False certainty in the acquisition of anatomical and physiotherapeutic knowledge.

BACKGROUND: Efficient metacognitive monitoring, that is the monitoring of one's own thought processes and specifically one's state of knowledge, is essential for effective clinical reasoning. Knowing what one does and does not know is a competency that students of health professions need to develop. Students often tend to develop false certainty in their own knowledge in the longer course of their education, but the time frame that is required for this effect to occur has remained unclear. We investigated whether students developed false certainty already after one course unit. METHODS: This study analysed data from one sample of medical students and four samples of physiotherapy students in two formal educational settings (total N = 255) who took knowledge tests before and after a course unit. We examined changes in students' confidence separately for correctly and incorrectly answered questions and analysed their ability to assign higher levels of confidence to correct answers than to incorrect answers (discrimination ability). RESULTS: Students' knowledge as well as confidence in their correct answers in knowledge tests increased after learning. However, consistently for all samples, confidence in incorrect answers increased as well. Students' discrimination ability improved only in two out of the five samples. CONCLUSIONS: Our results are in line with recent research on confidence increase of health professions students during education. Extending those findings, our study demonstrated that learning in two different formal educational settings increased confidence not only in correct but also in incorrect answers to knowledge questions already after just one learning session. Our findings highlight the importance of improving metacognition in the education of health professionals-especially their ability to know what they do not know.

Decision aids to prepare patients for shared decision making: Two randomized controlled experiments on the impact of awareness of preference-sensitivity and personal motives.

OBJECTIVE: To participate in shared decision making (SDM), patients need to understand their options and develop trust in their own decision-making abilities. Two experiments investigated the potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference-sensitivity (Study 1) and showing possible personal motives for decision making (Study 2) in addition to providing information about the treatment options. METHODS: Participants (Study 1: N = 117; Study 2: N = 217) were put into two scenarios (Study 1: cruciate ligament rupture; Study 2: contraception), watched a consultation video and were randomized into one of three groups where they received additional information in the form of (a) narrative patient testimonials; (b) non-narrative decision strategies; and (c) an unrelated text (control group). RESULTS: Participants who viewed the patient testimonials or decision strategies felt better prepared for a decision (Study 1: P < .001, ηP2  = 0.43; Study 2: P < .001, ηP2  = 0.57) and evaluated the decision-making process more positively (Study 2: P < .001, ηP2  = 0.13) than participants in the control condition. Decision certainty (Study 1: P < .001, ηP2  = 0.05) and satisfaction (Study 1: P < .001, ηP2  = 0.11; Study 2: P = .003, d = 0.29) were higher across all conditions after watching the consultation video, and certainty and satisfaction were lower in the control condition (Study 2: P < .001, ηP2  = 0.05). DISCUSSION: Decision aids that explain preference-sensitivity and personal motives can be beneficial for improving people's feelings of being prepared and their perception of the decision-making process. To reach decision certainty and satisfaction, being well informed of one's options is particularly relevant. We discuss the implications of our findings for future research and the design of DAs.

The impact of a physician's recommendation and gender on informed decision making: A randomized controlled study in a simulated decision situation.

OBJECTIVE: This study examined the influence of physicians' recommendations and gender on the decision-making process in a preference-sensitive situation. METHODS: N = 201 participants were put in a hypothetical scenario in which they suffered from a rupture of the anterior cruciate ligament (ACL). They received general information on two equally successful treatment options for this injury (surgery vs physiotherapy) and answered questions regarding their treatment preference, certainty and satisfaction regarding their decision and attitude towards the treatment options. Then, participants watched a video that differed regarding physician's recommendation (surgery vs physiotherapy) and physician's gender (female vs male voice and picture). Afterwards, they indicated again their treatment preference, certainty, satisfaction and attitude, as well as the physician's professional and social competence. RESULTS: Participants changed their treatment preferences in the direction of the physician's recommendation (P < .001). Decision certainty (P < .001) and satisfaction (P < .001) increased more strongly if the physician's recommendation was congruent with the participant's prior attitude than if the recommendation was contrary to the participant's prior attitude. Finally, participants' attitudes towards the recommended treatment became more positive (surgery recommendation: P < .001; physiotherapy recommendation: P < .001). We found no influence of the physician's gender on participants' decisions, attitudes, or competence assessments. CONCLUSION: This research indicates that physicians should be careful with recommendations when aiming for shared decisions, as they might influence patients even if the patients have been made aware that they should take their personal preferences into account. This could be particularly problematic if the recommendation is not in line with the patient's preferences.

