First-year residents' caring, medical knowledge, and clinical judgment in relation to laboratory utilization.
OBJECTIVE
To investigate first-year residents' levels of caring (concern for others' well-being), medical knowledge, and clinical judgment in relation to their levels of laboratory utilization.


METHODS
Self-report questionnaires about caring, knowledge, and judgment were given in 1986-87 to 36 first-year residents in a three-year internal medicine residency program of the McGaw Medical Center of Northwestern University. Inpatient laboratory utilization data obtained from structured chart audits over a one-year period were used to construct comparable diagnosis- and severity-specific physician practice profiles, from which the residents received overall utilization scores for laboratory test charges. Statistical methods included Cronbach's alpha reliability coefficient and multiple regression analysis.


RESULTS
The multiple regression analysis showed that medical knowledge was an independent predictor of increased laboratory utilization (standardized beta = .54, p < .04, partial R2 = .07); clinical judgment was an independent predictor of decreased utilization (standardized beta = -.53, p < .05, partial R2 = .06); and caring was unrelated to utilization (standardized beta = .15, ns, partial R2 = .01).


CONCLUSIONS
The finding that clinical judgment was related to less laboratory utilization suggests that future research should investigate the decision-making concomitants of judgment to better understand its translation into resource utilization. It is possible that the relationship between medical knowledge and laboratory utilization is developmentally specific, and thus the knowledge of more experienced physicians, who would likely be more precise decision makers than first-year residents, may be related to decreased rather than increased utilization.
Yarnold
P R
PR
Department of Medicine, Northwestern University Medical School, Chicago, IL.
Martin
G J
GJ
Feinglass
J
J
Curry
R H
RH
Bryant
F B
FB
Lyons
J S
JS
Hughes
R L
RL
D002641:Chicago; D002983:Clinical Competence; D003657:Decision Making; D004645:Empathy; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D007600:Judgment; D007755:Laboratories, Hospital / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis