Table 1
Instructional example of the SCT questions with the two different formats as provided to the respective groups in this study
|
Case scenario |
|
A mother of a 15-month-old boy visits your consulting hour because her son is crying all the time and has been agitated for two days now |
|
Hypothesis: Constipation |
|
Additional data: He is constantly tugging at his right ear |
|
With this new additional data the hypothesis: |
|
(Adapted instructions: ‘Take into account the differential diagnosis’) |
|
(Standard instructions: ‘Consider other diagnoses as excluded’) |
|
• Becomes more likely |
|
• Is not influenced |
|
• Becomes less likely |
|
For the groups with the adapted instructions the following was added: You may consider an inflammation of the ear as a likely diagnosis. As a consequence, the hypothesis ‘constipation’ will move to a lower position in your differential diagnosis. ‘Becomes less likely’ could therefore be your answer to this question |
|
For the groups with the standard instructions the following was added: You may consider an inflammation of the ear as a likely diagnosis. However, do not take this diagnosis into account when answering the question. Constipation in itself does not become more or less likely by the tugging at an ear. ‘Is not influenced’ could therefore be your answer to this question |
Table 2
Results for the SCT (for the students) with the two different instructions
|
Test with adapted instructions (include differential diagnosis when answering the questions) |
Test with standard instructions (exclude other diagnoses when answering the questions) |
p value | |
|---|---|---|---|
|
N = 29; 100 questions per test |
N = 30; 100 questions per test | ||
|
Mean score (SD) |
81.50 (3.80) |
82.94 (5.01) |
p = 0.220 (independent Student’s t test) |
|
Range: 5.76–100 test with adapted instructions, 5.92–100 test with standard instructions |
73.18–89.10 |
70.12–92.08 | |
|
Cronbach’s alpha |
0.388 |
0.655 | |
|
Mean number of confusion indications (SD) |
4.17 (4.42) |
16.70 (28.47) |
Mann–Whitney test Z U = −1,481 p = 0.139 |
|
Answer option ‘no influence’ chosen (% of all responses) |
23.3 % |
40.2 % |
p < 0.001 (independent Student’s t test) |