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PubMedDate not supplied

Diagnostic judgments of nurse practitioners providing primary gynecologic care: a quantitative analysis.

OBJECTIVES: To determine the accuracy of experienced nurse practitioners' judgments of the probability of chlamydial infection of the cervix, to identify the clinical factors ("cues") related to the judgments, and to discern likely sources of judgment error. DESIGN: Cross-sectional study with prospective data collection. SETTING: Urban hospital-based clinic. PATIENTS: 492 nonpregnant women receiving primary gynecologic care. INTERVENTIONS: Four nurse practitioners recorded clinical data, tested women for chlamydial infection, and judged the probability of chlamydial infection using six categories: less than 1%, 1-4%, 5-9%, 10-24%, 25-50%, and greater than 50%. MEASUREMENTS AND MAIN RESULTS: Chlamydial infection was detected by immunofluorescent assay in 31 (6%) of the 492 women. Although the median probability judgment was 5-9%, judgments were only weakly related (p = 0.08) to actual rates of infection. In a multivariate analysis, eight clinical cues were independently (p less than 0.05) related to nurse practitioners' probability judgments: age less than 20 years; past chlamydial or gonococcal infection; new sex partner; partner with suspected genital infection; genito-urinary symptoms; cervicitis, purulent vaginal discharge; and malodorous vaginal discharge. A linear model based on the eight cues, weighted according to their regression coefficients, predicted chlamydial infection more accurately than did the nurse practitioners' actual judgments (ROC curve areas 0.69 vs. 0.58, respectively; p less than 0.05). However, only two of the eight cues (age less than 20 years and purulent vaginal discharge) were actually related to chlamydial infection in a second multivariate model; this model bad accuracy similar to that of an empirically derived prediction rule (ROC curve areas 0.77 and 0.80, p = 0.27). CONCLUSIONS: Nurse practitioners were often inaccurate in their diagnostic judgments. Our analyses suggest that this inaccuracy stemmed from both the inconsistent use of clinical cues and the use of cues that were not related to chlamydial infection. Therefore, interventions such as algorithms that promote consistency and accuracy in diagnostic use of relevant cues would be likely to improve their diagnostic judgments.

Adult↗

PubMed1984

Effects of social influences and waiting on time judgment.

Utilizing social judgment theory, the relationships of three social cues to time judgment under low physical temporal-cue conditions were explored. These social influences were as follows: being free to interact with another person, being told by the experimenter to expect to wait a specified period of time, and seeing another person's time judgment. 72 college students, randomly assigned to conditions of free social interaction (alone-interactive) and of waiting expectancy (expected-unexpected), made time estimates after 4 min., 7 sec. Each person under interactive conditions made another judgment after seeing a partner's judgment. Mean estimation was lower alone than under interactive conditions and lower under expected than unexpected waiting conditions. Under interactive conditions, correlations were positive between the individual's first and second judgments, between the partners' second judgments, and between the individual's second and the partner's first judgments. Social cues may influence time judgment.

Adult↗

PubMed1999

Interpreting the judgment of surgical faculty regarding resident competence.

BACKGROUND: It is reasonable to propose that competence is a multifaceted characteristic defined in part by some minimum level of knowledge and skill. In this study we examined the relationship between surgical faculty's judgment of clinical competence, as measured by a surgical resident objective structured clinical examination (OSCE), and the residents' objective performance on the skills being tested. METHODS: Fifty-six general surgery residents at all levels of training participated in a 30-station OSCE. At the completion of each station, the faculty proctor made several overall judgments regarding each resident's performance, including a global judgment of competent or not competent. The competence judgment was applied to the objective percentage performance score in three different ways to construct methods for determining competence based solely upon this objective percentage score. RESULTS: The average mean competent score (MCS) across the stations was 61%, and the average mean noncompetent score (MNCS) was 38%. The difference between MCS and MNCS for each station was very consistent. Upper threshold scores above which a judgment of competent was always made, and lower threshold scores below which a judgment of noncompetent was always made were observed. Overall, the average mean and threshold scores for competent and noncompetent groups were remarkably similar. For performance scores in the range between the threshold competent and noncompetent scores at each station, measures other than objective performance on the skills being evaluated determined the judgment of competent or not competent. CONCLUSIONS: Empirically determined minimum acceptable standards for objective performance in clinical skills and knowledge appeared to have been subconsciously applied to the competence judgment by the faculty evaluators in this study. Other factors appeared to have become determinate when the objective performance score fell within a range of uncertainty.

