Can clinical decision support systems be an asset in medical education? An experimental approach.

BACKGROUND: Diagnostic accuracy is one of the major cornerstones of appropriate and successful medical decision-making. Clinical decision support systems (CDSSs) have recently been used to facilitate physician's diagnostic considerations. However, to date, little is known about the potential assets of CDSS for medical students in an educational setting. The purpose of our study was to explore the usefulness of CDSSs for medical students assessing their diagnostic performances and the influence of such software on students' trust in their own diagnostic abilities. METHODS: Based on paper cases students had to diagnose two different patients using a CDSS and conventional methods such as e.g. textbooks, respectively. Both patients had a common disease, in one setting the clinical presentation was a typical one (tonsillitis), in the other setting (pulmonary embolism), however, the patient presented atypically. We used a 2x2x2 between- and within-subjects cluster-randomised controlled trial to assess the diagnostic accuracy in medical students, also by changing the order of the used resources (CDSS first or second). RESULTS: Medical students in their 4th and 5th year performed equally well using conventional methods or the CDSS across the two cases (t(164) = 1,30; p = 0.197). Diagnostic accuracy and trust in the correct diagnosis were higher in the typical presentation condition than in the atypical presentation condition (t(85) = 19.97; p < .0001 and t(150) = 7.67; p < .0001).These results refute our main hypothesis that students diagnose more accurately when using conventional methods compared to the CDSS. CONCLUSIONS: Medical students in their 4th and 5th year performed equally well in diagnosing two cases of common diseases with typical or atypical clinical presentations using conventional methods or a CDSS. Students were proficient in diagnosing a common disease with a typical presentation but underestimated their own factual knowledge in this scenario. Also, students were aware of their own diagnostic limitations when presented with a challenging case with an atypical presentation for which the use of a CDSS seemingly provided no additional insights.

Dietary preferences in the context of intra-couple dynamics: Relationship types within the German NutriAct family cohort.

To promote healthy diets in older age, a comprehensive understanding of factors influencing dietary behaviour and underlying preferences is essential. Romantic relationships are focal socialisation contexts, in which diet-related preferences and practices are dynamically negotiated. Our aim was to reconstruct intra-couple dynamics shaping dietary preferences and comparatively analyse relationship types among older couples. Data basis was the NutriAct Family Study - a German web-based cohort. Analyses were based on three a priori defined relationship types: 1) both partners' mutual adaptation of dietary preferences (symmetrical convergence), 2) unilateral adaptation (asymmetrical convergence) and 3) persistence of individual preferences. Relationship types were, among others, comparatively analysed using ANOVAs. Intra-couple dynamics within the asymmetrical convergence type were measured by multivariate logistic regression. The dyadic sample consisted of 398 couples resp. N = 796 individuals aged 63.99 years (SD = 6.15). All three relationship types were identified (symmetrical convergence: n = 62, 15.6 %; asymmetrical convergence: n = 199, 50.0 %; persistence: n = 137, 34.4 %). Within the asymmetrical convergence type, women were more likely to take a dominating role compared to their male partners (OR: 24.40; 95%CI: 14.37-41.41). This study demonstrates the fundamental influence of intra-couple dynamics on individual dietary preferences, whereby traditional gender roles have shown to play a central moderating role. Our study findings are relevant for the development and implementation of public health (nutrition) strategies, since they highlight the importance of understanding dietary preferences as jointly constructed and shaped in the intra-couple context, rather than as isolated, individually developed ones. In this context, future research directions and practical implications targeting not only individuals but involving couples are discussed.

Method-oriented systematic review on the simple scale for acceptance measurement in advanced transport telematics.

Acceptance intuitively is a precondition for the adaptation and use of technology. In this systematic review, we examine academic literature on the "simple scale for acceptance measurement" provided by Van der Laan, Heino, and de Waard (1997). This measure is increasingly applied in research on mobility systems without having been thoroughly analysed. This article aims to provide such a critical analysis. We identified 437 unique references in three aggregated databases and included 128 articles (N = 6,058 participants) that empirically applied the scale in this review. The typical study focused on a mobility system using a within-subjects design in a driving simulator in Europe. Based on quality indicators of transparent study aim, group allocation procedure, variable definitions, sample characteristics, (statistical) control of confounders, reproducibility, and reporting of incomplete data and test performance, many of the 128 articles exhibited room for improvements (44% below.50; range 0 to 1). Twenty-eight studies (22%) reported reliability coefficients providing evidence that the scale and its sub-scales produce reliable results (median Cronbach's α >.83). Missing data from the majority of studies limits this conclusion. Only 2 out of 10 factor analyses replicated the proposed two-dimensional structure questioning the use of these sub-scales. Correlation results provide evidence for convergent validity of acceptance, usefulness, and satisfying with limited confidence, since only 14 studies with a median sample size of N = 40 reported correlation coefficients. With these results, the scale might be a valuable addition for technology attitude research. Firstly, we recommend thorough testing for a better understanding of acceptance, usefulness, and satisfying. Secondly, we suggest to report scale results more transparently and rigorously to enable meta-analyses in the future. The study protocol is available at the Open Science Framework (https://osf.io/j782c/).

Assessing acceptance of electric automated vehicles after exposure in a realistic traffic environment.

After years of hypothetical surveys and simulator studies, automated vehicles (AVs) are now being tested in realistic traffic environments adding validity to knowledge about their acceptance. We present data from a pilot test with participants (n = 125) after experiencing a ride in an electric AV on a large clinic area in Berlin, Germany. As a first contribution, we bridge the gap between missing definitions of key constructs, confusion about their operationalisations, and a rigorous test of their statistical properties and data structure by examining scales on acceptance, trust, perceived safety, intention to use, and-for the first time applied to AVs-the emotions amusement, fear, surprise, and boredom. Tests of reliability and normality were satisfying for almost all constructs (Cronbach's alphas ≥ .69; six of eight scales normally distributed). The vehicles were accepted (M = 1.22; SD = 0.70; range -2 to 2), trusted (M = 3.29; SD = 0.81; range 1 to 5), and perceived as safe (M = 3.29; SD = 1.03; range 1 to 5). However, factor analyses did not reflect the hypothesised data structure, and validity concerns question the suitability of some constructs for attitude assessment of electric AVs. Our open item for comments added valuable insights in qualitative aspects of user attitudes towards electric AVs regarding driving style, technical features, and (unsettling) audio-visual feedback. We thus argue for broader conceptualisations of key constructs based on interdisciplinary exchange and multi-methodical study designs.