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Table 2 Proportions of correct and incorrect answers for the 28 key feature items, calculated across the two e-seminars, and exit exam and the retention test

From: How can we teach medical students to choose wisely? A randomised controlled cross-over study of video- versus text-based case scenarios

Diseases Key features (Items) Proportion of correct answers Frequent or relevant incorrect answers (proportion)
Pulmonary embolism Diagnosis of pulmonary embolism 58.6% Acute coronary syndrome (8.0%); aortic dissection (3.9%)
Wells Score to assess likelihood of PE 74.0% Assessment of hemodynamic stability (5.2%)
Thorax CT scan to confirm PE in a patient with high clinical probability 50.0% Thrombolysis without confirmation (17.7%); other imaging (9.7%); D-dimer testing (9.7%)
Right ventricular strain for risk stratification 51.9%  
Fibrinolysis for unstable pulmonary embolism 66.6% Other medical treatment (10.2%)
Arterial hypertension Diagnosis of secondary hypertension 49.6% Essential hypertension (11.5%); cardiac disease (10.4%)
Diagnosis of diastolic dysfunction 17.5% Other myocardial disease (60.8%)
Discontinuation of ACE inhibitors due to typical cough 93.7%  
Hyponatremia Hospital admission for chronic symptomatic hyponatremia 70.5% Rapid sodium supplementation (11.0%)
Thiazide diuretics as cause of hyponatremia 83.0% Hypovolemia (3.4%)
Diagnosis of central pontine myelinolysis following rapid sodium supplementation 64.9% Cerebral oedema (13.6%)
Atrial fibrillation Orthostatic challenge after syncope 72.5% Tilt testing (22.8%)
ECG diagnosis of tachyarrhythmia 61.8% Conduction blocks (13.7%); myocardial infarction (1.9%)
CHA2DS2-VASc score for anticoagulation 83.6%  
Lupus erythematosus Diagnosis of nephrotic syndrome 80.3% Nephritic syndrome (8.0%)
Diagnosis of systemic lupus erythematosus 83.8% Non-specific glomerulonephritis (4.3%)
Renal biopsy to confirm lupus nephritis 79.8% Imaging (4.6%)
COPD Diagnosis of COPD 91.1%  
Confirmation of COPD by FEV1/VC < 70% 64.7% FEV1 (13.6%); FEV1/VC % predicted (15.8%)
ABG analysis for suspected CO2 intoxication 67.2% Imaging (7.2%)
Treatment of CO2 intoxication by non-invasive ventilation 53.3% Oxygen (16.9%); CPAP (11.4%); buffering (6.7%)
Pneumonia Diagnosis of left apical pneumonia in a chest X-ray 72.8% Incorrect or no localisation (23.3%)
Decision on hospitalisation based on the CRB-65 score 75.9% Decision based on additional laboratory tests (5.6%)
Hyperthyroidism Diagnosis of hyperthyroidism from lab results 88.8% Hypothyroidism (4.1%)
Stopping amiodarone in a pt. with hyperthyroidism 66.2% other medical (11.4%) or surgical (5.7%) treatment
Pulmonary fibrosis Diagnosis of pulmonary fibrosis 53.8% Pulmonary oedema (12.5%); pneumonia (9.4%)
Amiodarone as cause of pulmonary fibrosis 78.9% Atrial fibrillation (4.8%)
Indication for long-term oxygen therapy 47.6% Mechanical ventilation (24.2%)
  1. ABG arterial blood gases, ACE angiotensin converting enzyme, CAD coronary artery disease, CHA2DS2-VASc congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65–74, and sex category (female), CO2 carbon dioxide, COPD chronic obstructive pulmonary disease, CPAP continuous positive airway pressure, CRB confusion/respiratory rate/blood pressure, CT computed tomography, ECG electrocardiogram, FEV1 forced expiratory volume in 1 s, NIV non-invasive ventilation, PAD peripheral artery disease, PE pulmonary embolism, VC vital capacity
  2. Italics indicate the key feature assessed in each item; answers that were frequently entered instead of these are shown in the last column of the table