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On Assessing the Quality of Physicians’ Clinical Judgment

The Search for Outcome Variables

Janet Mee

National Board of Medical Examiners

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.

Key Words: urinary tract infection • cost function • regression analysis • clinical judgment analysis

Evaluation & the Health Professions, Vol. 27, No. 4, 369-382 (2004)
DOI: 10.1177/0163278704270009


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