A Consensual Theoretical Framework Study for the Diagnostic Safety-Focused Critical Thinking Training Program in Emergency Medicine Education: A Three-Phase Study

Abstract

OBJECTIVE: We aimed to determine opinions of the selected experts on the goals and objectives of diagnostic safety-focused critical thinking postgraduate training program in emergency medicine education. This program will be designed to mitigate cognitive errors caused by cognitive biases and heuristics used during diagnostic processes under time pressure and uncertainty in emergency medicine practice. MATERIAL and METHODS: This study is the consensual framework study within the context of the third step of a ongoing doctorate dissertation study in accordance with Kern’s Curriculum Development Model that is a six-step approach. The study is a combination of both quantitative and qualitative research method. We planned a three phase expert group meeting consisting of a need analysis, a semi-structured interview, and a questionnaire study as part of curriculum development process in emergency medicine. The need analysis that is the first phase was made using three stages including literature review, synthesis of the researcher readings about literature, and an unstructured expert meeting. The unstructured expert meeting was made on a virtual platform with two selected emergency medicine specialists. In this section, emergency medicine residents’ needs about diagnostic errors, cognitive biases and safety measures were discussed. It is then defined and invited 12 designated experts for the semi-structured interview phase including both emergency medicine specialists and medical education specialists having masters or doctoral degree. The interview was conducted on the same virtual platform with the participation of eight of 12 experts. In this phase, participants respectively presented their opinion about the subject through prepared five questions and several impromptu questions. The questionnaire study phase was made on a virtual survey platform with the participation of the same 12 experts invited previous semi-structured interview. The participants answered 43 questions generated by researcher at the end of previous phase. Video records of the virtual sections were obtained from the given virtual platform and analyzed by the researcher. The descriptive statistics connected the survey were generated from the answers of 43 questions. RESULT: Twelve domain experts were included in this study. Eighty-three percent of the participants was emergency medicine specialists who are experienced in their domains. Four of the 12 experts (33.3%) had PhD degree on medical education and informatics. In total 14 items were established for target group’s needs analysis at the first phase: 10 items (71.4%) through literature review and synthesizing by researcher and 4 items (28.6%) from the unstructured expert meeting. Two items (33.3%) for the program’s goals and five items (25%) for the program’s objectives were stated at the semi-structured interview. Before the third phase, four goal items (66.7%) and 15 objective items (75%) through literature review and synthesizing were generated by researcher. Totally, 40 items including 14 need items, six goal items and 20 objective items were obtained. At the survey statistics, the participants agreed with 13 need items, five goal items, and 13 objective items with 100%

one need item, one goal item, and seven objective items with 83.3-91.7%. CONCLUSION: This is a first consensual framework study conducted in order to define the needs, goals, and objectives of a diagnostic safety-focused critical thinking training program in emergency medicine post-graduate education as far as is known. This is an awareness-raising study because of its significant emphasis about diagnostic error, cognitive biases and critical thinking skills as a de-biasing tool. The 40 items achieved consensus may be used for implementation stage of the given training program.