Animals↗

PubMed2003

Reducing bias in frequency judgment by improving source monitoring.

A common finding in judgment and decision making is that people's frequency judgments often fail to map onto objective frequencies. The present research examined the possibility that one source of bias in frequency judgment is attributable to people's inability to screen out irrelevant memory traces. We used a two-list source-monitoring paradigm to investigate whether frequency judgments are influenced by "extra-experimental" experiences and whether enhancing source monitoring improves judgment accuracy. Across four experiments we found: (1) frequency judgments regarding one list were biased by the second, (2) manipulating encoding between lists improved source monitoring and resulted in more accurate judgments, (3) manipulating item context between lists improved source monitoring and resulted in more accurate judgments, but only when the context was item specific, and (4) manipulating simple-background context between lists was ineffective at improving source monitoring.

Decision Making↗

PubMed1982

Loci of contextual effects in judgment.

Three experiments investigated the loci of contextual effects in judgment. Experiment 1 demonstrated the effect of stimulus spacing on category ratings and magnitude estimations of the darkness of dot patterns. Variations in the stimulus spacing were shown to affect both category ratings and magnitude estimations in a similar fashion. Experiment 2 was designed to determine whether contextual effects due to stimulus spacing influence the scale values or the judgment function. Subjects judged "differences" and "ratios" of the subjective darkness of dot patterns. Differences in mean judgments of single stimuli from Experiment 1 did not predict the rank order of judged "differences" and "ratios" from Experiment 2. The estimated scale values of the stimuli appeared to be independent of stimulus spacing. These findings suggest that contextual effects due to the stimulus spacing occur in the judgment function for within-modality judgments. Experiment 3 examined contextual effects in cross-modality judgments. Stimulus spacing and stimulus range were manipulated for "difference" and "total" judgments. Unlike the within-modality results, the stimulus range and spacing influenced the scale values. A contextual theory of within- and cross-modality judgment is presented.

Discrimination Learning↗

PubMed2002

Life-satisfaction is a momentary judgment and a stable personality characteristic: the use of chronically accessible and stable sources.

Social cognition research indicates that life-satisfaction judgments are based on a selected set of relevant information that is accessible at the time of the life-satisfaction judgment. Personality research indicates that life-satisfaction judgments are quite stable over extended periods of time and predicted by personality traits. The present article integrates these two research traditions. We propose that people rely on the same sources to form repeated life-satisfaction judgments over time. Some of these sources (e.g., memories of emotional experiences, academic performance) provide stable information that explains the stability in life-satisfaction judgments. Second, we propose that the influence of personality traits on life satisfaction is mediated by the use of chronically accessible sources because traits produce stability of these sources. Most important, the influence of extraversion and neuroticism is mediated by use of memories of past emotional experiences. To test this model, participants repeatedly judged life-satisfaction over the course of a semester. After each assessment, participants reported sources that they used for these judgments. Changes in reported sources were related to changes in life-satisfaction judgments. A path model demonstrated that chronically accessible and stable sources are related to stable individual differences in life-satisfaction. Furthermore, the model supported the hypothesis that personality effects were mediated by chronically accessible and stable sources. In sum, the results are consistent with our theory that life-satisfaction judgments are based on chronically accessible sources.

Cognition↗

PubMed1998

Judgments of personal and environmental risks of consumer products--do they differ?

Many psychometric studies have investigated judgments concerning personal risks from technologies, activities or consumer products, but only a few studies have included judgments of risk to the environment. Thus, little is known about this aspect of environmental risk perception, and whether it differs from personal risk perception. This study investigates risk judgments for 30 consumer products of various types such as herbal remedies, mobile telephones, genetically engineered drugs, or garden pesticides. A survey was conducted in two German cities: Leipzig and West Berlin. In total, 408 subjects evaluated the consumer products with regard to personal and environmental risk (and other risk-related aspects) and whether they would recommend the product to others. The findings show statistically significant differences between the mean values of perceived personal risk and environmental risk for most products. Despite these differences, the rank order of mean personal risk and environmental risk judgments for the products is quite similar. However, separate analyses for each product reveal that correlations between perceived personal and environmental risk vary strongly across products. Multiple regression analyses with personal and environmental risk judgments as predictors and product recommendation as criterion, run separately for each consumer product, show that it is mainly the judgment of perceived personal risk that explains product recommendation. Perceived risk to the environment adds little explanatory power. The study also explores differences in judgments of personal and environmental risk with regard to two sociodemographic variables: location (former East Germany vs. West Germany) and gender. Differences in both types of risk judgments are found with regard to location but not for gender.