Wikipedia outperforms individuals when it comes to hindsight bias.

Hindsight bias-the tendency to overestimate in hindsight what one knew in foresight-is a robust and pervasive human error. A recent study with Wikipedia articles, however, found evidence for a hindsight bias only for disasters but not for any other event category (e.g., elections). Although this might suggest Wikipedia articles to be less biased than individuals, alternative explanations had not been ruled out. The present study set out to answer this question by comparing individuals' and Wikipedia's representation of the very same event in foresight and hindsight. In particular, we made use of a state election and surveyed one part of participants before and after the outcome and had other participants rate the corresponding Wikipedia article versions with regard to the extent to which the article was suggestive of a particular outcome and presented it as foreseeable and inevitable. In line with prior research and our hypotheses, we found a hindsight bias at the individual level but not in Wikipedia articles. Applying Bayesian statistics, there was substantial support for the null hypothesis (i.e., no hindsight bias) in Wikipedia. By controlling for the potential impact of participants' own hindsight bias on their article ratings we can rule out alternative explanations of our findings. Therefore, our findings are the first to demonstrate Wikipedia's superiority over individuals when it comes to hindsight bias.

The impact of physicians' recommendations on treatment preference and attitudes: a randomized controlled experiment on shared decision-making.

Making decisions based on their own evaluation of relevant information and beliefs is very challenging for patients. Many patients feel that they lack the knowledge to make a decision and expect a recommendation by their physician. We conducted an experimental study to examine the impact of physicians' recommendations on the decision-making process. N = 194 medical laypeople were placed in a hypothetical scenario where they suffered from a cruciate ligament rupture and were faced with the decision about a treatment (surgery or physiotherapy). In a 3 × 2 between-group design we investigated the impact of physicians' recommendations (for surgery, for physiotherapy, no recommendation) and reasoning style (scientific, narrative) on treatment preference, certainty and satisfaction regarding treatment preference, and attitudes. We found that the recommendation had a significant influence on treatment preference and attitudes toward both treatments. Additionally, we found a significant increase in certainty and satisfaction after the intervention, independently of whether they received a recommendation. This finding suggested that a recommendation was not required to strengthen participants' confidence in their decision. There were no effects of reasoning style. We discuss the implications and suggest that physicians should be careful with recommendations in situations in which patients' preferences are important.

Music-space associations are grounded, embodied and situated: examination of cello experts and non-musicians in a standard tone discrimination task.

In recent research, a systematic association of musical pitch with space has been described in the so-called Spatial-Pitch-Association-of-Response Codes-effect (SPARC). Typically, high pitch is associated with upper/right and low pitch with lower/left space. However, a theoretical classification of these associations regarding their experiential sources is difficult. Therefore, we applied a theoretical framework of numerical cognition classifying similar Space-Associated Response Codes (SARC) effects according to their groundedness, embodiedness and situatedness. We tested these attributes with a group of non-musicians and with a group of highly skilled cello players playing high tones with lower hand positions (i.e., reverse SPARC alignment) in a standard SPARC context of a piano and a reversed SPARC context of a cello. The results showed that SPARC is grounded, in general. However, for cello player SPARC is also situated and embodied. We conclude that groundedness, embodiedness and situatedness provide general characteristics of mapping cognitive representations to space.

How Confidence in Prior Attitudes, Social Tag Popularity, and Source Credibility Shape Confirmation Bias Toward Antidepressants and Psychotherapy in a Representative German Sample: Randomized Controlled Web-Based Study.

BACKGROUND: In health-related, Web-based information search, people should select information in line with expert (vs nonexpert) information, independent of their prior attitudes and consequent confirmation bias. OBJECTIVE: This study aimed to investigate confirmation bias in mental health-related information search, particularly (1) if high confidence worsens confirmation bias, (2) if social tags eliminate the influence of prior attitudes, and (3) if people successfully distinguish high and low source credibility. METHODS: In total, 520 participants of a representative sample of the German Web-based population were recruited via a panel company. Among them, 48.1% (250/520) participants completed the fully automated study. Participants provided prior attitudes about antidepressants and psychotherapy. We manipulated (1) confidence in prior attitudes when participants searched for blog posts about the treatment of depression, (2) tag popularity -either psychotherapy or antidepressant tags were more popular, and (3) source credibility with banners indicating high or low expertise of the tagging community. We measured tag and blog post selection, and treatmentefficacy ratings after navigation. RESULTS: Tag popularity predicted the proportion of selected antidepressant tags (beta=.44, SE 0.11; P<.001) and blog posts (beta=.46, SE 0.11; P<.001). When confidence was low (-1 SD), participants selected more blog posts consistent with prior attitudes (beta=-.26, SE 0.05; P<.001). Moreover, when confidence was low (-1 SD) and source credibility was high (+1 SD), the efficacy ratings of attitude-consistent treatments increased (beta=.34, SE 0.13; P=.01). CONCLUSIONS: We found correlational support for defense motivation account underlying confirmation bias in the mental health-related search context. That is, participants tended to select information that supported their prior attitudes, which is not in line with the current scientific evidence. Implications for presenting persuasive Web-based information are also discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03899168; https://clinicaltrials.gov/ct2/show/NCT03899168 (Archived by WebCite at http://www.webcitation.org/77Nyot3Do).

Development of domain-specific epistemological beliefs of physiotherapists: a longitudinal study.

BACKGROUND: Epistemological beliefs (EBs) and therapeutic health concepts are two important factors of influence that affect how healthcare professionals process treatment-relevant information. A previous investigation compared physiotherapy students' EBs and therapeutic health concepts with those of professionals in a cross-sectional study. That study design, however, did not allow for any conclusions about the temporal development of these concepts. This shortcoming has been addressed in the study presented here, which aimed to assess that temporal development. METHODS: In a longitudinal study, physiotherapists filled in a questionnaire that measured their personal EBs about physiotherapy and about medicine, as well as their biomedical and biopsychosocial therapeutic health concepts. The participants were first examined during their medical training (December 2011). The follow-up measure was about 3 years later when the participants had become professional physiotherapists (January 2015). The development of their EBs was examined using paired sample t-tests and Wilcoxon signed-rank test. RESULTS: The analysis was based on 41 participants who filled in the questionnaire at both time points and were working as physiotherapists at the time of the second measurement. There was a development of physiotherapy-related and a development of medicine-related EBs: Physiotherapy-related as well as medicine-related EBs were more sophisticated when physiotherapists had already entered the working world than during their physiotherapy training. Due to psychometric problems of the scales, the development of their therapeutic health concepts could not be analyzed. CONCLUSIONS: EBs are an important factor for (lifelong) learning. Physiotherapy-related and medicine-related EBs developed similarly in both domains. This is an indication that the temporal development of EBs is an expression of professionalization of healthcare personnel in their occupational field. The findings demonstrate that the development of EBs is not completed at the end of vocational training; it appears to be a development that continues even after the transition to professional life.

Biases in the production and reception of collective knowledge: the case of hindsight bias in Wikipedia.

The Web 2.0 enabled collaboration at an unprecedented level. In one of the flagships of mass collaboration-Wikipedia-a large number of authors socially negotiate the world's largest compendium of knowledge. Several guidelines in Wikipedia restrict contributions to verifiable information from reliable sources to ensure recognized knowledge. Much psychological research demonstrates, however, that individual information processing is biased. This poses the question whether individual biases translate to Wikipedia articles or whether they are prevented by its guidelines. The present research makes use of hindsight bias to examine this question. To this end, we analyzed foresight and hindsight versions of Wikipedia articles regarding a broad variety of events (Study 1). We found the majority of articles not to contain traces of hindsight bias-contrary to prior individual research. However, for a particular category of events-disasters-we found robust evidence for hindsight bias. In a lab experiment (Study 2), we then examined whether individuals' hindsight bias is translated into articles under controlled conditions and tested whether collaborative writing-as present in Wikipedia-affects the resultant bias (vs. individual writing). Finally, we investigated the impact of biased Wikipedia articles on readers (Study 3). As predicted, biased articles elicited a hindsight bias in readers, who had not known of the event previously. Moreover, biased articles also affected individuals who knew about the event already, and who had already developed a hindsight bias: biased articles further increased their hindsight.

Have a look around: the effect of physical environments on risk behaviour in work-related versus non-work related decision-making tasks.

Due to ubiquitous computing, knowledge workers do not only work in typical work-associated environments (e.g. the office) but also wherever it best suits their schedule or preferences (e.g. the park). In two experiments using laboratory and field methods, we compared decision making in work and non-work environments. We hypothesised that participants make riskier work-related decisions when in work-associated environments and riskier non-work-related decisions in non-work-associated environments. Therefore, if environment (work vs. non-work) and decision-making task (work-related vs. non-work-related) are incongruent, then risk-taking should be lower, as the decision maker might feel the situation is unusual or inappropriate. Although results do not reveal that work-associated environments generally encourage riskier work-related decisions (and likewise for non-work), we found environmental effects on decision making when including mood as a moderator. Practitioner summary: Mobile workers are required to make decisions in various environments. We assumed that decisions are more risky when they are made in a fitting environment (e.g. work-related decisions in work environments). Results of the two experiments (laboratory and field) only show an environmental effect when mood is included as a moderator.

The impact of physicians' communication styles on evaluation of physicians and information processing: A randomized study with simulated video consultations on contraception with an intrauterine device.

OBJECTIVE: This study aimed at examining the impact of different types of physicians' communication styles on people's subsequent evaluation of physician attributes as well as on their information processing, attitude and decision making. METHOD: In a between-group experiment, 80 participants watched one of three videos in which a gynaecologist displayed a particular communication style in a consultation situation on contraception with an intrauterine device. We compared doctor-centred communication (DCC) vs patient-centred communication (PCC) vs patient-centred communication with need-orientation (PCC-N). RESULTS: In the PCC condition, participants perceived the physician to be more empathetic and more competent than in the DCC condition. In the DCC condition, participants showed less attitude change compared to the other conditions. In the PCC-N condition, the physician was perceived as more empathetic and more socially competent than in the other conditions. However, participants acquired less knowledge in the PCC-N condition. CONCLUSION: We conclude that appropriate application of particular communication styles depends on specific consultation goals. Our results suggest that patients' needs should be addressed if the main goal is to build a good relationship, whereas a traditional PCC style appears to be more effective in communicating factual information.

How to rapidly construct a spatial-numerical representation in preliterate children (at least temporarily).

Spatial processing of numbers has emerged as one of the basic properties of humans' mathematical thinking. However, how and when number-space relations develop is a highly contested issue. One dominant view has been that a link between numbers and left/right spatial directions is constructed based on directional experience associated with reading and writing. However, some early forms of a number-space link have been observed in preschool children who cannot yet read and write. As literacy experience is evidently not necessary for number-space effects, we are searching for other potential sources of this association. Here we propose and test a hypothesis that the number-space link can be quickly constructed in preschool children's cognition on the basis of spatially oriented visuo-motor activities. We trained 3- and 4-year-old children with a non-numerical spatial movement task (left-to-right or right-to-left), where via touch screen children had to move a frog across a pond. After the training, children had to perform a numerosity comparison task. After left-to-right training, we observed a SNARC-like effect (reactions to smaller numbers were faster on the left side, and reactions to larger numbers on the right side), and after right-to-left training a reverse effect. These results are the first to show a causal link between visuo-motor activities and number-space associations in children before they learn to read and write. We argue that simple activities, such as manual games, dominant in a given society, might shape number-space associations in children in a way similar to lifelong reading training.

The Impact of Personality Factors and Preceding User Comments on the Processing of Research Findings on Deep Brain Stimulation: A Randomized Controlled Experiment in a Simulated Online Forum.

BACKGROUND: Laypeople frequently discuss medical research findings on Web-based platforms, but little is known about whether they grasp the tentativeness that is inherent in these findings. Potential influential factors involved in understanding medical tentativeness have hardly been assessed to date. OBJECTIVE: The research presented here aimed to examine the effects of personality factors and of other users' previous contributions in a Web-based forum on laypeople's understanding of the tentativeness of medical research findings, using the example of research on deep brain stimulation. METHODS: We presented 70 university students with an online news article that reported findings on applying deep brain stimulation as a novel therapeutic method for depression, which participants were unfamiliar with. In a randomized controlled experiment, we manipulated the forum such that the article was either accompanied by user comments that addressed the issue of tentativeness, by comments that did not address this issue, or the article was accompanied by no comments at all. Participants were instructed to write their own individual user comments. Their scientific literacy, epistemological beliefs, and academic self-efficacy were measured. The outcomes measured were perceived tentativeness and tentativeness addressed in the participants' own comments. RESULTS: More sophisticated epistemological beliefs enhanced the perception of tentativeness (standardized ß=.26, P=.034). Greater scientific literacy (stand. ß=.25, P=.025) and greater academic self-efficacy (stand. ß=.31, P=.007) were both predictors of a more extensive discussion of tentativeness in participants' comments. When forum posts presented in the experiment addressed the issue of tentativeness, participants' subsequent behavior tended to be consistent with what they had read in the forum, F2,63=3.66; P=.049, ηp(2)=.092. CONCLUSIONS: Students' understanding of the tentativeness of research findings on deep brain stimulation in an online forum is influenced by a number of character traits and by the previous comments that were contributed to the forum by other users. There is potential for targeted modification of traits such as scientific literacy, epistemological beliefs, and academic self-efficacy to foster critical thinking in laypeople who take part in online discussions of medical research findings.

The impact of epistemological beliefs and cognitive ability on recall and critical evaluation of scientific information.

Scientific research findings are frequently picked up by the mainstream media, but it is largely unclear which factors have an impact on laypeople's processing of the presented scientific information. In this study, we investigated the influence of cognitive and metacognitive inter-individual differences on recall and on critical evaluation of new scientific information that was presented in a journalistic article. Sixty-three participants (80 % female; mean age 24.1 ± 3.3 years) read a newspaper article reporting research findings on a recently developed and yet unproven treatment for depression. We found that more sophisticated, domain-specific epistemological beliefs and a higher cognitive ability were independently associated with better recall of content from the article. Additionally, participants with more sophisticated epistemological beliefs displayed a more critical evaluation of the article. Cognitive ability was unrelated to critical evaluation and to epistemological beliefs. There were also no interaction effects of cognitive ability and epistemological beliefs on recall or on critical evaluation. Based on our preliminary findings and previous evidence of epistemological beliefs as a modifiable feature, we discuss this inter-individual characteristic as a potential target for the promotion of better understanding of scientific topics by the general public.

Impact of Scientific Versus Emotional Wording of Patient Questions on Doctor-Patient Communication in an Internet Forum: A Randomized Controlled Experiment with Medical Students.

BACKGROUND: Medical expert forums on the Internet play an increasing role in patient counseling. Therefore, it is important to understand how doctor-patient communication is influenced in such forums both by features of the patients or advice seekers, as expressed in their forum queries, and by characteristics of the medical experts involved. OBJECTIVE: In this experimental study, we aimed to examine in what way (1) the particular wording of patient queries and (2) medical experts' therapeutic health concepts (for example, beliefs around adhering to a distinctly scientific understanding of diagnosis and treatment and a clear focus on evidence-based medicine) impact communication behavior of the medical experts in an Internet forum. METHODS: Advanced medical students (in their ninth semester of medical training) were recruited as participants. Participation in the online forum was part of a communication training embedded in a gynecology course. We first measured their biomedical therapeutic health concept (hereinafter called "biomedical concept"). Then they participated in an online forum where they answered fictitious patient queries about mammography screening that either included scientific or emotional wording in a between-group design. We analyzed participants' replies with regard to the following dimensions: their use of scientific or emotional wording, the amount of communicated information, and their attempt to build a positive doctor-patient relationship. RESULTS: This study was carried out with 117 medical students (73 women, 41 men, 3 did not indicate their sex). We found evidence that both the wording of patient queries and the participants' biomedical concept influenced participants' response behavior. They answered emotional patient queries in a more emotional way (mean 0.92, SD 1.02) than scientific patient queries (mean 0.26, SD 0.55; t74=3.48, P<.001, d=0.81). We also found a significant interaction effect between participants' use of scientific or emotional wording and type of patient query (F2,74=10.29, P<.01, partial η(2)=0.12) indicating that participants used scientific wording independently of the type of patient query, whereas they used emotional wording particularly when replying to emotional patient queries. In addition, the more pronounced the medical experts' biomedical concept was, the more scientifically (adjusted ß=.20; F1,75=2.95, P=.045) and the less emotionally (adjusted ß=-.22; F1,74=3.66, P=.03) they replied to patient queries. Finally, we found that participants' biomedical concept predicted their engagement in relationship building (adjusted ß=-.26): The more pronounced their biomedical concept was, the less they attempted to build a positive doctor-patient relationship (F1,74=5.39, P=.02). CONCLUSIONS: Communication training for medical experts could aim to address this issue of recognizing patients' communication styles and needs in certain situations in order to teach medical experts how to take those aspects adequately into account. In addition, communication training should also make medical experts aware of their individual therapeutic health concepts and the consequential implications in communication situations.

The role of tentative decisions and health concepts in assessing information about mammography screening.

Breast cancer awareness campaigns and screening programs are important public health issues. In order to deepen women's knowledge about mammography screening, a balanced presentation of arguments is considered to be relevant. Yet, little is known about how women process this information and assess pro and contra arguments, which, in turn, can be embedded in different health paradigms. The aim of this experimental study was to determine the impact of both women's pre-formed, tentative decisions about whether to participate in mammography screening and of their individual health concepts on their assessment of different arguments about mammography screening. The results showed that women who would tend at the outset to participate in mammography screening rated information about advantages as more relevant than information about disadvantages--in contrast to women who did not intend to participate. In addition, the greater the fit was between women's individual health concepts and the health concept presented in the arguments, the more they considered the information presented to be relevant. We conclude that presenting balanced information about mammography screening does not guarantee balanced processing of that information. Health professionals need to be aware of people's prior beliefs and of the health paradigm in which information is embedded.

Confirmation bias in web-based search: a randomized online study on the effects of expert information and social tags on information search and evaluation.

BACKGROUND: The public typically believes psychotherapy to be more effective than pharmacotherapy for depression treatments. This is not consistent with current scientific evidence, which shows that both types of treatment are about equally effective. OBJECTIVE: The study investigates whether this bias towards psychotherapy guides online information search and whether the bias can be reduced by explicitly providing expert information (in a blog entry) and by providing tag clouds that implicitly reveal experts' evaluations. METHODS: A total of 174 participants completed a fully automated Web-based study after we invited them via mailing lists. First, participants read two blog posts by experts that either challenged or supported the bias towards psychotherapy. Subsequently, participants searched for information about depression treatment in an online environment that provided more experts' blog posts about the effectiveness of treatments based on alleged research findings. These blogs were organized in a tag cloud; both psychotherapy tags and pharmacotherapy tags were popular. We measured tag and blog post selection, efficacy ratings of the presented treatments, and participants' treatment recommendation after information search. RESULTS: Participants demonstrated a clear bias towards psychotherapy (mean 4.53, SD 1.99) compared to pharmacotherapy (mean 2.73, SD 2.41; t173=7.67, P<.001, d=0.81) when rating treatment efficacy prior to the experiment. Accordingly, participants exhibited biased information search and evaluation. This bias was significantly reduced, however, when participants were exposed to tag clouds with challenging popular tags. Participants facing popular tags challenging their bias (n=61) showed significantly less biased tag selection (F2,168=10.61, P<.001, partial eta squared=0.112), blog post selection (F2,168=6.55, P=.002, partial eta squared=0.072), and treatment efficacy ratings (F2,168=8.48, P<.001, partial eta squared=0.092), compared to bias-supporting tag clouds (n=56) and balanced tag clouds (n=57). Challenging (n=93) explicit expert information as presented in blog posts, compared to supporting expert information (n=81), decreased the bias in information search with regard to blog post selection (F1,168=4.32, P=.04, partial eta squared=0.025). No significant effects were found for treatment recommendation (Ps>.33). CONCLUSIONS: We conclude that the psychotherapy bias is most effectively attenuated-and even eliminated-when popular tags implicitly point to blog posts that challenge the widespread view. Explicit expert information (in a blog entry) was less successful in reducing biased information search and evaluation. Since tag clouds have the potential to counter biased information processing, we recommend their insertion.

Personal experiences and emotionality in health-related knowledge exchange in Internet forums: a randomized controlled field experiment comparing responses to facts vs personal experiences.

BACKGROUND: On the Internet, people share personal experiences as well as facts and objective information. This also holds true for the exchange of health-related information in a variety of Internet forums. In online discussions about health topics, both fact-oriented and strongly personal contributions occur on a regular basis. OBJECTIVE: In this field experiment, we examined in what way the particular type of contribution (ie, factual information vs personal experiences) has an impact on the subsequent communication in health-related Internet forums. METHODS: For this purpose, we posted parallelized queries to 28 comparable Internet forums; queries were identical with regard to the information contained but included either fact-oriented descriptions or personal experiences related to measles vaccination. In the factual information condition, we posted queries to the forums that contained the neutral summary of a scientific article. In the personal experiences condition, we posted queries to the forums that contained the same information as in the first condition, but were framed as personal experiences RESULTS: We found no evidence that personal experiences evoked more responses (mean 3.79, SD 3.91) from other members of the Internet forums than fact-oriented contributions (mean 2.14, SD 2.93, t26=0.126, P=.219). But personal experiences elicited emotional replies (mean 3.17, SD 1.29) from other users to a greater extent than fact-oriented contributions (mean 2.13, SD 1.29, t81=3.659, P<.001). CONCLUSIONS: We suggest that personal experiences elicited more emotional replies due to the process of emotional anchoring of people's own style of communication. We recommend future studies should aim at testing the hypotheses with more general and with less emotionally charged topics, constructing different fact-oriented posts, and examining additional potential factors of influence such as personality factors or particular communication situations.

