Intervening to Prevent Contextual Errors in Medical Decision Making

This study has been completed.
Information provided by (Responsible Party):
Department of Veterans Affairs Identifier:
First received: March 3, 2009
Last updated: April 15, 2014
Last verified: April 2014

This study will assess whether a medical education intervention improves the quality of medical decision making in the care of patients with complex psychosocial -- or contextual -- needs that are essential to address when planning their care. A group of internal medicine residents will be randomly assigned to participate in the seminar and practicum and then they, along with a control group that has not participated, will be assessed for the quality of their clinical decision making and its impact on patient care.

Condition Intervention
Psychosocial Factors
Behavioral: Seminar and Practicum on Contextualizing Care

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Intervening to Prevent Contextual Errors in Medical Decision Making

Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • outcome prospectively defined for each case based on contextual/psychosocial challenges that need to be addressed [ Time Frame: After 4 months of the recorded visit ] [ Designated as safety issue: No ]

Enrollment: 139
Study Start Date: October 2009
Study Completion Date: December 2012
Primary Completion Date: November 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm 1
Seminar and practicum that occurs over 4 week period for internal medicine residents, designed to provide a systematic approach to identifying and addressing contextual factors essential to planning patient care.
Behavioral: Seminar and Practicum on Contextualizing Care
A 4 hour seminar and practicum for internal medicine residents designed to provide a systematic approach to identifying contextual factors essential to planning patient care.

Detailed Description:

We plan to enroll 144 internal medicine residents at 2 VA hospitals, Jesse Brown and Hines, in a randomized controlled design. Half will participate in a 4 hour seminar series that is integrated into their ambulatory curriculum. Each month a total of 8 residents will participate. Following the intervention there will be 3 levels of assessment: (1) All participants, intervention and control, will participate in a brief exercise interviewing 4 standardized patients (SPs). Note that we will separately be enlisting the assistance of 8 attending physicians to assist with case development for these SPs. (2) The research team will subsequently enroll 3 real patients from each physician's practice with "red flags" such as poor adherence, or missed visits, suggestive of contextual issues that need to be addressed. Physicians will be scored on their performance at identifying the underlying contextual factors that account for these red flags and on formulating an appropriate plan of care. (3) The coders will prospectively define successful vs. unsuccessful outcomes for each case. At the follow up visit data will be collected on whether the desired outcome was achieved. The analysis will compare the skills, performance and outcomes of the intervention compared with the control group to determine the efficacy of training residents to individualize care.


Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Internal Medicine Residency with continuity of care clinics at either Jesse Brown or Hines VA Medical Centers

Exclusion Criteria:

  • All resident physicians who do not meet inclusion criteria
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Please refer to this study by its identifier: NCT00856557

United States, Illinois
Jesse Brown VAMC (WestSide Division)
Chicago, Illinois, United States, 60612
Sponsors and Collaborators
Principal Investigator: Saul J. Weiner, MD Jesse Brown VAMC