Limitations
’ complaints
MAY, DISEASES
This study has several limitations. First, it was conducted at a single institution, and the results might not be generalizable as the proficiency levels of students and residents were not assessed. Second, as the allocation to the three groups could not be blinded for participants and faculty members, subjective bias may have affected the results. Third, the case questions were set with reference to diseases as defined in the attainment objectives of clinical training provided by the Ministry of Health, Labour and Welfare and the National Medical Examination. From the viewpoint of difficulty level, it is possible that the diagnoses could have been made quickly using the CDSS based on specific symptoms. Moreover, we did not verify the usefulness of the CDSS in more complex cases. Fourth, as the study period was from May to December, there may be differences in clinical exposure and training between those who participated in the first and second half of the study. Fifth, as there was no set response time for answering the cases, it is difficult to determine whether the CDSS and Google groups spent more time using the system or pondering each question to explain their longer response times than the control group. Finally, the case questions were described in medical terms so that the symptoms could be easily grasped and retrieved. These questions differed from patients’ complaints in actual clinical practice, which in turn require practitioners/students to convert the patients’ complaints into medical terms that can be searched using the CDSS; this conversion process may lead to errors. It is essential to be able to extract appropriate keywords and verify whether these can be converted into medical terms and retrieved.