2023-04-05

**Type:** ACTUAL

**Last Update Submit Date:** 2023-03-13

**Overall Status:** COMPLETED

#### Primary Completion Date
**Date:** 2022-03-11

**Type:** ACTUAL

#### Results First Post Date
**Date:** 2023-04-05

**Type:** ACTUAL

**Results First Submit Date:** 2023-01-19

**Results First Submit QC Date:** 2023-03-13

#### Start Date
**Date:** 2021-12-15

**Type:** ACTUAL

**Status Verified Date:** 2023-03

#### Study First Post Date
**Date:** 2021-12-23
**Type:** ACTUAL
**Study First Submit Date:** 2021-12-08
**Study First Submit QC Date:** 2021-12-09
### Sponsor Collaborators Module

#### Collaborators

**Class:** NIH

**Name:** National Institute on Aging (NIA)

#### Lead Sponsor

**Class:** OTHER

**Name:** University of Pittsburgh

#### Responsible Party

**Investigator Affiliation:** University of Pittsburgh

**Investigator Full Name:** Deepika Mohan

**Investigator Title:** Associate Professor of Surgery

**Type:** PRINCIPAL_INVESTIGATOR

### Oversight Module

**Is FDA Regulated Device:** False

**Is FDA Regulated Drug:** False

**Oversight Has DMC:** False

### Description Module

**Brief Summary:** The objective of this study is to test the feasibility of using deliberate practice - goal-oriented training in the presence of a coach who can provide personalized, immediate feedback - to increase engagement. The research design involves recruitment of a national convenience sample of board-certified emergency physicians who will serve as trainees (n=30), pairing of the trainees with a coach, delivery of three 30-minute coaching sessions using the existing games as the training task, and assessment of the effect of the combined intervention on performance in the laboratory. The specific aims are:

1. To assess the fidelity of intervention delivery by measuring coaching skill acquisition, coaching skill drift and protocol adherence.
2. To assess the potential effect size of the intervention by comparing trainee performance on a validated virtual simulation with a control group of physicians (n=30).
3. To assess the acceptability of the intervention by using a mixture of validated instruments and semi-structured debriefing interviews with trainees to assess their engagement with the intervention.

**Detailed Description:** Deliberate practice - goal-oriented training in the presence of a coach who can provide personalized, immediate feedback - has successfully improved performance across multiple domains, including sports, music, and combat. When used in conjunction with simulation to improve surgical skill, it has a large effect on educational outcomes. It has characteristics that make its application in this context potentially powerful (e.g. personalized feedback/relationship with coach increase engagement) but also potentially challenging (e.g. the diagnostic process does not lend itself easily to assessment). The objective of this study is to test the feasibility of using deliberate practice to amplify the effect of a video game intervention. The team will recruit a national sample of board-certified emergency physicians (n=30) to serve as trainees, with members of the team (n=3) serving as coaches. Trainee-coach dyads will meet for 30 minutes/week for 3 weeks, by video-conferencing, to play one of the existing video games and to use it to practice pattern recognition. Aims are:

1. To assess the fidelity of intervention delivery. Approach: the team will standardize coaching skill during an 'on-boarding session,' measure skill drift over the course of training sessions, and measure protocol adherence (primary outcome). Hypothesis: \>90% of dyads will complete three training sessions.
2. To assess the potential effect size of the intervention. Approach: the team will compare performance of trainees (n=30) with a control group of physicians (n=30) on a validated virtual simulation. Hypothesis: Trainees will make ≥25% fewer diagnostic errors than control physicians (large effect size).
3. To assess the acceptability of the intervention. Approach: the team will conduct semi-structured debriefing interviews with trainees, assessing elements of the intervention that promote engagement.

This proposal will inform a future Stage III trial to compare the effect of different interventions on diagnostic error in trauma triage. If successful, this program of research will have an impact on patients by reducing the burden imposed by injury and by addressing the refractory problem of diagnostic error. It is novel conceptually in its effort to make heuristics a source of power, methodologically in its use of deliberate practice to improve diagnosis, and translationally in its use of video game technology. It is feasible because the investigative team has clinical and behavioral science expertise, experience developing deliberate practice interventions, and a track record of successfully building video games that can transform physician behavior. It responds to two national research priorities: 1) improving the diagnostic process; 2) maintaining health and independent living among the aging.

