Evidence-Based Training to Improve Physician Responses to Adverse Events

A study published in BMC Medical Education has found that an online game can be an effective and acceptable way to train junior doctors in care relating to adverse events from cancer treatment and increase their quality improvement awareness.

Adverse events are a significant barrier to ensuring that patients receive the best possible care for their diseases. Junior doctors, due to their direct involvement with patients, are often the ones responsible for treating adverse events. Therefore, it is important that health care institutions have the proper training and education in place so that doctors are prepared to deliver the highest quality of care. Despite significant advances in technology and treatment, the rate of adverse events reported in hospitals globally has remained consistent over the last 20 years. 
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In a study led by Anna Janssen, MA, University of Sydney (Australia), researchers tested the feasibility and acceptability of using Qstream—a novel evidence-based form of online education—in an oncology-specific context to improve safety and quality of care relating to adverse events from cancer treatment. 

Researchers from international sites in Australia, Denmark, and the United States developed the program, which they named the “Cancer Cup Challenge.” An advisory committee oversaw the development of a set of key learning objectives and turned them into one-sentence messages to be delivered to junior doctors. Clinical scenarios included examples such as fertility preservation and drug interactions, especially in regards to oral chemotherapy. 

A total of 8 key concepts were identified for use in the Cancer Cup challenges, each of which was associated with a short clinical case scenario reinforcing specific objectives. Respondents were then tasked with selecting the correct response among 4 multiple-choice options, each of which could be considered equally plausible to a participant. After choosing an answer, the challenge then delivered expert feedback that expanded on the intended message, providing resources for further reading. 

Volunteers to test the system were gathered from all three countries and received an email every 2 days containing at least 2 clinical case examples. If a question was answered incorrectly, it was resent 5 days later. If participants chose the right answer, the question was retired. The course was completed once all questions were retired. 

To evaluate the impact of a gamification element, participants were also divided into teams and were able to access an online page displaying league and individual scores. Periodic emails containing scores were also sent out. 

A total of 35 people registered for the course, 31 (88.57%) of which went on to complete each case. 76.67% of cases were answered correctly on the first attempt, with the most difficult question being one that explored the challenges of monitoring toxicity that patients experience at home. 

In a follow-up survey, most participants who completed the survey said they thought the course was interesting and the material relevant to their profession. Only about half (47.05%) said they enjoyed the team-based aspect of the course, but 82.36% indicated that they enjoyed the individual competition. The most common complaint among the participants was that the cases were too easy, though most stated that they would enjoy receiving more. 

In their conclusion, authors wrote that a Qstream tool could be used by organizations to engage junior doctors in patient safety and quality improvement training.

“Our findings also illustrate the benefits of tailoring content to the specialty-specific context of the trainee, as well as introducing a gamification element to enhance participation,” the authors concluded.—Sean McGuire 


Jansen A, Shaw T, Bradbury L, et al. A mixed methods approach to developing and evaluating oncology trainee education around minimization of adverse events and improved patient quality and safety. [Published online March 12, 2016]. BMC Med Educ. 2016. doi: 10.1186/s12909-016-0609-1.