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Fast and Frugal Models of Clinical Judgment in Novice and Expert Physicians

Department of Epidemiology and Public Health, Queens University Belfast, United Kingdom, f.kee{at}qub.ac.uk

John Jenkins, MD

Department of Child Health, Queens University Belfast, United Kingdom

Seana McIlwaine, BSc (Hons)

Northern Health and Social Services Board, County Hall, Ballymena, United Kingdom

Chris Patterson, PhD

Department of Epidemiology and Public Health, Queens University Belfast, United Kingdom

Sloan Harper, MB

Northern Health and Social Services Board, County Hall, Ballymena, United Kingdom

Michael Shields, MD

Department of Child Health, Queens University Belfast, United Kingdom

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.

Key Words: linear models • clinical judgment • fast and frugal

Medical Decision Making, Vol. 23, No. 4, 293-300 (2003)
DOI: 10.1177/0272989X03256004


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