### Conditions Module

**Conditions:**

- Trauma Injury

### Design Module

#### Design Info

**Allocation:** RANDOMIZED

**Intervention Model:** PARALLEL

**Intervention Model Description:** two arm randomized trial

##### Masking Info

**Masking:** SINGLE

**Masking Description:** Allocation to treatment v. control group will be masked to the person doing the analysis until the data is locked.

**Who Masked:**

- OUTCOMES_ASSESSOR

**Primary Purpose:** TREATMENT

#### Enrollment Info

**Count:** 72

**Type:** ACTUAL

**Phases:**

- NA

**Study Type:** INTERVENTIONAL

### Arms Interventions Module

#### Arm Group 1

**Description:** Trainees will be paired with a coach, and will meet, once per week for thirty minutes, over a three week period. During the training session, coach-trainee dyads will play a puzzle video game, and will discuss contextual cues that should inform triage decisions. At the completion of the three weeks, trainees will complete a semi-structured, debriefing interview and a virtual simulation to assess triage performance.

**Intervention Names:**

- Behavioral: Deliberate practice

**Label:** Deliberate practice

**Type:** EXPERIMENTAL

#### Arm Group 2

**Description:** Participants in the control group will complete a virtual simulation.

**Label:** Control

**Type:** NO_INTERVENTION

### Interventions

#### Intervention 1

**Arm Group Labels:**

- Deliberate practice

**Description:** As above

**Name:** Deliberate practice

**Type:** BEHAVIORAL

### Outcomes Module

#### Primary Outcomes

**Description:** A summary of the number of trainees who signed up for coaching sessions and completed all three sessions as assigned.

**Measure:** Percentage of Participants Who Signed up for the Intervention That Completed All 3 Coaching Sessions.

**Time Frame:** 3 week intervention period

#### Secondary Outcomes

**Description:** Proportion of severely injured patients NOT transferred to trauma centers/total number of severely injured patients evaluated during a validated virtual simulation

**Measure:** Under-triage

**Time Frame:** 3 weeks post-intervention (deliberate practice) or 3 weeks post-enrollment (control)

**Description:** Derived from semi-structured interviews conducted by members of the investigative team at the conclusion of the 3 week training period. These interviews will focus on participant perceptions of the acceptability of the intervention.

**Measure:** Number of Participants Who Describe Coaching as Acceptable.

**Time Frame:** 2- weeks post intervention

### Eligibility Module

**Eligibility Criteria:** Inclusion Criteria:

Board certified physicians who work at non-trauma centers in the United States

Exclusion Criteria:

Physicians without board certification (i.e., residents). Physicians who work only at trauma centers in the US.

**Healthy Volunteers:** True

**Maximum Age:** 70 Years

**Minimum Age:** 25 Years

**Sex:** ALL

**Standard Ages:**

- ADULT

- OLDER_ADULT

### Contacts Locations Module

#### Locations

**Location 1:**

**City:** Pittsburgh

**Country:** United States

**Facility:** University of Pittsburgh

**State:** Pennsylvania

**Zip:** 15213

#### Overall Officials

**Official 1:**

**Affiliation:** University of Pittsburgh

**Name:** Deepika Mohan, MD

**Role:** PRINCIPAL_INVESTIGATOR

### IPD Sharing Statement Module

**Access Criteria:** Access will be provided to researchers and interested parties.

**Description:** De-identified participant data will be shared with researchers conditional on approval from the University of Pittsburgh Office of Research

**Info Types:**

- STUDY_PROTOCOL

- SAP

- ICF

- CSR

**IPD Sharing:** YES

**Time Frame:** Data will be made available at the conclusion of the analytic phase of the trial, and for 3 years thereafter.

