Table 1
Diagnoses of the cases used in the different phases of the study
|
Learning phase |
Test phase |
|---|---|
|
– |
Case 2.0 —Stomach cancer (Filler) |
|
Case 1.1—Acute myocardial infarction with heart failure |
Case 2.1—Chronic CAD, with decompensated heart failure by anaemia |
|
Case 1.2—Community-acquired pneumonia (Filler) |
Case 2.2—Acute pyelonephritis (Filler) |
|
Case 1.3—Aortic stenosis with heart failure |
Case 2.3—Chronic mitral insufficiency with secondary heart failure |
|
Case 1.4—Nephrotic syndrome (Filler) |
Case 2.4—Meningoencephalitis (Filler) |
|
Case 1.5—Hypertensive cardiomyopathy |
Case 2.5—Hypertensive cardiomyopathy |
|
Case 1.6—Acute viral hepatitis (Filler) |
Case 2.6—Acute appendicitis |
|
Case 1.7—Alcoholic cardiomyopathy |
Case 2.7—Viral myocarditis |
|
– |
Case 2.8—Rheumatoid arthritis (Filler) |
Table 2
A case of acute myocardial infarction with heart failure
|
A 59-year-old businessman presents in the emergency department with severe dyspnoea. For the last 2 months, the patient has noted increasing shortness of breath: at first on climbing the stairs, and since last week at the least effort. The last two nights were particularly difficult, the patient experiencing shortness of breath even when lying down which forced him to sleep sitting up in a chair. He did not notice any cough or sputum. He used a salbutamol inhaler, which he uses as needed for asthma, without result. In the last 24 h he has also noted 4–5 episodes of tightness of the chest, of moderate intensity, lasting 5 to 10 min. No palpitations or syncope. He had a cold last week, which resolved spontaneously. Medical history: Hypertension for some 20 years, apparently well controlled with diltiazem 240 mg daily. Seasonal asthma, for which he periodically takes steroids, using a dosing inhaler, and salbutamol. The patient smokes ½ pack of cigarettes/day; he reports a healthy diet | |
|
Physical examination: |
BP 100/60, steady pulse 105/min; the patient is clammy; RR 28/min, dyspnoea at rest with saturation of 88% on arrival—ambient air—and 92% using nasal cannula at 2 l/min; oral temperature 36.5. Jugular veins not distended. Heart sounds are normal, with presence of a B3. Presence of a systolic murmur noted, 2/6 at the apex radiating towards the armpit. On pulmonary examination, crackles noted bilaterally in the lower thirds and wheezes noted on expiration. The abdomen is normal. The lower limbs are normal |
|
Laboratory results: |
Blood count, electrolytes, creatinine and glycaemia are normal. The ECG shows q waves (inferior) and inversion of the T wave from V2 to V6 with displacement of 2 mm in V3, V4, V5. Elevated troponins, 0.12. Chest X‑ray showed perihilar haze, septal lines and a slight right pleural effusion |
Table 3
Means and standard deviations of diagnostic accuracy scores under the conditions of the experiment (self-explanation versus hypothetico-deduction) for male and female participants
|
Experimental condition |
Mean |
Standard deviation |
N |
|---|---|---|---|
|
Hypothetico-deduction |
0.22 |
0.14 |
45 |
|
Self-explanation |
0.17 |
0.12 |
43 |
|
Total |
0.20 |
0.13 |
88 |