Adolescent↗

PubMed2002

Momentary and integrative response strategies in causal judgment.

Associative models of causal learning predict recency effects. Judgments at the end of a trial series should be strongly biased by recently presented information. Prior research, however, presents a contrasting picture of human performance. López, Shanks, Almaraz, and Fernández (1998) observed recency, whereas Dennis and Ahn (2001) found the opposite, primacy. Here we replicate both of these effects and provide an explanation for this paradox. Four experiments show that the effect of trial order on judgments is a function of judgment frequency, where incremental judgments lead to recency while single final judgments abolish recency and lead instead to integration of information across trials (i.e., primacy). These results challenge almost all existing accounts of causal judgment. We propose a modified associative account in which participants can base their causal judgments either on current associative strength (momentary strategy) or on the cumulative change in associative strength since the previous judgment (integrative strategy).

Adolescent↗

PubMed1998

Memorability judgments for high- and low-frequency words.

Five experiments were conducted in order to examine subjects' judgments of the memorability of high- (HF) and low-frequency (LF) words in the context of a recognition memory task. In Experiment 1, the subjects were provided study/test experience with a list of HF and LF words prior to making memorability judgments for a new list of HF and LF items. The findings were consistent with previous evidence (Greene & Thapar, 1994; Wixted, 1992) suggesting that subjects are not explicitly aware of the greater recognition memorability of LF words. Experiments 2-5 embedded the memorability judgment task within the recognition test itself. In these experiments, the subjects consistently gave higher memorability ratings to LF items. The contrast between the pattern of results found when the subjects made their judgments at the time of list presentation (Experiment 1) and that when they made their judgments during the recognition test (Experiments 2-5) is consistent with recent evidence that even seemingly highly related metamnemonic judgments (e.g., ease of learning judgments vs. judgments of learning for the same items) may be based on very different factors if they occur at different points in the study/test cycle. The present findings are also consistent with the possibility that very rapid retrieval of memorability information for HF and LF words may affect recognition decisions and may contribute to the recognition memory word frequency effect.

Analysis of Variance↗

PubMed1989

[Developmental changes in judgment of weights addition].

As weight is invisible, some judgmental criteria are needed in judging weight. An experiment was carried out using the second, fourth, sixth, eighth graders and college students to reveal (1) what weights positions make subjects more errors in judgment of weights addition and (2) what relationships will be found between the judgments and judgmental criteria. Subjects were engaged in the tasks to judge weights addition in two conditions, height of weights and relative positions, and were asked the judgmental criteria in two situations, visual exteroceptive and realistic proprioceptive situations. Results showed clearly the developmental changes. The fourth graders dominantly produced errors in height of weights conditions and tended to depend on the criteria in realistic situations. In the contrast to this, the eighth graders committed errors in relative differences of weights positions and depended on the criteria in visual situations as well as realistic ones. Sex differences were also observed in terms of criteria. No relations between the judgments and judgmental criteria was found in girls' judgments of weights additions.

Adolescent↗

PubMed1990

Are two (inexperienced) heads better than one (experienced) head? Averaging house officers' prognostic judgments for critically ill patients.

Inexperienced physicians may make prognostic judgments and management decisions about acutely ill patients in the absence of supervision. We hypothesized that mathematically combining judgments of junior and senior house officers might yield aggregate judgments as good as those made by experienced critical care attending physicians. We obtained independent quantitative assessments of the likelihood of in-hospital survival for 269 sequential intensive care unit admissions from the patient's intern or resident and the critical care fellow and attending physician on duty within 24 hours of admission, and compared these judgements with mortality data. By logistic regression, the residents' and fellows' judgments added independent prognostic information to each other (likelihood ratio chi 2, 7.6; df = 1). The junior house officers' and fellows' assessments were significantly less reliable than the attending physicians' by calibration curves, and by Brier scores, 0.126 and 0.127 vs 0.119. All physicians had good discriminating ability (receiver operating characteristic areas [SE] were 0.83 [0.03], 0.85 [0.03], 0.86 [0.03], respectively). A simple average of the residents' and fellows' judgments was slightly but significantly more reliable by calibration curve and by Brier score, 0.117, and as discriminating (ROC area = 0.85, SE = 0.03) as the attending physicians' judgments. Nonmedical studies have shown that averaging independent judgments may compensate for people's tendency to make extreme estimates, and may take advantage of their complementary abilities. This first medical application of this technique suggests that this form of voting by secret ballot may prove useful for health care teams making other judgments and decisions.

