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To investigate interrater reliability on categorical and dimensional judgments of personality disorder, five clinicians completed five different judgment tasks for each of 10 case vignettes. The reliability estimates support previously unconfirmed statements that dimensional judgments are substantially more reliable than categorical diagnoses.
A primary question that must be resolved in the development of tasks to assess the quality of physicians' clinical judgment is, "What is the outcome variable?" One natural choice would seem to be the correctness of the clinical decision. In this article, we use data on the diagnosis of urinary tract infections among young girls to illustrate why, in many clinical situations, this is not a useful variable. We propose instead a judgment weighted by the relative costs of an error. This variable has the disadvantage of requiring expert judgment for scoring, but the advantage of measuring the construct of interest.
Our objective was to study whether "compensatory" models provide better descriptions of clinical judgment than fast and frugal models, according to expertise and experience. Fifty practitioners appraised 60 vignettes describing a child with an exacerbation of asthma and rated their propensities to admit the child. Linear logistic (LL) models of their judgments were compared with a matching heuristic (MH) model that searched available cues in order of importance for a critical value indicating an admission decision. There was a small difference between the 2 models in the proportion of patients allocated correctly (admit or not-admit decisions), 91.2% and 87.8%, respectively. The proportion allocated correctly by the LL model was lower for consultants than juniors, whereas the MH model performed equally well for both. In this vignette study, neither model provided any better description of judgments made by consultants or by pediatricians compared to other grades and specialties.
In contingency judgment a primacy effect exists when a conclusion about the relationship between clinical variables is inordinately influenced by cases seen earlier rather than later in a presentation sequence. In this study, medical and nursing trainees evidenced this behavior in a hypothetical clinical judgment situation. The behavior was tied to an attention decrement explanation, by which inattention to the later-presented cases leads to inaccurate recall of the relative frequencies of observed cases, which in turn induces a misjudgment of a disease-finding contingency. An explicit intervention based on this hypothesis, forcing attention to later cases by warning that recall of the case frequencies would be required, was effective in reducing primacy effects among medical students. A related, but less explicit, intervention was also tried. This intervention did not significantly reduce primacy effects among nursing students, but was somewhat effective among general undergraduate students performing a non-clinical contingency judgment task.
OBJECTIVE: Compare U.K. and U.S. physicians' judgments of population probabilities of important outcomes of invasive cardiac procedures; and values held by them about risk, uncertainty, regret, and justifiability relevant to utilization of cardiac treatments. DESIGN: Cross-sectional study. SETTING: University hospital and VA medical center in the United States; two teaching hospitals in the United Kingdom. PARTICIPANTS: 171 housestaff and attendings at U.S. teaching hospitals; 51 physician trainees and consultants at U.K. hospitals. MEASURES: Judgments of probabilities of severe complications and deaths due to Swan-Ganz catheterization, cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG); judgments of malpractice risks for case vignettes; Nightingale's risk-aversion instrument; Gerrity's reaction-to-uncertainty instrument; questions about need to justify decisions; responses to case vignettes regarding regret. RESULTS: The U.S. physicians judged rates of two bad outcomes of cardiac procedures (complications due to cardiac catheterization; death due to CABG) to be significantly higher (p < or = 0.01) than did the U.K. physicians (U.S. medians, 5 and 3.5, respectively; U.K. medians 3 and 2). The median ratio of (risk of malpractice suit I error of omission)/(risk of suit I error of commission) judged by U.K. physicians, 3, was significantly (p=0.0006) higher than that judged by U.S. physicians, 1.5. The U.K. physicians were less often risk-seeking in the context of possible losses than the U.S. physicians (odds ratio for practicing in the U.K. as a predictor of risk seeking 0.3, p=0.003). The U.K. physicians had significantly more discomfort with uncertainty than did the U.S. physicians, as reflected by higher scores on the stress scale (U.K. median 48, U.S. 42, p=0.0001) and the reluctance-to-disclose-uncertainty scale (U.K. 40, U.S. 37, p < 0.0001) of the Gerrity instrument. There was no clear international difference in perceived need to justify decisions, or in regret. CONCLUSIONS: The results were not clearly consistent with the uncertainty hypothesis that international practice variation is due to differences in judged rates of outcomes of therapy or with the imperfect-agency hypothesis that practice variation is due to differences in physicians' personal values. The causes and implications of practice variations remain unclear.