## Document Section

### Large Document Module

#### Large Docs

- Date: 2021-01-06

- Filename: Prot_000.pdf

- Has ICF: False

- Has Protocol: True

- Has SAP: False

- Label: Study Protocol

- Size: 224872

- Type Abbrev: Prot

- Upload Date: 2023-01-12T17:19

- Date: 2022-11-25

- Filename: SAP_001.pdf

- Has ICF: False

- Has Protocol: False

- Has SAP: True

- Label: Statistical Analysis Plan

- Size: 104759

- Type Abbrev: SAP

- Upload Date: 2023-01-12T17:22

- Date: 2021-01-06

- Filename: ICF_002.pdf

- Has ICF: True

- Has Protocol: False

- Has SAP: False

- Label: Informed Consent Form

- Size: 101037

- Type Abbrev: ICF

- Upload Date: 2023-01-17T16:25

## Derived Section

### Condition Browse Module - Browse Branches

- Abbrev: BC26

- Name: Wounds and Injuries

- Abbrev: All

- Name: All Conditions

### Condition Browse Module - Browse Leaves

- ID: M17685

- Name: Wounds and Injuries

- Relevance: HIGH

- As Found: Trauma

### Condition Browse Module - Meshes

- ID: D000014947

- Term: Wounds and Injuries

### Misc Info Module

- Version Holder: 2024-05-24

## Results Section

### Adverse Events Module

#### Event Groups

**Group ID:** EG000

**Title:** Deliberate Practice

**Deaths Num At Risk:** 36

**Description:** Trainees will be paired with a coach, and will meet, once per week for thirty minutes, over a three week period. During the training session, coach-trainee dyads will play a puzzle video game, and will discuss contextual cues that should inform triage decisions. At the completion of the three weeks, trainees will complete a semi-structured, debriefing interview and a virtual simulation to assess triage performance.

Deliberate practice: As above

**ID:** EG000

**Other Num at Risk:** 36

**Serious Number At Risk:** 36

**Title:** Deliberate Practice

**Group ID:** EG001

**Title:** Control

**Deaths Num At Risk:** 36

**Description:** Participants in the control group will complete a virtual simulation.

**ID:** EG001

**Other Num at Risk:** 36

**Serious Number At Risk:** 36

**Title:** Control

**Frequency Threshold:** 0

**Time Frame:** 3 months

## Results Section - Baseline Characteristics Module

### Denomination Counts

**Group ID:** BG000

**Value:** 36

**Group ID:** BG001

**Value:** 36

**Group ID:** BG002

**Value:** 72

**Units:** Participants

### Group

**ID:** BG000

**Title:** Deliberate Practice

**Description:** Trainees will be paired with a coach, and will meet, once per week for thirty minutes, over a three week period. During the training session, coach-trainee dyads will play a puzzle video game, and will discuss contextual cues that should inform triage decisions. At the completion of the three weeks, trainees will complete a semi-structured, debriefing interview and a virtual simulation to assess triage performance.

