A Clinical Decision Support System for AF Thromboprophylaxis: Its Impact on Residents' Learning and Confidence in Clinical Decision-Making.

Rationale

Mobile health (mHealth) offers a modern educational approach for delivering behavioural interventions and enhancing healthcare professionals' knowledge, particularly through technology-enhanced tools like clinical decision support systems (CDSS). Given the complexity of AF thromboprophylaxis-balancing thromboembolic/bleeding risk, comorbidities, considering lab data, and drug interactions such tools are critical, as evidence-based thromboprophylaxis reduces both stroke risk and mortality.

Aims

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Objectives

This study aimed to examine changes in clinical pharmacy and cardiology residents' performance on case-based multiple-choice questions (MCQs) related to AF thromboprophylaxis and their self-reported confidence in their responses following exposure to the ACAFiB CDSS.

Methods

Using a quasi‑experimental pre‑test/post‑test design, the ACAFiB web‑based CDSS was assessed for its potential to assist in improving learning and confidence. Fifteen complex clinical scenarios in multiple‑choice format were used for the pre‑test, and another 15 thematically similar scenarios were used for the post‑test. Thirty‑one residents participated in two exams, 1 week apart. During the pre‑test, participants could search freely, whereas in the post‑test, they were restricted to using only ACAFiB. They also reported their confidence level for each response.

Results

Test scores increased from 7.06 ± 2.08 to 10.74 ± 2.11 (p < 0.001; effect size: 1.71), and confidence-weighted scores increased from 0.71 ± 10.05 to 17.90 ± 10.52 (p < 0.001; effect size: 1.43) following ACAFiB exposure. These findings indicate improved performance on the case-based assessment and higher confidence-weighted scores after use of the CDSS. No significant differences were observed between residents based on specialty, residency entry year, or gender.

Conclusion

In conclusion, this study suggests that the use of the ACAFiB CDSS is associated with improvements in residents' clinical decision-making performance and confidence in managing thromboprophylaxis for AF patients. Future studies should evaluate the tool's effectiveness using patient‑centred outcomes.