Clinical Competence↗

PubMed1985

Measuring physicians' judgment--the use of clinical data by Australian rheumatologists.

Most therapeutic decisions depend upon the clinical judgment of physicians assessing their patients. However the inherent and wide variation in such judgments is usually ignored. Rheumatoid arthritis typifies those diseases in which much information is available on which to base decisions, but little is known about how physicians combine the data to evaluate their patients' response to treatment. Thirty-four Australian rheumatologists recorded their assessments of the progress of 50 rheumatoid patients treated with 'second line' agents, based on data presented on previously validated written forms. Clinical judgment analysis, a form of multiple regression analysis, was then used to model the way physicians' judgments related to the available data. There were major differences of judgment in the assessments of response to therapy. This was so even when only 'clinically important' changes were identified. The variance in judgments which could be modelled by clinical judgment analysis ranged from 45% to 94%. Both individual inconsistency and differences in the underlying use of data contributed to disagreements between clinicians' assessments of identical cases. Identifying underlying differences in the way clinical data relate to clinicians' judgments is a step towards improving clinical consistency.

Arthritis, Rheumatoid↗

PubMed1994

Estimating neonatal mortality risk: an analysis of clinicians' judgments.

BACKGROUND: Clinicians' estimates of mortality risk in the neonatal intensive care unit (NICU) have implications for patient triage, transfer, initiation and termination of life support, and allocation of medical resources. The accuracy of these judgments has not been studied, nor the differences between nurses and attending physicians. OBJECTIVES: 1) evaluate the accuracy of subjective judgments of NICU unit mortality risk, 2) identify the key components of clinician judgments, 3) compare accuracy between attending physicians and nurses, and 4) examine the utility of combining an objectively computed risk and clinician judgments to improve predictions. METHODS: We obtained estimates of mortality risk on 544 admissions to two NICUs on the day of admission from the attending physician and primary nurse. These were compared with an objective computed mortality risk based on birth weight and the Score for Neonatal Acute Physiology (SNAP) using a linear judgment analysis model, as well as with actual outcomes. RESULTS: Physicians and nurses had good discriminating power with actual mortality rates ranging from 0% among low risk patients to 67% among those with the highest mortality estimates. Physicians had a tendency to overestimate mortality risk. Clinicians base their estimates on the same factors and similar judgment weights as the empiric mortality risk model (22% birth weight, 62% illness severity (SNAP), 13% low Apgar, and 3% for intrauterine growth restriction). Clinicians place additional emphasis on therapeutic as well as physiologic factors. When the computed risk and physician judgment were combined, both made significant contributions in a logistic mortality risk model. CONCLUSIONS: Clinician judgments of mortality risk are fairly accurate and similar to an objective illness severity index. This simple method provides insight into clinical decision making and has important applications in improving direct patient care, appropriate allocation of medical resources, and medical training.

Clinical Competence↗

PubMed2002

The anterior frontomedian cortex and evaluative judgment: an fMRI study.

This study investigated the neuronal basis of evaluative judgment. Judgments can be defined as the assessment of an external or internal stimulus on an internal scale and they are fundamental for decision-making and other cognitive processes. Evaluative judgments (I like George W. Bush: yes/no) are a special type of judgment, in which the internal scale is related to the person's value system (preferences, norms, aesthetic values, etc.). We used functional magnetic resonance imaging to examine brain activation during the performance of evaluative judgments as opposed to episodic and semantic memory retrieval. Evaluative judgment produced significant activation in the anterior frontomedian cortex (BA 10/9), the inferior precuneus (BA 23/31), and the left inferior prefrontal cortex (BA 45/47). The results show a functional dissociation between the activations in the anterior frontomedian cortex and in the inferior precuneus. The latter was mainly activated by episodic retrieval processes, supporting its function as a multimodal association area that integrates the different aspects of retrieved and newly presented information. In contrast, the anterior frontomedian cortex was mainly involved in evaluative judgments, supporting its role in self-referential processes and in the self-initiation of cognitive processes.

