Ss rated on a 1 to 13 Likert scale their preference for four environmental scenes which differed in complexity. Ss were then given 30 sec. to solve each of 10 3-, 5-, or 7-letter single-solution anagrams. Finally the Ss rated four new slides which were of the same complexity level as the slides seen during the first session. Change scores were calculated by subtracting the preference ratings at each complexity level during the first session from the rating at the corresponding complexity level during the second session. The Anagram Complexity X Slide Complexity interaction was significant: the complexity of the slides showing the most positive change scores was inversely related to the complexity of the anagrams attempted. The results were discussed in terms of optimal level of stimulation theories.

Arousal↗

PubMedDate not supplied

Systematic errors in medical decision making: judgment limitations.

Much of medical practice involves the exercise of such basic cognitive tasks as estimating probabilities and synthesizing information. Scientists studying cognitive processes have identified impediments to accurate performance on these tasks. Together the impediments foster "cognitive bias." Five factors that can detract from accurate probability estimation and three that impair accurate information synthesis are discussed. Examples of all eight factors are illustrated by reference to published articles. The authors suggest ways to minimize the negative influences of these factors.

Cognition↗

PubMedDate not supplied

Hindsight bias: an impediment to accurate probability estimation in clinicopathologic conferences.

Although clinicopathologic conferences (CPCs) have been valued for teaching differential diagnosis, their instructional value may be compromised by hindsight bias. This bias occurs when those who know the actual diagnosis overestimate the likelihood that they would have been able to predict the correct diagnosis had they been asked to do so beforehand. Evidence for the presence of the hindsight bias was sought among 160 physicians and trainees attending four CPCs. Before the correct diagnosis was announced, half of the conference audience estimated the probability that each of five possible diagnoses was correct (foresight subjects). After the correct diagnosis was announced the remaining (hindsight) subjects estimated the probability they would have assigned to each of the five possible diagnoses had they been making the initial differential diagnosis. Only 30% of the foresight subjects ranked the correct diagnosis as first, versus 50% of the hindsight subjects (p less than 0.02). Although less experienced physicians consistently demonstrated the hindsight bias, more experienced physicians succumbed only on easier cases.

Clinical Competence↗

PubMedDate not supplied

Hemodynamic assessment in managing the critically ill: is physician confidence warranted?

Prior to right-heart catheterization of 846 patients, 198 study physicians estimated values of pulmonary capillary wedge pressure (WP), cardiac index (Cl), and systemic vascular resistance index (VRI). The physicians also expressed their confidence in these estimates. Actual values of WP, Cl, and VRI as determined by catheterization enabled the authors to evaluate the quality of the physicians' judgments. The discrimination of the judgments was modest; areas under the ROC curves for WP, Cl, and VRI were 0.724, 0.681, and 0.656, respectively. Calculated using clinically relevant cutoff values, sensitivities were 64%, 50%, and 64%, and specificities were 71%, 75%, and 63%, respectively. Calibration of the estimates of WP, Cl, and VRI was also modest; physicians tended to overestimate low values and underestimate high values. Physicians were generally confident of their estimates, but there was no relation between confidence and accuracy. Experienced physicians were no more accurate than less experienced ones, although they were significantly more confident. The authors conclude that physicians should not use their levels of confidence in their subjective estimates of cardiac function in deciding whether to base therapy on these estimates.

Cardiac Catheterization↗

PubMedDate not supplied

The covariance decomposition of the probability score and its use in evaluating prognostic estimates. SUPPORT Investigators.

The probability score (PS) or Brier score has been used in a large number of studies in which physician judgment performance was assessed. However, the covariance decomposition of the PS has not previously been used to evaluate medical judgment. The authors introduce the technique and demonstrate it by analyzing prognostic estimates of three groups: physicians, their patients, and the patients' decision-making surrogates. The major components of the covariance decomposition--bias, slope, and scatter--are displayed in covariance graphs for each of the three groups. The decomposition reveals that whereas the physicians have the best overall estimation performance, their bias and their scatter are not always superior to those of the other two groups. This is primarily due to two factors. First, the physicians' prognostic estimates are pessimistic. Second, the patients place the large majority of their estimates in the most optimistic category, thereby achieving low scatter. The authors suggest that the calculational simplicity of this decomposition, its informativeness, and the intuitive nature of its components make it a useful tool with which to analyze medical judgment.

Bias↗