TY - JOUR
T1 - There's an app for that
T2 - Teaching residents to communicate diagnostic uncertainty through a mobile gaming application
AU - McCarthy, Danielle M.
AU - Formella, Kyle T.
AU - Ou, Eric Z.
AU - Vozenilek, John A.
AU - Cameron, Kenzie A.
AU - Salzman, David H.
AU - Doty, Amanda MB
AU - Piserchia, Katherine
AU - Papanagnou, Dimitrios
AU - Rising, Kristin L.
N1 - Clear doctor patient communication is integral to good clinical care and considered a core competency of medical training. However, communication skills training is cost and time intensive [1] . Technology-based approaches offer the capability of replicating clinical environments and providing feedback, while reducing training resources. These approaches range in complexity from use of telehealth video platforms to engage with remote simulated patients [2] to avatars who engage in virtual human simulation (e.g. Kognito© or AliveSim© platforms) [3,4] . Other innovative communication skills technology uses include interactive web-based video simulations [5] , a web-based video annotation system to support student self-evaluation [6] , and the recently developed Video-Based Communication Assessment supported by the National Board of Medical Examiners [7] . While these approaches are authentic to the clinical environment, they also are time-intensive to build and use, costly in effort, and may require use of computer software or hardware at a central site, limiting portability.
This project was supported by the Agency for Healthcare Research and Quality under grant number R18HS025651 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
PY - 2022/6
Y1 - 2022/6
N2 - Background: Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training. Objective: To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery. Patient involvement: The app under study is designed to improve doctor-patient communication. Methods: The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants’ use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill. Results: Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI (0.91–4.84)]. Discussion: Despite positive reviews of app use, overall use was low and there was no association with achieving mastery. Practical value: Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn't be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated. Availability of data and materials: The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request.
AB - Background: Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training. Objective: To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery. Patient involvement: The app under study is designed to improve doctor-patient communication. Methods: The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants’ use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill. Results: Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI (0.91–4.84)]. Discussion: Despite positive reviews of app use, overall use was low and there was no association with achieving mastery. Practical value: Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn't be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated. Availability of data and materials: The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request.
KW - Diagnostic uncertainty
KW - Doctor-patient communication
KW - Medical education
KW - Mobile application
UR - https://www.scopus.com/pages/publications/85117391993
UR - https://www.scopus.com/pages/publications/85117391993#tab=citedBy
U2 - 10.1016/j.pec.2021.09.038
DO - 10.1016/j.pec.2021.09.038
M3 - Article
C2 - 34674922
AN - SCOPUS:85117391993
SN - 0738-3991
VL - 105
SP - 1463
EP - 1469
JO - Patient Education and Counseling
JF - Patient Education and Counseling
IS - 6
ER -