Yanagita Yasutaka, Shikino Kiyoshi, Yokokawa Daiki, Ishizuka Kosuke, Tsukamoto Tomoko, Li Yu, Uehara Takanori, Ikusaka Masatomi
Department of General Medicine, Chiba University Hospital, Chiba, Japan.
Department of Community-Oriented Medical Education, Chiba University School of Medicine, Chiba, Japan.
BMC Med Educ. 2025 May 15;25(1):711. doi: 10.1186/s12909-025-07294-5.
The role of appropriate semantic qualifiers (SQs) in the effective use of a clinical decision support system (CDSS) is not yet fully understood. Previous studies have not investigated the input. This study aimed to investigate whether the appropriateness of SQs modified the impact of CDSS on diagnostic accuracy among medical students.
For this randomized controlled trial, a total of forty-two fifth-year medical students in a clinical clerkship at Chiba University Hospital were enrolled from May to December 2020. They were divided into the CDSS (CDSS use; 22 participants) and control groups (no CDSS use; 20 participants). Students were presented with ten expert-developed case vignettes asking for SQs and a diagnosis. Three appropriate SQs were established for each case vignette. The participants were awarded one point for each SQ that was consistent with the set SQs. Those with two or more points were considered to have provided appropriate SQs. The CDSS used was the Current Decision Support. We evaluated diagnostic accuracy and the appropriateness of SQ differences between the CDSS and control groups.
Data from all 42 participants were analyzed. The CDSS and control groups provided 133 (60.5%; 220 answers) and 115 (57.5%; 200 answers) appropriate SQs, respectively. Among CDSS users, diagnostic accuracy was significantly higher with appropriate SQs compared to inappropriate SQs (χ(1) = 4.97, p = 0.026). With appropriate SQs, diagnostic accuracy was significantly higher in the CDSS group compared to the control group (χ(1) = 1.16 × 10, p < 0.001). With inappropriate SQs, there was no significant difference in diagnostic accuracy between the two groups (χ(1) = 8.62 × 10, p = 0.769).
Medical students may make more accurate diagnoses using the CDSS if appropriate SQs are set. Improving students' ability to set appropriate SQs may improve the effectiveness of CDSS use.
This study was registered with the University Hospital Medical Information Network Clinical Trials Registry on 24/12/2020 (Unique trial number: UMIN000042831).
恰当的语义限定词（SQ）在临床决策支持系统（CDSS）有效使用中的作用尚未得到充分理解。以往研究未对输入内容进行调查。本研究旨在探讨SQ的恰当性是否会改变CDSS对医学生诊断准确性的影响。
在这项随机对照试验中，于2020年5月至12月招募了千叶大学医院42名正在进行临床实习的五年级医学生。他们被分为CDSS组（使用CDSS；22名参与者）和对照组（不使用CDSS；20名参与者）。向学生展示了十个由专家编写的病例 vignette，要求提供SQ并做出诊断。为每个病例 vignette 设定了三个恰当的SQ。与设定的SQ一致的每个SQ，参与者可得一分。获得两分或更多分的人被认为提供了恰当的SQ。所使用的CDSS是当前决策支持系统。我们评估了CDSS组和对照组之间的诊断准确性以及SQ差异的恰当性。
对所有42名参与者的数据进行了分析。CDSS组和对照组分别提供了133个（60.5%；共220个回答）和115个（57.5%；共200个回答）恰当的SQ。在CDSS使用者中，与不恰当的SQ相比，恰当的SQ下诊断准确性显著更高（χ(1) = 4.97，p = 0.026）。在恰当的SQ下，CDSS组的诊断准确性显著高于对照组（χ(1) = 1.16 × 10，p < 0.001）。在不恰当的SQ下，两组之间的诊断准确性没有显著差异（χ(1) = 8.62 × 10，p = 0.769）。
如果设定恰当的SQ，医学生使用CDSS可能会做出更准确的诊断。提高学生设定恰当SQ的能力可能会提高CDSS使用的有效性。
本研究于2020年12月24日在大学医院医学信息网络临床试验注册中心注册（唯一试验编号：UMIN000042831）。
