title: Applying Judgment Analysis Theory and Methods to Obtain an Insight Into Clinical Judgments: Implementation and Findings With a Simulated Neonatal Intensive Care Unit Setup.
abstract: BACKGROUND
  Clinicians who provide acute care are required to quickly identify and judge the illness severity of patients who experience deterioration in their clinical state. Accuracy of judgments can only be tested with respect to a valid reference, but in most health care areas, there is no such score. Judgment analysis theory and methods are presented and proposed as a framework to obtain insight into clinical judgments. A study in a simulated neonatal intensive care unit setup is described to demonstrate the applicability of the proposed methodology.
  
  
  METHODS
  Sixteen participants from a neonatal intensive care unit department reviewed 31 clips of simulated cases. The participants were directed to use a 5-point scale to rate their personal interpretation regarding the illness severity of the simulated patient. Judgment analysis techniques were used to identify the judgment capabilities of the participants and to determine factors that influence those capabilities.
  
  
  RESULTS
  Most participants interpreted the clinical signs information consistently, but interpretation varied remarkably between clinicians, providing possible explanation to the differences between the clinicians' judgments. Significant correlations were found between the doctors' years of medical experience and attributes of their judgments.
  
  
  CONCLUSIONS
  Judgment analysis can be used to obtain insight into clinical judgments and to identify and quantify factors that affect clinicians' judgments. Judgment analysis can promote health care by enhancing clinical assessment teaching, by providing objective and personalized feedback to team members about their judgment performance, and by introducing a unified and objective method to study elements that affect clinical judgments.
authors.affiliation: MSR, Israel Center for Medical Simulation (I.N., L.P.-G., R.S., A.Z.), and Edmond and Lily Safra Children's Hospital (O.G., Z.S.), Chaim Sheba Medical Center, Tel Hashomer; and Medical Education Department (A.Z.), Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Izhak
authors.initials: I
authors.lastname: Nadler
authors.forename: Omer
authors.initials: O
authors.lastname: Globus
authors.forename: Liat
authors.initials: L
authors.lastname: Pessach-Gelblum
authors.forename: Zipora
authors.initials: Z
authors.lastname: Strauss
authors.forename: Rina
authors.initials: R
authors.lastname: Sela
authors.forename: Amitai
authors.initials: A
authors.lastname: Ziv
mesh_terms: D004503:Education, Medical, Graduate / Q000379:methods*; D004509:Education, Nursing, Continuing / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007318:Inservice Training; D007363:Intensive Care Units, Neonatal; D007600:Judgment; D008348:Manikins; D009359:Neonatology / Q000193:education*; D012720:Severity of Illness Index; D000066908:Simulation Training; D014741:Video Recording