Error Management Training and Adaptive Expertise in Learning Computed Tomography Interpretation: A Randomized...

Area of Science:

• Medical Education
• Cognitive Skill Development
• Diagnostic Expertise

Background:

• Adaptive expertise is crucial for physicians to manage novel clinical cases and minimize errors.
• Error management training (EMT) is known to enhance procedural skills but its impact on cognitive skills in medical education remains unclear.

Purpose of the Study:

• To assess if error management training (EMT) improves adaptive expertise in learning head computed tomography (CT) interpretation, a key cognitive skill.

Main Methods:

• A 3-arm randomized clinical trial involving 212 emergency medicine residents.
• Participants were assigned to difficult EMT, easy EMT, or error avoidance training (EAT) control.
• The study evaluated adaptive expertise in head CT interpretation using a posttest.

Main Results:

• The difficult EMT group demonstrated superior adaptive expertise compared to easy EMT and EAT groups (60.6% vs. 45.2% vs. 40.9%, P < .001).
• Making more errors during training in the difficult EMT cohort mediated 87.2% of the improvement in adaptive expertise.
• Difficult EMT was more effective for residents earlier in their training.

Conclusions:

• Error management training (EMT) is an effective strategy for developing physicians' adaptive expertise in cognitive skills.
• The findings support the use of EMT, particularly with challenging cases, to enhance diagnostic reasoning and reduce medical errors.