Discussion
trauma, nontrauma, ’
In this pilot randomized clinical trial, we delivered a novel deliberate practice intervention to practicing emergency medicine physicians with high fidelity. Most physicians described the intervention as valuable and the time required as appropriate. They also reported intentions to adopt the lessons learned during the training sessions. The intervention had an effect on physicians’ adherence to trauma triage practice guidelines during an online simulation.These results confirm those of previous studies, which demonstrated the ability of deliberate practice to facilitate the acquisition of expertise in medicine, across domains as varied as communication in the emergency department or intensive care unit, resuscitation, and surgery.If these results transfer to the clinical setting, deliberate practice could address national priorities to improve public health outcomes.This pilot randomized clinical trial allowed us to test several concerns about delivering a deliberate practice intervention in trauma triage. One concern was how to design a training task that captured the core challenges of trauma triage at nontrauma centers—uncertainty, time pressure, and low rates of true-positive cases. The use of a customized video game provided physicians with an opportunity to practice the diagnostic task repeatedly and rapidly. A second concern was how to help participants refine the heuristics (intuitive judgments) guiding their judgments. Having participants think aloud while playing the game gave coaches access to participants’ cognitive processes, expressed in their natural terms, helping coaches to select and to convey potentially missed cues (eg, frailty). A third concern was the feasibility and acceptability of such an intervention among busy practicing clinicians. We found that most physicians enrolled in the trial, albeit a self-selected sample, relished the opportunity to interact with someone whom they perceived as a content expert. In debriefing interviews, respondents emphasized the social aspect of the intervention, underscoring the value they found in the connections that they formed with the coach.