Physicians' diagnoses of acute otitis media (AOM) and their treatment choices were investigated using judgment and decision-making analyses. Thirty-two pediatricians in the Albany, New York, area provided probability judgments of the presence of AOM and made treatment decisions for 32 patient vignettes, each described in terms of historical and examination variables. Their probability judgments were well predicted by linear combinations of the patient variables (R2s ranged from 0.76 to 0.97). Information about the observed condition of the eardrum proved to be most critical to the physicians' diagnoses. They demonstrated good levels of agreement on diagnoses. They varied, however, in their tendencies to treat with amoxicillin rather than another antibiotic. Case vagueness was related to the rate of antibiotic treatment. The rate of antibiotic treatment was higher for vague than for non-vague cases when the mean judged probability of AOM was low. In combination, the findings highlight the importance of performing and interpreting ear examinations and the role that consistent training may have in improving management of AOM.
If aesthetic aspects of art are objective and reside in the art, as Arnheim (1954) argues, then perceiving them may be akin to any other kind of reality testing. Further, if neurosis impairs reality testing, it would also impair aesthetic judgment, especially if aesthetic cues are vital and relevant to the human experience as Arnheim maintains. This hypothesis was investigated by administration of personality tests to measure neuroticism, especially Cattell's Sixteen Personality Factor Questionnaire (16PF), and art judgment tasks, especially Child's slide comparisons, to 105 University of Michigan undergraduates. The hypothesis was supported by a high negative correlation between the 16PF's neuroticism scale and art judgment, r = -.48; t(103) = -.5.61, p less than .0001. The results are discussed in terms of growth versus adjustment models of mental health, and the possible inhibiting role of verbalization over visualization in aesthetic perception.
Tversky and Kahneman's (1983) account of conjunctive probability judgment in terms of the representativeness heuristic is questioned. Instead, potential surprise (Shackle, 1969) is proposed as an important mechanism underlying subjective probability judgment. Study 1 reveals that, consistent with Shackle's theory, probabilities assigned to conjunctions are predominantly determined by the magnitude of the smaller component event probability. Also consistent with Shackle, Study 2 shows that for disjunctions, this role is performed by the larger component. Study 3 again contrasts the relative roles played by the component events in determining the value assigned to the conjunction. The results of the study are consistent with two reasoning processes: one analytically based, in which due account is taken of both component events, the other heuristic in nature and consistent with Shackle's theory of potential surprise. The implications of these results for a range of different types of judgment, e.g. with regard to person perception, stereotyping, categorization, and typicality, are evaluated.
Previous research on category activation effects demonstrates that extreme exemplar priming can lead to contrast effects as well as assimilation effects in target judgments. Two experiments extended this line of research by investigating the moderating role of perceived comparability, that is, the extent to which the exemplar and target are believed to belong to the same category and thus can be compared. In both experiments, participants judged the speed of a person displayed on a picture following priming with animals exemplifying either extreme speed ('cheetah') or extreme slowness ('turtle'). In addition, in the second experiment a behavioural measure was included. In the first experiment individual differences concerning the perceived comparability between animals and humans were assessed. In the second experiment perceived comparability was experimentally varied. Results showed that the direction of category activation effects (i.e. assimilation versus contrast) depended on the extent to which the prime and target categories were seen as comparable. Contrast effects on both judgments and behaviour emerged when the prime and the target category were perceived as comparable. However, assimilation effects on judgment and behaviour ensued when the prime and target category were not perceived as comparable.
The mandate of the U.S. Advisory Committee on Human Radiation Experiments required that the Committee take a position on the validity of retrospective moral judgments. However, throughout its period of operation, the Committee remained divided on the question of whether sound judgments of individual culpability and wrongdoing should be included in its Final Report. This essay examines the arguments that various committee members marshalled to support their opposing views on retrospective moral judgment and explains the significance of the controversy.
Findings that decision makers can come to different conclusions depending on the order in which they receive information have been termed the "information order bias." When trained, experienced individuals exhibit similar behaviors; however, it has been argued that this result is not a bias, but rather, a pattern-matching process. This study provides a critical examination of this claim. It also assesses both experts' susceptibility to an outcome framing bias and the effects of varying task loads on judgment. Using a simulation of state-of-the-art ship defensive systems operated by experienced, active-duty U.S. Navy officers, we found no evidence of a framing bias, while task load had a minor, but systematic effect. The order in which information was received had a significant impact, with the effect being consistent with a judgment bias. Nonetheless, we note that pattern-matching processes, similar to those that produce inferential and reconstructive effects on memory, could also explain our results. Actual or potential applications of this research include decision support system interfaces or training programs that might be developed to reduce judgment bias.
