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In seven judgement situations, the GP was uncertain about the diagnosis.
Each of the 15 GPs judged 6 case vignettes, which resulted in 90 judgement situations.
However, in a third of the judgement situations, no information about echocardiography was utilized in the general practitioners' diagnostic reasoning.
In three judgement situations, the final diagnosis was in the same direction as the X-ray argument (three CHF).
In our study, the GPs used other diseases as an argument in a total of 70 judgement situations, mostly as arguments for CHF (91%).
However, in more than one third of the judgement situations, the information about ECHO that was presented was not used as an argument.
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The ejection fraction is often considered a gold standard in heart failure diagnostics, and the fact that it was not included as a variable in the case vignettes might have made the judgement situation difficult for some of the participants.
The present paper discusses a safety monitoring system design that has gray zone output, in which the gray zone output expresses no judgement for uncertain situations.
Multiple studies from the fields of psychology and auditing show that people's judgement about current situations are influenced by earlier experiences, perceptions about the history and the future, recent failures or successes and their situation compared to others [ 24, 25].
Students use the interactive nature of simulations to develop arguments, make judgements and evaluate situations.
The process is only akin to reflective equilibrium because the individual cases (the equivalent of the specific judgements about particular situations) are either immune from revision, or are highly resistant to revision.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com