Coagulation test understanding and ordering by medical trainees: Novel teaching approach

Background: Coagulation testing provides a prime opportunity to make an impact on the reduction of unnecessary laboratory test ordering, as there are clear indications for testing. Despite the prothrombin time/international normalized ratio and activated partial thromboplastin time being validated for specific clinical indications, they are frequently ordered as screening tests and often ordered together, suggesting a gap in understanding of coagulation. Methods: Based on a needs assessment, we developed an online educational module on coagulation for trainees, incorporating education on testing cost, specificity, and sensitivity. Fifty participating resident physicians and medical students completed a validated premodule quiz, postmodule quiz after completion of the module, and a latent quiz 3 to 6 months after to assess longer-term knowledge retention. Trainees provided responses regarding their subjective laboratory test-ordering practices before and after module completion. Results: The median premodule quiz score was 67% (n = 50; range, 24%-86%) with an increase of 24% to a median postmodule quiz score of 91% (n = 50; range, 64%-100%). There was evidence of sustained knowledge acquisition with a latent quiz median score of 89% (n = 40; range, 67%-100%). Trainees were more likely to consider the sensitivity, specificity, and cost of laboratory investigations before ordering them following completion of the educational module. Conclusions: Using the expertise of medical educators and incorporating trainee feedback, we employed a novel approach to the teaching of coagulation to maximize its approachability and clinical relevance. We found sustained knowledge retention regarding coagulation and appropriate coagulation test ordering, and a subjective change to trainee ordering habits following participation in our educational intervention.