Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning...

Area of Science:

• Medical Education
• Emergency Medicine
• Communication Skills

Background:

• Standardized communication strategies are lacking for emergency department (ED) patients with diagnostic uncertainty.
• Effective communication is crucial for patient understanding and adherence to follow-up care after ED discharge.

Purpose of the Study:

• To test the efficacy of the Uncertainty Communication Education Module (UCEM) in improving physicians' ability to communicate diagnostic uncertainty.
• To establish competency in communicating diagnostic uncertainty through simulation-based mastery learning.

Main Methods:

• A waitlist randomized controlled trial involving 109 resident physicians across two sites.
• Intervention included a simulation-based mastery learning curriculum with feedback, online modules, and deliberate practice.
• Assessment occurred at baseline (T1), post-intervention (T2), and follow-up (T3) using standardized patient encounters and the Uncertainty Communication Checklist (UCC).

Main Results:

• Immediate access physicians demonstrated significantly higher mastery of communicating diagnostic uncertainty at T2 (52.7%) compared to delayed access physicians (3.7%, P < .001).
• The odds of achieving mastery were substantially higher for the immediate access group (OR, 31.1).
• No significant differences were observed based on training site or stage of training.

Conclusions:

• The Uncertainty Communication Education Module significantly improved emergency physicians' mastery of communicating diagnostic uncertainty.
• Simulation-based training is effective in enhancing communication skills related to diagnostic uncertainty.
• Further research is needed to evaluate the clinical impact of these enhanced communication skills.