Intervening to Prevent Contextual Errors in Medical Decision Making

• 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 ]
  

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.