MedsOnCall Pager App: A Pilot Project for Practicing Safe Clinical Decision-making

Errors in clinical decision-making contribute to approximately half of in-hospital adverse events. The steep learning curve when students transition to residents is particularly susceptible to increased errors. Decision-making skills are a major contributor to preparedness for residency and educators agree that decision-making should be purposefully taught and tested. Despite this, little structured assessment of decision-making currently exists. This innovation report describes the development and piloting of the MedsOnCall (MOC) Pager App, a simulated pager program designed as a learning and assessment tool for senior medical students and junior residents to practice safe clinical decision-making as they transition between these two roles. Learners are randomly “paged” by the app about a list of virtual patients. To answer, they must integrate pertinent patient information efficiently. Learners then receive a page-management question that further probes their decision-making skills by asking them to consider the urgency and their level of confidence when determining the virtual patient’s needs. The pilot version of the app was successfully alpha-tested in 2016 and 2017 with twenty fourth year medical students at our institution. Subjectively, students greatly enjoyed using the MOC Pager app to practice answering pages in a safe environment. The app was then adapted for the National Cardiac Surgery Bootcamp in 2017 for use by first-year residents. With demonstrated success as a pilot project, our group aims to rebuild the app for customizable use by multidisciplinary learners anywhere in the world simultaneously. We also plan to collect validity evidence, integrate in-app feedback capability, and disseminate the app on multiple platforms.