This was a cross-sectional study of the effects of age, sex, and moral dilemma content on adult moral reasoning. Hypothetical dilemmas were presented to sixty men and women, thirty of whom were elderly and thirty in early middle age. With education controlled there were no age or sex differences in moral maturity. Dilemma content had a significant effect on moral judgment, with a tendency for each age group to use a higher level of judgment when the situation described was age-appropriate, i.e., relevant to that group's stage of life. There was a significant age difference on a measure of spontaneous role taking: old persons made more definitive moral judgments than the younger adults, who attempted to reconcile the various points of view represented in a dilemma.
This study investigated altruistic moral judgment among the elderly, and examined its relationships to demographic and personality variables, self-reported helping, and subjective social integration (the perception that one is integrated into one's social milieu). The moral judgment interview included three stories, each of which contained a moral dilemma. Participants solved each dilemma and gave reasons for their solutions. The moral dilemmas and scoring system emphasized the positive, prosocial aspects of morality, rather than a prohibition-oriented approach. The categories used most often were, in descending order of frequency 1) pragmatic needs-of-others oriented reasons, 2) empathy-based reasons, 3) reasons based on internalized and/or abstract moral principles, and 4) hedonistic reasons. Of the higher levels of moral judgment, only reasoning based on abstract internalized principles had significant positive relationships with self-reported helping, the personality correlates of helping, and with subjective social integration into one's social milieu.
Two studies examined the role played by transient and sustained visual mechanisms in the determination of similarity judgments produced in response to pairs of geometrical stimuli. In two experiments, subjects were trained to attend to two dimensions of a set of stimuli and to assign similarity ratings with respect to those two dimensions only. An INDSCAL multidimensional scaling analysis of the subsequent similarity ratings showed that subjects emphasized global blob, or low spatial frequency-dependent, dimensions of the stimuli when they were presented for brief durations (20 msec.), irrespective of the dimensions to which the subjects and had been trained to attend. This finding suggested that low spatial frequency selective transient mechanisms dominated the perceptual processes which underlie the similarity judgments. When the stimulus duration was raised to 50 msec. so that sustained mechanisms could also make a signficicant contribution to the perceptual processes underlying the similarity judgments, subjects emphasized only those dimensions on which they had been trained. The implications of the present findings for the concepts of selective attention and automatic activation were discussed.
The purpose of the present experiment was to examine the role of familiar size in judgments of size and egocentric distance under natural (non-reduced) viewing conditions. Independent groups (ns = 14) judged normal and large off-size chairs and control objects presented at a distance of 25.6 m. Subjects also judged the size of unfamiliar objects (adjacent stimuli) attached to the chairs and stakes. The results indicate that the effects of familiar size are specific to spatial judgments of the familiar object itself since judgments of the adjacent stimuli were unaffected by familiar size.
Temporal imbalances between the successive stimulation of pairs of loci on each forearm altered judgments of the equality of the spatial extents between sets of loci. The spatial judgments became increasingly inaccurate as the temporal imbalance was increased, i.e., the Tau effect. Changes in stimulus intensity also influenced the dependency of spatial judgments on temporal factors. The data suggest that concomitant variations of spatial, temporal, and intensitive components of a vibrotactile stimulus "package" can produce systematic perceptual effects of potential significance in the design of vibrotactile sensory substitution systems.
Two groups of subjects judged the lengths of component parts of either an abstract representation of the human body form or a control figure lacking any body-like resemblance. Although subjects recognized the abstract figure as a human body the pattern of errors in judgments of length of the component parts failed to replicate the well established error pattern obtained in judgments of length of actual human body-parts. The results are discussed with respect to the hypothesis that recognition of a stimulus as human body is the critical determinant of the pattern of errors in judgments of lengths of body-parts.
The aim of the experiment was to study the relation between accuracy of judgment of facial expressions of emotions and time for judgment. The results for 34 college students confirmed previous data showing high performance in identification of all emotions, although there were some important differences between emotions. Also, times for judgment were longer for the emotions which were more difficult to identify.