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We have previously published the study protocol for this trial.28 We developed a video game (Night Shift) in collaboration with Schell Games (Pittsburgh, PA) and conducted a randomized controlled trial of the effect of the game compared with traditional didactic education, administered through commercially available applications, on triage by US emergency physicians practicing at non-trauma centers.

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Our goal was to recruit a national sample of emergency medicine physicians who make triage decisions.

To that end, we recruited board ertified and board eligible physicians working primarily outside level I/II trauma centers in the US at the 2016 annual scientific meeting of the American College of Emergency Physicians (October 16-18).

Medical diagnosis often requires physicians to collect and integrate complex uncertain information from multiple sources.1 Under normal conditions, that process requires reliance on heuristic cognitive processes.23 Heuristics generate solutions to complex problems through pattern recognition and simplifying assumptions.

When calibrated well, heuristics allow people to function under conditions of time pressure and uncertainty.4 When calibrated poorly, however, they result in predictable errors in judgment.5 As a result, many interventions attempt to reduce reliance on heuristic cognitive processes.6 Some of these interventions focus on increasing physicians’ use of clinical practice guidelines through direct instruction (such as warning about the risks of relying on heuristics, checklists of necessary actions) or outcome feedback (such as telling physicians how they have done).7891011 Others try to shift the locus of decision making from the bedside clinician to a third party such as a decision tool or an external consultant.1213 To date, these interventions have had mixed success, with limited transference across task domains.6 More importantly, they do not directly deal with the long term need to improve the heuristic processes that underpin most physician decision making.1141516Behavioral scientists agree that people develop well calibrated heuristics when the decisional context provides reliable valid cues to the problem and they have the opportunity to learn the relevant contextual cues.17 Typically, calibration—the process of refining the accuracy of judgment—requires an experience-feedback loop.

The scale ranges from I (fully resourced hospital; serves as regional referral center) to IV (minimally resourced hospital; capable of stabilizing patients but must refer severe injuries to a higher level of care).

Hospitals that have not applied for accreditation are referred to as non-trauma centers.

Narrative engagement is defined as the use of compelling stories to communicate and encode principles of best practice decision.

We compared the efficacy of a narrative engagement video game with that of a prominent education intervention for improving simulated decisions in trauma triage with emergency medicine physicians practicing at non-trauma centers as participants.

Physicians were randomized with a 2×2 factorial design to intervention (game Main outcome measures Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries.

Participants completed the simulation within four weeks of their intervention.

The triage of trauma patients by physicians occurs at non-trauma centers and level III/IV centers.

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