Measuring Quality of Medical Student Performance at Contextualizing Care

This study has been completed.
Sponsor:
Collaborator:
The National Board of Medical Examiners
Information provided by:
University of Illinois at Chicago
ClinicalTrials.gov Identifier:
NCT01088438
First received: March 12, 2010
Last updated: April 11, 2011
Last verified: March 2011
  Purpose

During the project, fourth-year medical students participating in a Medicine sub-internship will be randomized to an intervention group or a control group; the intervention group will receive additional training in the application of qualitative methodology to elicit and incorporate contextual factors in the clinical encounter. All students will participate in an SP assessment consisting of four standardized patients (SPs), blinded to trial arm, presenting cases with and without important biomedical and contextual factors in a counterbalanced factorial design. Performance will be compared between trial arms; the investigators hypothesize better performance in the intervention arm. In addition, performance will be compared with United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge scores to determine whether contextualizing ability is independent of clinical knowledge, and consistency of performance across individual SP cases will be studied to determine the number of cases necessary to achieve sufficient reliability for the assessment to be used.


Condition Intervention
Education, Medical, Undergraduate
Medical History Taking
Diagnosis
Behavioral: Contextualization workshop

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Official Title: Measuring Quality of Medical Student Performance at Contextualizing Care

Further study details as provided by University of Illinois at Chicago:

Primary Outcome Measures:
  • Developing an Appropriate Treatment Plan (for Contextual Variant of Encounters) [ Time Frame: 1 month ] [ Designated as safety issue: No ]
    Probability that the learner writes a correct treatment plan for the standardized patient encounters undertaken at assessment at end of subinternship that include contextual red flags. All learners are scheduled to see 4 encounters, based on combinations of four cases and four potential variants (baseline, biomedical, contextual, biocontextual) with counterbalancing by study month; each has a single contextual variant encounter. Treatment plans are assessed by an investigator blinded to the learner's assignment to intervention or control group.

  • Probing for Contextual Issues [ Time Frame: 1 month ] [ Designated as safety issue: No ]
    Probability that the learner probes contextual red flags raised in standardized patient encounters undertaken at assessment at end of subinternship. Each learner undertakes four encounters, each of which presents a contextual red flag that may or may not be probed; in a small number of cases, the standardized patient was ill and the learner undertook fewer than four encounters as a result. Assessment of probing is made by an investigator blinded to learner's assignment to group.

  • Probing for Biomedical Issues [ Time Frame: 1 month ] [ Designated as safety issue: No ]
    Probability that the learner probes biomedical red flags raised in standardized patient encounters undertaken at assessment at end of subinternship. Each learner undertakes four encounters, each of which presents a biomedical red flag that may or may not be probed; in a small number of cases, the standardized patient was ill and the learner undertook fewer than four encounters as a result. Assessment of probing is made by an investigator blinded to learner's assignment to group.


Enrollment: 189
Study Start Date: July 2008
Study Completion Date: June 2010
Primary Completion Date: March 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Contextualization workshop
A four-hour course on contextualization.
Behavioral: Contextualization workshop
A four-hour course on contextualization.
No Intervention: Control
No intervention

Detailed Description:

Clinical decision making requires two distinct skills: the ability to classify patients' conditions into diagnostic and management categories that permit the application of "best evidence" guidelines, and the ability to individualize or - more precisely - to contextualize care for patients whose circumstances and needs require variation from the standard approach to care. Most assessment in medical education places heavy emphasis on biomedical decision-making with little emphasis on how to incorporate contextual factors that may be essential to planning patients' care.

The goal of this project is to demonstrate and provide validity evidence for an innovative standardized patient (SP) method of assessing medical students in the clinical years on their ability to detect and respond to individual contextual factors in a patient encounter that overcomes the aforementioned challenges.

During the project, fourth-year medical students participating in a Medicine sub-internship will be randomized to an intervention group or a control group; the intervention group will receive additional training in the application of qualitative methodology to elicit and incorporate contextual factors in the clinical encounter. All students will participate in an SP assessment consisting of four SPs, blinded to trial arm, presenting cases with and without important biomedical and contextual factors in a counterbalanced factorial design. Performance will be compared between trial arms. In addition, performance will be compared with United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge scores to determine whether contextualizing ability is independent of clinical knowledge, and consistency of performance across individual SP cases will be studied to determine the number of cases necessary to achieve sufficient reliability for the assessment to be used.

  Eligibility

Ages Eligible for Study:   21 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Fourth-year medical students at University of Illinois at Chicago
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01088438

Locations
United States, Illinois
University of Illinois at Chicago
Chicago, Illinois, United States, 60612
Sponsors and Collaborators
University of Illinois at Chicago
The National Board of Medical Examiners
Investigators
Principal Investigator: Alan Schwartz, PhD University of Illinois at Chicago
  More Information

Publications:
Responsible Party: Alan Schwartz, University of Illinois at Chicago
ClinicalTrials.gov Identifier: NCT01088438     History of Changes
Other Study ID Numbers: NBME0708-12
Study First Received: March 12, 2010
Results First Received: March 14, 2011
Last Updated: April 11, 2011
Health Authority: United States: Institutional Review Board

Keywords provided by University of Illinois at Chicago:
medical education
decision making
diagnostic error
contextualization

ClinicalTrials.gov processed this record on August 20, 2014