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.
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