Deliberate practice: As above

### Group

**ID:** BG001

**Title:** Control

**Description:** Participants in the control group will complete a virtual simulation.

### Group

**ID:** BG002

**Title:** Total

**Description:** Total of all reporting groups

### Measure

#### Measurement

**Group ID:** BG000

**Value:** 0

#### Measurement

**Group ID:** BG001

**Value:** 0

#### Measurement

**Group ID:** BG002

**Value:** 0

**Category Title:** <=18 years

#### Measurement

**Group ID:** BG000

**Value:** 35

#### Measurement

**Group ID:** BG001

**Value:** 35

#### Measurement

**Group ID:** BG002

**Value:** 70

**Category Title:** Between 18 and 65 years

#### Measurement

**Group ID:** BG000

**Value:** 1

#### Measurement

**Group ID:** BG001

**Value:** 1

#### Measurement

**Group ID:** BG002

**Value:** 2

**Category Title:** >=65 years

**Class Title:** 

### Measure

#### Measurement

**Group ID:** BG000

**Value:** 13

#### Measurement

**Group ID:** BG001

**Value:** 15

#### Measurement

**Group ID:** BG002

**Value:** 28

**Category Title:** Female

#### Measurement

**Group ID:** BG000

**Value:** 23

#### Measurement

**Group ID:** BG001

**Value:** 21

#### Measurement

**Group ID:** BG002

**Value:** 44

**Category Title:** Male

**Class Title:** 

### Measure

#### Measurement

**Group ID:** BG000

**Value:** 1

#### Measurement

**Group ID:** BG001

**Value:** 3

#### Measurement

**Group ID:** BG002

**Value:** 4

**Category Title:** Hispanic or Latino

#### Measurement

**Group ID:** BG000

**Value:** 35

#### Measurement

**Group ID:** BG001

**Value:** 33

#### Measurement

**Group ID:** BG002

**Value:** 68

**Category Title:** Not Hispanic or Latino

#### Measurement

**Group ID:** BG000

**Value:** 0

#### Measurement

**Group ID:** BG001

**Value:** 0

#### Measurement

**Group ID:** BG002

**Value:** 0

**Category Title:** Unknown or Not Reported

**Class Title:** 

### Measure

#### Measurement

**Group ID:** BG000

**Value:** 0

#### Measurement

**Group ID:** BG001

**Value:** 1

#### Measurement

**Group ID:** BG002

**Value:** 1

**Category Title:** American Indian or Alaska Native

#### Measurement

**Group ID:** BG000

**Value:** 10

#### Measurement

**Group ID:** BG001

**Value:** 7

#### Measurement

**Group ID:** BG002

**Value:** 17

**Category Title:** Asian

#### Measurement

**Group ID:** BG000

**Value:** 0

#### Measurement

**Group ID:** BG001

**Value:** 0

#### Measurement

**Group ID:** BG002

**Value:** 0

**Category Title:** Native Hawaiian or Other Pacific Islander

#### Measurement

**Group ID:** BG000

**Value:** 0

#### Measurement

**Group ID:** BG001

**Value:** 3

#### Measurement

**Group ID:** BG002

**Value:** 3

**Category Title:** Black or African American

#### Measurement

**Group ID:** BG000

**Value:** 26

#### Measurement

**Group ID:** BG001

**Value:** 25

#### Measurement

**Group ID:** BG002

**Value:** 51

**Category Title:** White

#### Measurement

**Group ID:** BG000

**Value:** 0

#### Measurement

**Group ID:** BG001

**Value:** 0

#### Measurement

**Group ID:** BG002

**Value:** 0

**Category Title:** More than one race

#### Measurement

**Group ID:** BG000

**Value:** 0

#### Measurement

**Group ID:** BG001

**Value:** 0

#### Measurement

**Group ID:** BG002

**Value:** 0

**Category Title:** Unknown or Not Reported

**Class Title:** 

### Measure

#### Measurement

**Group ID:** BG000

**Value:** 10

#### Measurement

**Group ID:** BG001

**Value:** 9

#### Measurement

**Group ID:** BG002

**Value:** 19

**Category Title:** Northeast

#### Measurement

**Group ID:** BG000

**Value:** 10

#### Measurement

**Group ID:** BG001

**Value:** 9

#### Measurement

**Group ID:** BG002

**Value:** 19

**Category Title:** Southeast

#### Measurement

**Group ID:** BG000

**Value:** 4

#### Measurement

**Group ID:** BG001

**Value:** 5

#### Measurement

**Group ID:** BG002

**Value:** 9

**Category Title:** Midwest

#### Measurement

**Group ID:** BG000

**Value:** 3

#### Measurement

**Group ID:** BG001

**Value:** 5

#### Measurement

**Group ID:** BG002

**Value:** 8

**Category Title:** Southwest

#### Measurement

**Group ID:** BG000

**Value:** 9

#### Measurement

**Group ID:** BG001

**Value:** 8

#### Measurement

**Group ID:** BG002

**Value:** 17

**Category Title:** West

**Class Title:** United States

### Measure

#### Measurement

**Group ID:** BG000

**Value:** 31

#### Measurement

**Group ID:** BG001

**Value:** 33

#### Measurement

**Group ID:** BG002

**Value:** 64

**Class Title:** 

### Measure

#### Measurement

**Group ID:** BG000

**Value:** 29

#### Measurement

**Group ID:** BG001

**Value:** 30

#### Measurement

**Group ID:** BG002

**Value:** 59

**Class Title:** Emergency Medicine

#### Measurement

**Group ID:** BG000

**Value:** 3

#### Measurement

**Group ID:** BG001

**Value:** 1

#### Measurement

**Group ID:** BG002

**Value:** 4

**Class Title:** Family Practice

#### Measurement

**Group ID:** BG000

**Value:** 1

#### Measurement

**Group ID:** BG001

**Value:** 2

#### Measurement

**Group ID:** BG002

**Value:** 3

**Class Title:** Internal Medicine

#### Measurement

**Group ID:** BG000

**Value:** 3

#### Measurement

**Group ID:** BG001

**Value:** 3

#### Measurement

**Group ID:** BG002

**Value:** 6

**Class Title:** Other (e.g. general surgery)

**Denomination Units Selected:** 

## Results Section - Baseline Characteristics Module

### Measure 1
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Title:** Age, Categorical
