title: Family physicians' diagnostic gut feelings are measurable: construct validation of a questionnaire.
abstract: BACKGROUND
  Family physicians perceive that gut feelings, i.e. a 'sense of reassurance' or a 'sense of alarm', play a substantial role in diagnostic reasoning. A measuring instrument is desirable for further research. Our objective is to validate a questionnaire measuring the presence of gut feelings in diagnostic reasoning.
  
  
  METHODS
  We constructed 16 case vignettes from real practice situations and used the accompanying 'sense of reassurance' or the 'sense of alarm' as reference labels. Based on the results of an initial study (26 family physicians), we divided the case vignettes into a group involving a clear role for the sense of reassurance or the sense of alarm and a group involving an ambiguous role. 49 experienced family physicians evaluated each 10 vignettes using the questionnaire. Construct validity was assessed by testing hypotheses and an internal consistency procedure was performed.
  
  
  RESULTS
  As hypothesized we found that the correlations between the reference labels and corresponding items were high for the clear-case vignettes (0.59 - 0.72) and low for the ambiguous-case vignettes (0.08 - 0.23). The agreement between the classification in clear sense of reassurance, clear sense of alarm and ambiguous case vignettes as derived from the initial study and the study population's judgments was substantial (Kappa = 0.62). Factor analysis showed one factor with opposites for sense of reassurance and sense of alarm items. The questionnaire's internal consistency was high (0.91). We provided a linguistic validated English-language text of the questionnaire.
  
  
  CONCLUSIONS
  The questionnaire appears to be valid. It enables quantitative research into the role of gut feelings and their diagnostic value in family physicians' diagnostic reasoning.
authors.affiliation: Caphri School for Public Health and Primary Care, Department of Primary Medicine, Maastricht University, P,O, Box 616, Maastricht, 6200 MD, The Netherlands. cf.stolper@maastrichtuniversity.nl
authors.forename: Christiaan F
authors.initials: CF
authors.lastname: Stolper
authors.forename: Margje W J
authors.initials: MW
authors.lastname: Van de Wiel
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: De Vet
authors.forename: Alexander L B
authors.initials: AL
authors.lastname: Rutten
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
authors.forename: Marloes A
authors.initials: MA
authors.lastname: Van Bokhoven
authors.forename: Trudy
authors.initials: T
authors.lastname: Van der Weijden
authors.forename: Geert Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D003657:Decision Making; D003933:Diagnosis; D005163:Factor Analysis, Statistical; D005194:Family Practice / Q000379:methods; D006801:Humans; D019545:Intuition; D010821:Physicians, Family / Q000523:psychology*; D025341:Principal Component Analysis; D036301:Qualitative Research; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires