Discussion
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DISEASE, PATHOLOGY, DISEASES, RARE DISEASES
Our aim was to evaluate students’ diagnostic accuracy and trust in their diagnoses using conventional methods and a CDSS in two clinical scenarios with different degrees of difficulty. When a common disease presenting with typical signs and symptoms was concerned, students reached a very high level of diagnostic accuracy close to 100%. In the case of a common disease presenting in an atypical way, students’ accuracy decreased substantially. In both scenarios, we found no significant difference in accuracy when students used conventional methods or relied on the output of the CDSS. This result leads us to refute our original hypothesis that students would come to more accurate diagnoses when they use conventional methods as compared to the use of a CDSS.Obviously, between the two cases there was a relevant difference in students' trust in their own diagnoses: in the typical case condition, students exhibited higher trust in their diagnoses while in the atypical case trust was much lower. But, in sharp contrast to the very high accuracy with which they solved the typical case students had much less trust in their own diagnosis. Conversely, for the case with the atypical presentation, average accuracy ratings paralleled average trust ratings. In addition, we also observed another slight, though not statistically significant, influence on the students’ trust in their diagnoses: the latter was lower when the CDSS was used first for the typical case and higher when they used the CDSS first in the atypical case.Our findings suggest that students' diagnostic accuracy in common diseases is strongly influenced by the presence of typical signs and symptoms and less channelled by technological support. The accuracy observed in the typical case indicates that students have the ability to correctly diagnose a textbook-like presentation with which they are familiar. In contrast, their diagnostic performance declines when confronted with an atypical presentation, even of a common disease. This observation highlights the challenges students face in recognising uncommon manifestations of common diseases.We can show that the CDSS did not provide a particular help to improve students' ability to come to accurate diagnostic conclusions. However, the CDSS may play a notable role in enhancing students' trust and confidence especially when students are confronted with more complex cases. In these scenarios the CDSS may act almost like a second opinion and as a source of reassurance which gives students greater confidence in their own diagnostic decision-making process. In this sense the use of the CDSS may offer valuable psychological support as a tool to boost students' confidence and decision-making skills. Therefore, it would be helpful in the future to explore more the psychological and educational impacts of CDSS in different diagnostic scenarios and with larger sample sizes. Additionally, our study provides in an exemplary fashion how an experimental set-up could work to assess other dimensions of student`s diagnostic accuracy, i.e. rare diseases or diagnoses in morphological fields such as radiology or pathology.Hitherto, the focus of the research revolving around supporting devices for medical decision-making has almost exclusively addressed rare diseases or challenging and unusual clinical constellations [Also, we consider it to be a particular strength of our study that we did not measure diagnostic accuracy in a dichotomous way that only differentiates between correct or incorrect. To refine our results we developed a scale ranging from 1 to 5 based on Ramnarayan et al. [