Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261.
Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213.
Proc Natl Acad Sci U S A. 2018 Sep 11;115(37):9204-9209. doi: 10.1073/pnas.1805450115. Epub 2018 Aug 27.
Trauma triage depends on fallible human judgment. We created two "serious" video game training interventions to improve that judgment. The interventions' central theoretical construct was the representativeness heuristic, which, in trauma triage, would mean judging the severity of an injury by how well it captures (or "represents") the key features of archetypes of cases requiring transfer to a trauma center. Drawing on clinical experience, medical records, and an expert panel, we identified features characteristic of representative and nonrepresentative cases. The two interventions instantiated both kinds of cases. One was an adventure game, seeking narrative engagement; the second was a puzzle-based game, emphasizing analogical reasoning. Both incorporated feedback on diagnostic errors, explaining their sources and consequences. In a four-arm study, they were compared with an intervention using traditional text-based continuing medical education materials (active control) and a no-intervention (passive control) condition. A sample of 320 physicians working at nontrauma centers in the United States was recruited and randomized to a study arm. The primary outcome was performance on a validated virtual simulation, measured as the proportion of undertriaged patients, defined as ones who had severe injuries (according to American College of Surgeons guidelines) but were not transferred. Compared with the control group, physicians exposed to either game undertriaged fewer such patients [difference = -18%, 95% CI: -30 to -6%, = 0.002 (adventure game); -17%, 95% CI: -28 to -6%, = 0.003 (puzzle game)]; those exposed to the text-based education undertriaged similar proportions (difference = +8%, 95% CI: -3 to +19%, = 0.15).
创伤分诊依赖于易出错的人为判断。我们创建了两种“严重”视频游戏培训干预措施，以改善这种判断。干预措施的核心理论结构是代表性启发式，在创伤分诊中，这意味着通过判断损伤与需要转至创伤中心的病例典型代表的关键特征的吻合程度（或“代表性”）来判断损伤的严重程度。我们借鉴临床经验、病历和专家小组，确定了具有代表性和非代表性病例的特征。这两种干预措施都体现了这两种情况。一种是冒险游戏，寻求叙事参与；另一种是基于拼图的游戏，强调类比推理。两者都包含对诊断错误的反馈，解释其来源和后果。在一项四臂研究中，它们与使用传统基于文本的继续医学教育材料的干预措施（主动对照）和无干预（被动对照）条件进行了比较。在美国的非创伤中心工作的 320 名医生被招募并随机分配到一个研究组。主要结果是在经过验证的虚拟模拟中的表现，以分诊不足的患者比例来衡量，这些患者定义为有严重损伤（根据美国外科医师学会指南）但未转院的患者。与对照组相比，接触到任何一种游戏的医生分诊不足的此类患者比例较低[差异=-18%，95%置信区间：-30 至-6%， = 0.002（冒险游戏）；-17%，95%置信区间：-28 至-6%， = 0.003（拼图游戏）]；接触基于文本的教育的医生分诊不足的比例相似[差异=+8%，95%置信区间：-3 至+19%， = 0.15]。
