title: Assessing Correlations of Physicians' Practice Intensity and Certainty During Residency Training.
abstract: BACKGROUND
  Variation in physicians' practice patterns contributes to unnecessary health care spending, yet the influences of modifiable determinants on practice patterns are not known. Identifying these mutable factors could reduce unnecessary testing and decrease variation in clinical practice.
  
  
  OBJECTIVE
  To assess the importance of the residency program relative to physician personality traits in explaining variations in practice intensity (PI), the likelihood of ordering tests and treatments, and in the certainty of their intention to order.
  
  
  METHODS
  We surveyed 690 interns and residents from 7 internal medicine residency programs, ranging from small community-based programs to large university residency programs. The surveys consisted of clinical vignettes designed to gauge respondents' preferences for aggressive clinical care, and questions assessing respondents' personality traits. The primary outcome was the participant-level mean response to 23 vignettes as a measure of PI. The secondary outcome was a certainty score (CS) constructed as the proportion of vignettes for which a respondent selected "definitely" versus "probably."
  
  
  RESULTS
  A total of 325 interns and residents responded to the survey (47% response rate). Measures of personality traits, subjective norms, demographics, and residency program indicators collectively explained 27.3% of PI variation. Residency program identity was the largest contributor. No personality traits were significantly independently associated with higher PI. The same collection of factors explained 17.1% of CS variation. Here, personality traits were responsible for 63.6% of the explained variation.
  
  
  CONCLUSIONS
  Residency program affiliations explained more of the variation in PI than demographic characteristics, personality traits, or subjective norms.
authors.forename: C Jessica
authors.initials: CJ
authors.lastname: Dine
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bellini
authors.forename: Gretchen
authors.initials: G
authors.lastname: Diemer
authors.forename: Allison
authors.initials: A
authors.lastname: Ferris
authors.forename: Ashish
authors.initials: A
authors.lastname: Rana
authors.forename: Gina
authors.initials: G
authors.lastname: Simoncini
authors.forename: William
authors.initials: W
authors.lastname: Surkis
authors.forename: Charles
authors.initials: C
authors.lastname: Rothschild
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data*; D004503:Education, Medical, Graduate; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D010551:Personality; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D019564:Unnecessary Procedures / Q000706:statistics & numerical data