Medical Students' Attitudes Toward AI in Medicine and their Expectations for Medical Education.

Objectives: Artificial intelligence (AI) is used in a variety of contexts in medicine. This involves the use of algorithms and software that analyze digital information to make diagnoses and suggest adapted therapies. It is unclear, however, what medical students know about AI in medicine, how they evaluate its application, and what they expect from their medical training accordingly. In the study presented here, we aimed at providing answers to these questions. Methods: In this survey study, we asked medical students about their assessment of AI in medicine and recorded their ideas and suggestions for considering this topic in medical education. Fifty-eight medical students completed the survey. Results: Almost all participants were aware of the use of AI in medicine and had an adequate understanding of it. They perceived AI in medicine to be reliable, trustworthy, and technically competent, but did not have much faith in it. They considered AI in medicine to be rather intelligent but not anthropomorphic. Participants were interested in the opportunities of AI in the medical context and wanted to learn more about it. They indicated that basic AI knowledge should be taught in medical studies, in particular, knowledge about modes of operation, ethics, areas of application, reliability, and possible risks. Conclusions: We discuss the implications of these findings for the curricular development in medical education. Medical students need to be equipped with the knowledge and skills to use AI effectively and ethically in their future practice. This includes understanding the limitations and potential biases of AI algorithms by teaching the sensible use of human oversight and continuous monitoring to catch errors in AI algorithms and ensure that final decisions are made by human clinicians.

Social identities and the achievement gap: Incompatibility between social class background and student identity increases student disidentification, which decreases performance and leads to higher dropout rates.

Education is not equally distributed across all people. It has often been found that students from low social class background have lower access to universities, less academic achievement and higher dropout rates compared with their peers (called the 'achievement gap'). We investigate how the student social identity contributes to the emergence of the achievement gap and focus on student disidentification, a negative internalized relation to the in-group. We predict that disidentification reduces academic performance (Hypothesis 1) and increases university dropout rates (Hypothesis 2). Moreover, we predict that social class background affects identity incompatibility which, in turn, increases student disidentification (Hypothesis 3). We explore whether social class background affects long-term identity incompatibility, or whether identity incompatibility affects long-term disidentification by comparing two mediation models. Hypotheses 1 and 3 were supported cross-sectionally in a large sample (N = 2768), and longitudinally in a sub-sample 1.5 years later (N = 591). The data demonstrate that social class background has a long-term effect on incompatibility, which is related to disidentification. Hypothesis 2 was also supported in a (partly overlapping) sub-sample (N = 1077). The current research demonstrates that students with low social class background suffer from identity-related adaptation problems that affect their academic trajectories.

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.

Collectively biased representations of the past: Ingroup Bias in Wikipedia articles about intergroup conflicts.

Individuals tend to present their own group (the ingroup) in a systematically more favourable way (ingroup bias). By examining socially negotiated and publicly accessible Wikipedia articles about intergroup conflicts, we investigated ingroup bias at a collective level. Specifically, we compared articles about the same intergroup conflicts (e.g., the Falklands War) in the corresponding language versions of Wikipedia (e.g., the Spanish and English Wikipedia articles about the Falklands War). Study 1 featured a content coding of translated Wikipedia articles by trained raters, which showed that articles systematically presented the ingroup in a more favourable way (e.g., Argentina in the Spanish article and the United Kingdom in the English article) and, in reverse, the outgroup as more immoral and more responsible for the conflict. These findings were replicated and extended in Study 2, which was limited to the lead sections of articles but included considerably more conflicts and many participants instead of a few trained coders. This procedure allowed for separate analyses for each conflict, which showed considerable variance in the results pattern with a stronger ingroup bias for (1) more recent conflicts and (2) conflicts in which the proportion of ingroup members among the top editors was larger. Finally, a third study ruled out that these effects were driven by translations or the raters' own nationality. Therefore, this paper is the first to demonstrate ingroup bias in Wikipedia - a finding that is of practical as well as theoretical relevance as we outline in the discussion.

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.

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.

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).

Attitude confidence and source credibility in information foraging with social tags.

There is growing concern that online information searchers are overconfident and therefore largely search for information which reinforces their prior attitudes, blinded by confirmation bias. This study tests if this effect can be reduced in content aggregation platforms, when social tag clouds show popular topics among experts. We manipulated (1) confidence in prior attitudes, and (2) the credibility of the expert community that tagged the content. We found that both factors influence navigation in different ways. First, attitude confidence moderated the influence of prior attitudes when choosing how much attitude-consistent content in blog posts to read. When attitude confidence was high, prior attitudes were positively associated with selection of blog posts, when low, not positively associated. After navigation, when confidence was high, the content of attitude-consistent blog posts was more favourably evaluated, whereas when confidence was low, attitude inconsistent blog posts were more favourably evaluated. Second, source credibility moderated the influence of prior attitudes on tag selection. When source credibility was low, prior attitudes did guide tag selection, when high, they did not. With low source credibility, people selected more attitude-consistent content. The findings advance social tagging theories by showing that not only semantic associations, but also attitudes play a role when people select and process tags and related content. The findings also show that credibility and confidence have a different impact on different stages of information selection and evaluation. Whereas credibility is more important when switching among pages, attitude confidence is more important when reading and evaluating the content of one page.

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.

Is there hindsight bias without real hindsight? Conjectures are sufficient to elicit hindsight bias.

After learning about an event, people often mistakenly believe to have predicted what happened all along (hindsight bias). However, what if what has happened is not known, but subject to conjecture? Could conjectures, in the absence of knowledge about the event, elicit the same bias and make people believe they "conjectured it all along", too? We examined this question in 2 studies. Immediately after the disappearance of flight MH370 in March, 2014, we asked N = 432 individuals about the likelihood of a number of possible events. One year later, N = 100 of these individuals participated again and were randomly assigned to 2 experimental conditions. Participants in the current conjecture group answered the same questions from their current perspective, participants in the reproduced conjecture group were asked to reproduce their earlier estimates. Results show that conjectures had changed over time and affected participants' reproductions of their earlier estimates. We replicated this finding in a controlled lab experiment (N = 94) and found a comparable magnitude of conjecture-based and knowledge-based hindsight bias. These findings demonstrate hindsight distortions in the absence of definite knowledge and extend theoretical assumptions about the prerequisites of hindsight bias in the context of events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Online peer consulting for health professionals.

BACKGROUND: Many health care professionals specialise in particular medical fields. Nevertheless, they often encounter patients with other indications for which they have only limited experience. In such situations it is helpful to consult colleagues who have specialised in the respective areas. The Internet provides the opportunity to connect with other specialists that can be used for peer consulting. We argue that health professionals should learn to make use of online peer consulting during vocational training. METHODS: We used an open-source platform that provided the opportunity to chat and upload documents. We recruited 45 first-year physiotherapy students as participants. The training for online peer consulting was integrated into courses where students were taught basic principles of gait analysis and learned how to document the findings of their examinations. Subsequently, the students evaluated the course and the online collaboration. FINDINGS: Students were highly motivated to use the online platform and perceived the online peer consulting and the atmosphere of collaboration on the platform to be very positive. In addition, students had a significant increase in content knowledge and were more confident in their own knowledge than they were before the online peer consulting. DISCUSSION: It seems appropriate to provide training for giving and gathering online peer feedback. This opportunity, provided at an early stage of training, could help prepare students for continuing co-operative exchange in their professional lives. Health care professionals should learn how to gather information from colleagues and how to provide adequate feedback.

Therapeutic Touch in Exercise Videos: A Randomized Experiment of the Impact on the Evaluation of Therapists' Competence and Viewers' Self-Reliance.

From a psychological health perspective, being physically touched is highly relevant throughout people's lives. Touch plays an important role in many contexts, such as in instructing movement exercises. Exercise videos have become a well-accepted format to support therapists in instructing movement exercises. In the study presented here we examined the impact of the use of therapeutic touch in exercise videos on people's evaluation of physiotherapists' competence and on their own self-reliance. In a between-group randomized experiment, 125 participants watched one of three videos that showed a physiotherapist who instructed a movement exercise to a patient. The physiotherapist touched the patient during the treatment (therapist-touch, TT), instructed the patient to use self-touch (ST), or provided only exercise instruction without physical touch (no-touch, NT). In the TT condition, the participants' perception was that the physiotherapist exhibited more professional competence. However, participants considered the movement exercise in this TT condition to have less potential for fostering their autonomy. Finally, participants in the ST condition had the biggest increase in perceived self-efficacy. The way of touching a patient in an exercise video influences the perception of the treatment. We conclude that therapeutic touch should be applied in exercise videos in a goal-oriented way: It seems appropriate to use ST if the aim is to strengthen viewers' self-reliance and to use TT to arouse trust in the competence of the therapist.

