Learning Retention in Radiograph Interpretation

Sponsor

The Hospital for Sick Children (Other)

Overall Status

Completed

CT.gov ID

NCT03370900

Collaborator

New York University (Other), St. Justine's Hospital (Other)

233

Enrollment

Arms

19.4

Actual Duration (Months)

Study Details

Study Description

Brief Summary

Learning retention after the deliberate practice of radiograph interpretation may be challenging for image types which are common enough to be clinically relevant but not so common that proficiency can be sustained through clinical practice. This is especially relevant for radiographs such as paediatric elbow films (EXR) that carry high risks for the patient if pathology is missed. Building on prior research in this area, this study will develop an innovative computer learning application for paediatric EXR interpretation. After an initial learning period, this study will quantitatively determine the rate of skill decay and the optimal timing for refresher-education.

Condition or Disease	Intervention/Treatment	Phase
Fractures, Bone	Other: Testing	N/A

Detailed Description

Objectives Learning retention after the deliberate practice of radiograph interpretation may be challenging for image types which are common enough to be clinically relevant but not so common that proficiency can be sustained through clinical practice. This is especially relevant for radiographs such as paediatric elbow films (EXR) that carry high risks for the patient if pathology is missed. Building on our prior research in this area, this study will develop an innovative computer learning application for paediatric EXR interpretation. After an initial learning period, this study will quantitatively determine the rate of skill decay and the optimal timing for refresher-education.

Design A prospective cohort design with purposive sampling will be used to develop the EXR education intervention. A four arm randomized control trial will be used to test for the outcomes of skill decay and optimal timing of refresher education.

Setting The education intervention will be developed at two tertiary care children's hospitals. Study participants will include physicians from two large paediatric education networks in the United States (Paediatric Outcomes in Simulation Education) and Canada (Paediatric Emergency Research Canada).

Statistical analysis For the primary analysis, a four-group multi-level model with time-points nested within participants will be used. Secondary analyses will include a time series approach within each block of 20 test EXR to check for sequential effects, and between each block to determine whether we can efficiently model skill decay curves that can separate the underlying learning attrition curve from the effects of "boluses" of education.

Conclusion This study anticipates that learners will increase their learning of elbow radiographs by participating in the deliberate practice of radiographs, with skill decay over time that will be mitigated by refresher education. The results will allow evidence based recommendations regarding refresher education for learning from item banks of radiographs.

Study Design

Study Type:

Interventional

Actual Enrollment :

233 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

This was a four arm randomized control trial. All participants completed an 80-case deliberately practiced learning set of pediatric elbow radiographs followed by an immediate 20-case post-test. Following this, Group 1 had no testing until 12 months; Groups 2, 3, and 4 had testing (20 cases without feedback) every 2 months until 12 months, but Group 3 also had refresher education (20 cases with feedback) at six months while Group 4 had refresher education at two, six, and ten months.This was a four arm randomized control trial. All participants completed an 80-case deliberately practiced learning set of pediatric elbow radiographs followed by an immediate 20-case post-test. Following this, Group 1 had no testing until 12 months; Groups 2, 3, and 4 had testing (20 cases without feedback) every 2 months until 12 months, but Group 3 also had refresher education (20 cases with feedback) at six months while Group 4 had refresher education at two, six, and ten months.

Masking:

Single (Outcomes Assessor)

Masking Description:

All analyses were blinded to group assignment

Primary Purpose:

Diagnostic

Official Title:

Optimizing Skill Retention in Radiograph Interpretation: A Multicentre Randomized Control Trial

Actual Study Start Date :

Nov 1, 2014

Actual Primary Completion Date :

Jun 15, 2016

Actual Study Completion Date :

Jun 15, 2016

Arms and Interventions

Arm	Intervention/Treatment
No Intervention: Learning and Assessment at 12 months Study participants will complete an 80 case learning set followed by a 20-case post test. The study intervention in this group is a 20-case test at 12 months.
Experimental: Testing Every Two Months Study participants will complete an 80 case learning set followed by a 20-case post test. Study participants in this group will receive the following study interventions: 20-case post tests without any feedback at 2, 4, 6, 8, 10, 12 months.	Other: Testing Participants either received 20 case testing with or without feedback
Experimental: Low Bolus Feedback Study participants will complete an 80 case learning set followed by a 20-case post test. Study participants in this group will receive the following study interventions: 20-case post tests at 2, 4, 6, 8, 10, 12 months. At 6 months, the 20-case post-test will be delivered with feedback.	Other: Testing Participants either received 20 case testing with or without feedback
Experimental: High Bolus Feedback Study participants will complete an 80 case learning set followed by a 20-case post test. Study participants in this group will receive the following study interventions: 20-case post tests at 2, 4, 6, 8, 10, 12 months. At 4, 8, and 12 months, the 20-case post-test will be delivered with feedback.	Other: Testing Participants either received 20 case testing with or without feedback

Outcome Measures

Primary Outcome Measures

Accuray [12 months after learning intervention]
The percent of cases that were diagnosed correctly by the study participants

Secondary Outcome Measures

Accuracy [2, 4, 6, 8, 10 months]
The percent of cases that were diagnosed correctly by the study participants
Experience Curve [12 months]
Learning and forgetting curve for each group by linking learning curve parameters (y-intercept, slope) with the amount of forgetting (T12 score).

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Pediatric and emergency medicine residents enrolled in an accredited residency in Canada and the United States

Exclusion Criteria:

None

Contacts and Locations

Locations

No locations specified.

Sponsors and Collaborators

The Hospital for Sick Children
New York University
St. Justine's Hospital

Investigators

Principal Investigator: Kathy Boutis, The Hospital for Sick Children

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

Responsible Party:

Kathy Boutis, Physician and Senior Associate Scientist, The Hospital for Sick Children

ClinicalTrials.gov Identifier:

NCT03370900

Other Study ID Numbers:

1000028986

First Posted:

Dec 13, 2017

Last Update Posted:

Dec 13, 2017

Last Verified:

Dec 1, 2017

Individual Participant Data (IPD) Sharing Statement:

Plan to Share IPD:

Studies a U.S. FDA-regulated Drug Product:

Studies a U.S. FDA-regulated Device Product:

Keywords provided by Kathy Boutis, Physician and Senior Associate Scientist, The Hospital for Sick Children

Education (Medical); Retention;

Additional relevant MeSH terms:

Fractures, Bone

Study Results

No Results Posted as of Dec 13, 2017