**Unit of Measure:** Participants
### Measure 2
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Title:** Sex: Female, Male
**Unit of Measure:** Participants
### Measure 3
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Title:** Ethnicity (NIH/OMB)
**Unit of Measure:** Participants
### Measure 4
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Title:** Race (NIH/OMB)
**Unit of Measure:** Participants
### Measure 5
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Title:** Region of Enrollment
**Unit of Measure:** Participants
### Measure 6
**Description:** Completion of Advanced Trauma Life Support (ATLS) course, which instructs learners in the American College of Surgeons guidelines for the triage of trauma patients.
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Title:** ATLS Certification
**Unit of Measure:** Participants
### Measure 7
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Title:** Specialty
**Unit of Measure:** Participants
## Results Section - More Information Module
### Certain Agreement
**PI Sponsor Employee:** True
### Limitations and Caveats
**Description:** First, we used a passive rather than an active control as the comparator, which may have magnified the effect of the intervention. Second, the differential rate of attrition for completing the virtual simulation in the control and intervention groups could introduce bias, if missingness was not random. Third, we used a simulation to assess behavior, albeit one with evidence of criterion validity, which limited inference about the efficacy of the intervention.
### Point of Contact
**Email:** dem73@pitt.edu
**Organization:** University of Pittsburgh
**Phone:** 404-375-9325
**Title:** Dr. Deepika Mohan
## Results Section - Outcome Measures Module
### Outcome Measure 1
### Outcome Measure 2
#### Analysis
**CI Lower Limit:** 2.76
**CI Number of Sides:** TWO_SIDED
**CI Percentage Value:** 95
**CI Upper Limit:** 69.6
**CI Upper Limit Comment:** 
**Dispersion Type:** 
**Dispersion Value:** 
**Estimate Comment:** 
**Group Description:** 
**Non-Inferiority Comment:** 
**Non-Inferiority Type:** SUPERIORITY
**Other Analysis Description:** 
**P-Value:** <0.001
**P-Value Comment:** 
**Parameter Type:** Odds Ratio (OR)
**Parameter Value:** 13.8
**Statistical Comment:** 
**Statistical Method:** Mixed Models Analysis
**Tested Non-Inferiority:** 
### Outcome Measure 3
## Results Section
### Outcome Measures Module
#### Outcome Measure 1
**Class:**
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 28
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 0
**Title:** Completed 3 coaching sessions
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 2
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 0
**Title:** Completed 2 coaching sessions
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 0
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 0
**Title:** Completed 1 coaching session
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 6
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 36
**Title:** Not assigned to coaching sessions
#### Outcome Measure 2
**Class:**
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 0.36
- **Upper Limit:** 
- **Value:** 0.85
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 0.50
- **Upper Limit:** 
- **Value:** 0.51
**Title:** 
#### Outcome Measure 3
**Class:**
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 26
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 0
**Title:** Participants received the intervention and who described it acceptable
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 2
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 0
**Title:** Participants who received the intervention and did not describe it as acceptable.
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 2
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 0
**Title:** Participants who received the intervention but did not complete an interview
##### Category
**Measurements:**
- **Comment:** 
- **Group ID:** OG000
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 6
- **Comment:** 
- **Group ID:** OG001
- **Lower Limit:** 
- **Spread:** 
- **Upper Limit:** 
- **Value:** 36
**Title:** Participants who did not receive the intervention
## Results Section
### Outcome Measures Module
#### Outcome Measure 1
**Description:** A summary of the number of trainees who signed up for coaching sessions and completed all three sessions as assigned.
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Population Description:** Board-certified emergency physicians who triage and treat adult patients in the emergency department of either a non-trauma center or a Level III/IV trauma center in the United States.
**Reporting Status:** POSTED
**Time Frame:** 3 week intervention period
**Title:** Percentage of Participants Who Signed up for the Intervention That Completed All 3 Coaching Sessions.
**Type:** PRIMARY
**Unit of Measure:** Participants
##### Group
**Description:** Trainees will be paired with a coach, and will meet, once per week for thirty minutes, over a three week period. During the training session, coach-trainee dyads will play a puzzle video game, and will discuss contextual cues that should inform triage decisions. At the completion of the three weeks, trainees will complete a semi-structured, debriefing interview and a virtual simulation to assess triage performance.

