The Visualization of Uncertainty in Clinical Diagnostic Reasoning for Pulmonary Embolism

The Visualization of Uncertainty in Clinical Diagnostic Reasoning for Pulmonary Embolism: a Randomized Controlled Trial.

Medical reasoning is a form of inquiry that examines the thought processes involved in making medical decisions. When physicians are faced with patients' symptoms or signs, their thought processes follow either direct shortcuts to suspect a diagnosis or go into a deeper and more analytic process to reach a diagnosis. The second pathway is less prone to biases and errors. This study explores whether the use of an interactive visual display of probabilities of pulmonary embolism generated from positive or negative test results will increase the adherence to evidence based guidelines in the diagnosis of pulmonary embolism.

Study Overview

• Status: Completed
• Conditions: Pulmonary Embolism; Clinical Reasoning; Diagnostic Uncertainty; Evidence Based Medicine; Visualization of Uncertainty
• Intervention / Treatment: Other: Visualized pulmonary embolism computer task model; Other: Didactic review lecture

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada, T2V1P9
      • University of Calgary

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 24 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Medical students, University of Calgary, in clerkship who finished at least 4 weeks of a block of medicine rotation at any hospital site.
• First year subspecialty or Internal Medicine residents.
• Practicing physicians in the subspecialties of Internal Medicine or Emergency Medicine.

Exclusion Criteria:

• Physicians in the subspecialty of Haematology or Respiratory

Study Plan

How is the study designed?

Design Details

• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Visualized pulmonary embolism computer task model; This group of participants was presented and trained to use a visual representation of diagnostic pathway for pulmonary embolism. The design of this visual representation is based on Bayes theorem and cognition enhancing visual design principles.	Other: Visualized pulmonary embolism computer task model; This group of participants was presented and trained to use a visual representation of diagnostic pathway for pulmonary embolism. The design of this visual representation is based on Bayes theorem and cognition enhancing visual design principles.
Active Comparator: Didactic review pulmonary embolism lecture; This group of participants was presented with a didactic lecture covering the diagnostic approach of pulmonary embolism.	Other: Didactic review lecture; This group of participants was presented with a didactic lecture covering the diagnostic approach of pulmonary embolism.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Concordance with medical diagnostic reasoning pathway for pulmonary embolism.	Concordance with medical diagnostic reasoning pathway for a case presentation suggestive of pulmonary embolism will be reflected by whether participants are stopping prematurely or proceeding with diagnostic steps inappropriately.	Paper-based clinical case scenarios were completed within 2 hour after either intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time.	The overall time taken to solve each clinical scenario may give insight to which decision making process was predominant to solve each clinical scenario.	Paper-based clinical case scenarios were completed within 2 hour after either intervention.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Survey.	The participants' responses to the satisfaction survey will provide feedback about the need for improvement or modification in interface of software	Survey was completed within 2 hours after completion of either intervention.

Collaborators and Investigators

• Sponsor: University of Calgary
• Investigators: Principal Investigator: Ghazwan Altabbaa, MD MSc, University of Calgary

Study record dates

Study Major Dates

• Study Start: March 1, 2011
• Primary Completion (Actual): October 1, 2011
• Study Completion (Actual): October 1, 2011

Study Registration Dates

• First Submitted: December 12, 2012
• First Submitted That Met QC Criteria: December 14, 2012
• First Posted (Estimate): December 19, 2012

Study Record Updates

• Last Update Posted (Estimate): December 19, 2012
• Last Update Submitted That Met QC Criteria: December 14, 2012
• Last Verified: December 1, 2012

More Information

Terms related to this study

• Keywords: randomized controlled study
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Respiratory Tract Diseases; Lung Diseases; Embolism and Thrombosis; Embolism; Pulmonary Embolism
• Other Study ID Numbers: 23231