Adult↗

PubMed1991

A model of clinical judgment processes in psychiatric nursing.

This study addressed judgment processes in psychiatric nursing by analyzing reported use of clinical cues cited as being relevant in the process of making a nursing judgment. Using an exploratory, qualitative approach, data were collected by interviewing 15 subjects who provided 36 in-depth interviews upon completion of an intake interview. Comparative content analysis was used to determine the underlying structure in subject reports. A model depicting judgment processes is presented and discussed. Results suggest that although judgments were highly context-dependent, all subjects assessed data labeled as universals in the psychiatric nursing assessment: suicidality, depression, drug and alcohol use, and patient functional abilities. Similarities among subjects were noted in that presenting behaviors were most salient, a categorization process occurs within the judgment process, and patients are included in the judgment process. Finally, nursing judgments uncovered an action orientation rather than a labeling function.

Adult↗

PubMed1987

Person memory and judgments: the impact of information that one is told to disregard.

Subjects read a series of behaviors with instructions to form an impression of the person who performed them. In some conditions, subjects were told after reading the behaviors that an administrative error had been made and that certain ones should be disregarded. If the behaviors that subjects were told to disregard were descriptively unrelated to the other behaviors in the series, their influence on trait judgments was greatest when they were presented last. If the behaviors to be disregarded were descriptively inconsistent with the remaining behaviors, their influence was greatest when they were first in the series but subjects were not told to ignore them until after the remaining ones were presented. If the to-be-disregarded behaviors implied the same trait as the remaining ones, they had an influence on trait judgments in both of these conditions. All of these effects were consistently greater when the trait implied by the behaviors to be disregarded was favorable. In fact, when behaviors implied an unfavorable trait, instructions to disregard them often led the behaviors to have a contrast effect on trait judgments. Subjects appeared to base their judgments on implications of the cognitive representations they formed of the person at the time information was first presented. They then adjusted these subjective judgments at the time they reported them to compensate for the influence they perceived the to-be-disregarded information to have, making relatively greater adjustments when this information was unfavorable than when it was favorable. An additional experiment provided further evidence of adjustment processes, but it indicated that subjects also base their judgments on a partial review of the information they have received. A general model of person memory and judgment proposed by Wyer and Unverzagt (1985) provided a satisfactory account of the results of these studies.

Attention↗

PubMed1988

Consensus in personality judgments at zero acquaintance.

This research focused on the target effect on a perceiver's judgments of personality when the perceiver and the target are unacquainted. The perceiver was given no opportunity to interact with the target, a condition we refer to as zero acquaintance. We reasoned that in order to make personality judgments, perceivers would use the information available to them (physical appearance). Consensus in personality judgments would result, then, from shared stereotypes about particular physical appearance characteristics. Results from three separate studies with 259 subjects supported this hypothesis. On two of the five dimensions (extraversion and conscientiousness) on which subjects rated each other, a significant proportion of variance was due to the stimulus target. Consensus on judgments of extraversion appears to have been largely mediated by judgments of physical attractiveness. Across the three studies there was also evidence that the consensus in judgments on these two dimensions had some validity, in that they correlated with self-judgments on those two dimensions.

Beauty↗

PubMed1995

Mood and judgment: the affect infusion model (AIM).

Evidence for the role of affective states in social judgments is reviewed, and a new integrative theory, the affect infusion model (AIM), is proposed as a comprehensive explanation of these effects. The AIM, based on a multiprocess approach to social judgments, identifies 4 alternative judgmental strategies: (a) direct access, (b) motivated, (c) heuristic, and (d) substantive processing. The model predicts that the degree of affect infusion into judgments varies along a processing continuum, such that judgments requiring heuristic or substantive processing are more likely to be infused by affect than are direct access or motivated judgments. The role of target, judge, and situational variables in recruiting high- or low-infusion judgmental strategies is considered, and empirical support for the model is reviewed. The relationship between the AIM and other affect-cognition theories is discussed, and implications for future research are outlined.

Affect↗