Deliberate practice: As above
**ID:** OG000
**Title:** Deliberate Practice
##### Group
**Description:** Participants in the control group who enrolled in the trial.
**ID:** OG001
**Title:** Control
#### Outcome Measure 2
**Description:** Proportion of severely injured patients NOT transferred to trauma centers/total number of severely injured patients evaluated during a validated virtual simulation
**Dispersion Type:** Standard Deviation
**Parameter Type:** MEAN
**Population Description:** Physicians who used the virtual simulation. We excluded physicians enrolled in the trial but who did not provide outcome data for analysis.
**Reporting Status:** POSTED
**Time Frame:** 3 weeks post-intervention (deliberate practice) or 3 weeks post-enrollment (control)
**Title:** Under-triage
**Type:** SECONDARY
**Unit of Measure:** proportion of patients under-triaged
##### Group
**Description:** Participants in the control group who completed a virtual simulation.
**ID:** OG000
**Title:** Control
##### Group
**Description:** Participants in the intervention arm who completed a virtual simulation
**ID:** OG001
**Title:** Deliberate Practice
#### Outcome Measure 3
**Description:** Derived from semi-structured interviews conducted by members of the investigative team at the conclusion of the 3 week training period. These interviews will focus on participant perceptions of the acceptability of the intervention.
**Parameter Type:** COUNT_OF_PARTICIPANTS
**Population Description:** Participants assigned to receive the deliberate practice intervention who completed an interview after the training sessions.
**Reporting Status:** POSTED
**Time Frame:** 2- weeks post intervention
**Title:** Number of Participants Who Describe Coaching as Acceptable.
**Type:** SECONDARY
**Unit of Measure:** Participants
##### Group
**Description:** Trainees will be paired with a coach, and will meet, once per week for thirty minutes, over a three week period. During the training session, coach-trainee dyads will play a puzzle video game, and will discuss contextual cues that should inform triage decisions. At the completion of the three weeks, trainees will complete a semi-structured, debriefing interview and a virtual simulation to assess triage performance.

Deliberate practice: As above
**ID:** OG000
**Title:** Deliberate Practice
##### Group
**Description:** Patients who enrolled in the trial and were randomized to not receive the intervention
**ID:** OG001
**Title:** Control
### Participant Flow Module
#### Group
**Description:** Trainees will be paired with a coach, and will meet, once per week for thirty minutes, over a three week period. During the training session, coach-trainee dyads will play a puzzle video game, and will discuss contextual cues that should inform triage decisions. At the completion of the three weeks, trainees will complete a semi-structured, debriefing interview and a virtual simulation to assess triage performance.

Deliberate practice: As above
**ID:** FG000
**Title:** Deliberate Practice
#### Group
**Description:** Participants in the control group will complete a virtual simulation.
**ID:** FG001
**Title:** Control
#### Period
**Title:** Overall Study
##### Withdraw
**Type:** Lack of Consent
###### Reason
**Group ID:** FG000
**Number of Subjects:** 1
###### Reason
**Group ID:** FG001
**Number of Subjects:** 0
##### Withdraw
**Type:** Conflicts with time
###### Reason
**Group ID:** FG000
**Number of Subjects:** 2
###### Reason
**Group ID:** FG001
**Number of Subjects:** 0
##### Withdraw
**Type:** Time slots were full
###### Reason
**Group ID:** FG000
**Number of Subjects:** 3
###### Reason
**Group ID:** FG001
**Number of Subjects:** 0
##### Withdraw
**Type:** Lost to Follow-up
###### Reason
**Group ID:** FG000
**Number of Subjects:** 0
###### Reason
**Group ID:** FG001
**Number of Subjects:** 15
##### Milestone
**Type:** STARTED
###### Achievement
**Group ID:** FG000
**Number of Subjects:** 36
###### Achievement
**Group ID:** FG001
**Number of Subjects:** 36
##### Milestone
**Type:** COMPLETED
###### Achievement
**Group ID:** FG000
**Number of Subjects:** 30
###### Achievement
**Group ID:** FG001
**Number of Subjects:** 21
##### Milestone
**Type:** NOT COMPLETED
###### Achievement
**Group ID:** FG000
**Number of Subjects:** 6
###### Achievement
**Group ID:** FG001
**Number of Subjects:** 15
**Recruitment Details:** A single email invitation was sent to 633 physicians who had previously participated in research (with valid contact information), asking them to forward the invitation to two colleagues. 78 responses were received. Five were excluded because they lived outside the contiguous 48 US States (e.g., in Canada or Puerto Rico) and one was excluded for refusing to consent to videotaping.
**Has Results:** True