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Background: Enhanced diagnostic reasoning by medical students has a positive effect on learning diagnostic procedures. Decision support systems (DSS) are intended to support this process in the clinical phase of medical education. The aim was to explore both the use and usefulness of such a system, as well as adjustments needed for an optimal implementation in undergraduate medical training. Methods: Using a dispersive implementation strategy, fourth-year medical students (n=130) were given access to a DSS (DXplain) during the two-semester course in internal medicine. The students were asked to participate in an internet-based questionnaire survey at the end Results: A majority (61.8%) of the users found the system more or less useful, 41.8% found it relatively easy to use, and a majority (54.9%) would like to have future access to the system. However, the usage was limited, and several issues needed for an optimal implementation were found related to interface, logic, usefulness, accessibility and motivation. Conclusion: The DXplain system were more or less useful and relatively easy to use in undergraduate medical training, and the usage was limited using an dispersive implementation. An optimal implementation needs to be stricter including taking several aspects of usefulness into account, and a pronounced integration in theoretical and clinical phases of the education is needed to take advantage of its full potential in undergraduate medical training.
Czasopismo
Rocznik
Tom
Strony
287--305
Opis fizyczny
Bibliogr. 18 poz., rys.
Twórcy
autor
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
autor
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden
autor
- Department of Microbiology, Tumor and Cell Biology, Clinical Microbiology, Karolinska Institute, Stockholm, Sweden
autor
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
Bibliografia
- 1. Ellaway, R., & Masters, K. (2008). AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment. Medical Teacher, 30(5), 455-473. DOI: 10.1080/01421590802108331.
- 2. Barnett, G. O., Cimino, J. J., Hupp, J. A., & Hoffer, E. P. (1987). Dxplain: an evolving diagnostic decision-support system. Journal of the American Medical Association, 258, 67-74. DOI: 10.1001/jama.1987.03400010071030. tp://lcs.mgh.harvard.edu/projects/DXplain.html, 2012-03-30.
- 3. Feldman, M.J., & Barnett, G.O. (1991). An approach to evaluating the accuracy of DXplain. Computer Methods and Programs in Biomedicine, 35(4), 261-266. DOI: 10.1016/0169-2607(91)90004-D.
- 4. Hoffer, E.P., Feldman, M.J., Kim, R.J., Famiglietti, K.T., & Barnett, G.O. (2005). DXplain: Patterns of Use of a Mature Expert System. American Medical Informatics Association Annual Symposium Proceedings 2005, 321-325. DOI: 10.1234/12345678.
- 5. Berner, E. S., Webster, G. D., Shugerman, A. A., Jackson, J. R., Algina, J., Baker, A. L., Ball, E. V., Cobbs, C. G., Dennis, V. W., & Frenkel, E. P. (1994). Performance of four computer-based diagnostic systems. New England Journal of Medicine, 330(25), 1792-1796. DOI: 10.1056/NEJM199406233302506.
- 6. Berner, E.S., Jackson, J.R., & Algina, J. (1996). Relationships among performance scores of four diagnostic decision support systems. Journal of the American Medical Informatics Association, 3(3), 208–215. DOI: 10.1136/jamia.1996.96310634.
- 7. Elkin, P. L., Liebow, M., Bauer, B. A., Chaliki, S., Wahner-Roedler, D., Bundrick, J. Lee, M., Brown, S. H., Froehling, D., Bailey, K., Famiglietti, K., Kim., R., Hoffer, E., Feldman, M., Barnett, G. O. (2010). The introduction of a diagnostic decision support system (DXplainTM) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging Diagnostic Related Groups (DRGs). International Journal of Medical Informatics, 79, 772–777. DOI: 10.1016/j.ijmedinf.2010.09.004.
- 8. Garg, A. X., Adhikari, N. K., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., & Haynes, R. B. (2005). Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Journal of the American Medical Association, 293(10), 1223-38. DOI: 10.1001/jama.293.10.1223.
- 9. Coiera, E., Westbrook, J., & Wyatt, J. (2006). The safety and quality of decision support systems. Yearbook of Medical Informatics, 45, 20-25. DOI: 10.1160/TH07-05-0367.
- 10. Bauer, B. A., Lee, M., Bergstrom, L., Wahner-Roedler, D.L., Bundrick, J. Litin, S., Hoffer, E., Kim, R.J., Famiglietti, K., Barnett, G. O., & Elkin, P. L. (2002). Internal medicine resident satisfaction with a diagnostic decision support system (DXplain) introduced on a teaching hospital service. Proceedings of the American Medical Informatics Association Symposium 2002, 31-35.
- 11. Lincoln, M. J., Turner, C. W., Haug, P. J., Warner, H. R., Williamson, J. W., Bouhaddou, O., Jessen, S. G., Sorenson, D., Cundick, R. C., & Grant, M. (1991). Iliad training enhances medical students' diagnostic skills. Journal of Medical Systems, 15(1), 93-110. DOI: 10.1007/BF00993883
- 12. Grum, C.M., Miller, J.G., & Wolf, F.M. (1994). Computer-based problem solving for primary care diagnosis in an internal medicine clerkship. Academic Medicine, 69, 429-430.
- 13. Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: heuristics and biases. Science, 185, 1124-1131. DOI: 10.1126/science.185.4157.1124.
- 14. Malterud, K. (1998). Kvalitativa metoder i medicinsk forskning [Qualitative Methods in Medical Research]. Lund: Studentlitteratur.
- 15. Krippendorff, K. (2003). Content Analysis: An Introduction to Its Methodology. Beverly Hills: Sage Publications, Inc.
- 16. Weber, S., Crago, E.A., Sherwood, P. R., & Smith, T. (2009). Practitioner Approaches to the Integration of Clinical Decision Support System Technology in Critical Care. The Journal of Nursing Administration, 39(11), 465-469. DOI: 10.1097/NNA.0b013e3181bd5fc2.
- 17. Childs S., Blenkninopp E., Hall A., Walton G. (2005). Effective e-learning for health professionals and students – barriers and their solutions. A systematic review of the literature – findings from the HeXL project. Health Informatn and Libraries Journal. 22. 20–32. DOI: 10.1111/j.1470-3327.2005.00614.x
- 18. Kanthan, R., Senger, J.L. (2011) The impact of specially designed digital games-based learning in undergraduate pathology and medical education. Archives of Pathology and Laboratory Medicine. 135(1), 135-142.
Typ dokumentu
Bibliografia
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