Web-based apps for reflection: a longitudinal study with hospital staff.

BACKGROUND: Reflection is an important cognitive process in workplace learning; however, it occurs only rarely on its own and therefore needs additional support. OBJECTIVE: In this study, we investigated the effect of software applications (apps) that aim to support reflection on hospital staff's actual reflection behavior. In doing so, we also analyzed the relationship between reflection and the job satisfaction of health care professionals. METHODS: Reflective learning was introduced in the ward of a neurological hospital by providing apps that aimed to foster particular aspects of individual and collaborative reflection. Data were collected repeatedly: once before the introduction of the apps and again 2 years after the initial measure. We used a questionnaire with subjective ratings of reflection and job satisfaction. Response rates were 34.4% (167/485) for the first and 40.6% (210/517) for the second measure. RESULTS: Collaborative reflection was increased (P=.047) after the provision of the apps (2010: mean 2.84, SD 0.72; 2012: mean 3.06, SD 0.63) in contrast to a control group of other wards of the same hospital (2010: mean 2.68, SD 0.67; 2012: mean 2.63, SD 0.68). In addition, we revealed a positive correlation between collaborative reflection and job satisfaction (r=.61, P<.001). CONCLUSIONS: The findings provide evidence for an effect of the apps on hospital employees' reflection behavior. Apps that foster reflective learning can increase health care professionals' reflection about work experiences and support them in discussing experiences in teams or with their supervisors. The relationship between collaborative reflection and job satisfaction suggests that opportunities for joint reflection on work experiences in a hospital have further impact over and above fostering reflective learning per se. We discuss the limitations of our study and provide suggestions for both future research and the development of Web-based apps.

Epistemological beliefs and therapeutic health concepts of physiotherapy students and professionals.

BACKGROUND: Health knowledge develops fast and includes a lot of ambiguous or tentative information. In their daily routine, both health care students and professionals continuously have to make judgments about the viability of health knowledge. People's epistemological beliefs (EBs) and their therapeutic health concepts are factors that influence how they deal with health knowledge. However, very little is known about the occurrence of these factors at different stages of people's career. The present study examines the EBs and therapeutic health concepts of physiotherapy students in their vocational training and the EBs and therapeutic health concepts of professionals. METHODS: In a cross-sectional study physiotherapy students and professional physiotherapists filled in a questionnaire that measured their personal EBs about physiotherapy and medicine, as well as their biomedical and biopsychosocial therapeutic health concepts. We compared the participants' EBs regarding both knowledge domains, and their therapeutic health concepts using paired samples t-tests. We also examined the differences between first-year students, advanced students, and professionals regarding their EBs and their therapeutic health concepts using ANOVAs. RESULTS: Eighty-three students and 84 professionals participated in this study, 114/167 (68%) participants were female. EBs as well as therapeutic health concepts differed depending upon the participants' training status. Professionals had more sophisticated EBs than students regarding both knowledge in physiotherapy (F(2, 164) = 6.74, P = 0.002, η(2)(p) = 0.08) and knowledge in medicine (F(2, 164) = 5.93, P = 0.003, η(2)(p) = 0.07). In addition, high values in a biopsychosocial therapeutic health concept already occurred in an early phase of training (F(2, 164) = 5.39, P = 0.005, η(2)(p) = 0.06), whereas increased values in a biomedical concept did not occur until people's professional life (F(2, 164) = 10.99, P < 0.001, η(2)(p) = 0.12). CONCLUSIONS: The specificities of personal EBs and therapeutic health concepts in different stages of health care training have so far been insufficiently considered in medical education research. The current study has aimed to shed light on the occurrence of these concepts in students as compared to professionals. We point out implications of our findings for educational practice and make suggestions for future research.