JMIR Publications

ABSTRACT

Background:

In medicine, the clinical decision-making process can be described using the dual- process theory consisting of the fast, intuitive System 1 commonly seen in seasoned physicians and the slow, deliberative System 2 associated with medical students. To date, limited literature exists on inducing System-1-type diagnosis in medical students.

Objective:

In this experimental study, we aim to (1) attempt to induce System-1-type diagnostic reasoning in inexperienced medical students through the acquisition of cognitive user interface heuristics and (2) understand the impact of clinical patient data visualizations on students' cognitive load and medical education.

Methods:

Participants were third- and fourth-year medical students recruited from the University of Pittsburgh School of Medicine who had completed 1+ clinical rotations. Students were presented eight patient cases on a novel EHR featuring a prominent data visualization designed to foster at-a-glance rapid case assessment and asked to diagnose the patient. Half of the participants were shown four of the eight cases repeatedly, up to four times with 30 seconds per case (Group A), and the other half of the participants were shown cases twice with two minutes per case (Group B). All participants were then asked to provide full diagnoses of all eight cases. Finally, participants were asked to evaluate and elaborate on their experience with the system.

Results:

Fifteen students participated. Participants in Group A scored slightly higher on average than participants in Group B, with a mean percentage correct of 0.76 (95% [0.68, 0.84]) vs 0.69 (95% [0.58, 0.80]) and spent on average 50% less time per question than Group B diagnosing patients (13.98 seconds vs 19.13 seconds, P = 0.03, respectively). When comparing the novel EHR design to previously-used EHRs, 73% of participants rated the new version on par or higher (3+/5). Ease of use and intuitiveness of this new system rated similarly high (mean score = 3.73/5 and 4.2/5, respectively). In qualitative thematic analysis of post-study interviews, most participants (n=11) spoke to “pattern-recognition” cognitive heuristic strategies consistent with System 1 decision-making.

Conclusions:

These results support the possibility of inducing Type-1 diagnostics in learners and the potential for data visualizations and user design heuristics to reduce cognitive burden in clinical settings. Clinical data presentation in the diagnostic reasoning process is ripe for innovation, and further research is needed to explore the benefit of using such visualizations in medical education. Clinical Trial: N/A