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.

Ubiquitous Working: Do Work Versus Non-work Environments Affect Decision-Making and Concentration?

New communication technologies and mobile devices have enabled knowledge workers to work independently of location and in more than one fixed environment (ubiquitous working). Previous research shows that physical environments can influence cognition and work performance. We manipulated environment (i.e., a virtual office as a typical work environment compared to a virtual garden as a non-work environment) and time pressure (i.e., inducing time pressure vs. no time pressure) in order to investigate whether the environment influences decision-making and concentration. N = 109 students participated in this laboratory experiment. We posited (a) that a work environment would activate a work-related schema which in turn would enhance concentration performance and make decisions more risky compared to non-work environments and (b) that the environmental effect is more pronounced if time pressure is present compared to conditions where no time pressure is present. We found modest hypothesis-confirming main effects of environment on decision-making and concentration but no interaction effect with time pressure. As we used an innovative methodology that entails several limitations, future research is needed to give insights into the process and to investigate whether results hold true for all types of work settings, work demands, or work activities.

Neither fish nor fowl: A perceived mismatch in norms and values between oneself, other students, and people back home undermines adaptation to university.

Students from low social-class background often struggle to adapt to university. Previous research shows that perceived incompatibility between social-class background identity and student identity is one reason, but little is known about the underlying causes of identity incompatibility. In three studies, we expected and found that students with low subjective social-class background perceived their values differently from other students, but also differently from people back home, and both increased identity incompatibility. Identity incompatibility negatively affected the student identity. Additionally, the current research also identifies specific patterns of norm and value differences that are prone to perceived identity incompatibility. The findings demonstrate that perceived differences in values from both groups are important mechanisms for identity incompatibility induced by the transition to university that may affect student identities and potentially their university trajectories.

Spatial Presentations, but Not Response Formats Influence Spatial-Numerical Associations in Adults.

According to theories of embodied numerosity, processing of numerical magnitude is anchored in bodily experiences. In particular, spatial representations of number interact with movement in physical space, but it is still unclear whether the extent of the movement is relevant for this interaction. In this study, we compared spatial-numerical associations over response movements of differing spatial expansion. We expected spatial-numerical effects to increase with the extent of physical response movements. In addition, we hypothesized that these effects should be influenced by whether or not a spatial representation of numbers was presented. Adult participants performed two tasks: a magnitude classification (comparing numbers to the fixed standard 5), from which we calculated the Spatial Numerical Association of Response Codes (SNARC) effect; and a magnitude comparison task (comparing two numbers against each other), from which we calculated a relative numerical congruity effect (NCE), which describes that when two relatively small numbers are compared, responses to the smaller number are faster than responses to the larger number; and vice versa for large numbers. A SNARC effect was observed across all conditions and was not influenced by response movement extent but increased when a number line was presented. In contrast, an NCE was only observed when no number line was presented. This suggests that the SNARC effect and the NCE reflect two different processes. The SNARC effect seems to represent a highly automated classification of numbers as large or small, which is further emphasized by the presentation of a number line. In contrast, the NCE likely results from participants not only classifying numbers as small or large, but also processing their relative size within the relevant section of their mental number line representation. An additional external presentation of a number line might interfere with this process, resulting in overall slower responses. This study follows up on previous spatial-numerical training studies and has implications for future spatial-numerical trainings. Specifically, similar studies with children showed contrasting results, in that response format but not number line presentation influenced spatial-numerical associations. Accordingly, during development, the relative relevance of physical experiences and presentation format for spatial-numerical associations might change.

The Impact of Visualization Format and Navigational Options on Laypeople's Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey.

BACKGROUND: Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes. OBJECTIVE: We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients' knowledge gain, emotions, attitude, and hypothetical decision-making ability. METHODS: In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation. RESULTS: In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options. CONCLUSION: Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN).