Family physicians’ diagnostic gut feelings are measurable: construct validation of a questionnaire

BMC Family Practice

Research Article

Trudy Van der Weijden¹  Geert Jan Dinant¹  Christiaan F Stolper¹  Marloes A Van Bokhoven¹  Henrica CW De Vet²  Paul Van Royen³  Margje WJ Van de Wiel⁴  Alexander LB Rutten⁵ 

[1] Caphri School for Public Health and Primary Care, Department of Primary Medicine, Maastricht University, P.O. Box 616, 6200, Maastricht, MD, The Netherlands;EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands;Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium;Faculty of Psychology & Neuroscience, Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands;Institute for Intellectually Impaired, Tilburg, The Netherlands;

关键词: Gut feelings;    Family medicine;    General practitioners;    Diagnostic reasoning;    Questionnaire;    Construct validation;    Medical decision-making;    Medical problem-solving;    Intuition;    Clinical reasoning;   

DOI  :  10.1186/1471-2296-14-1

 received in 2012-07-19, accepted in 2012-12-17,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundFamily 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.MethodsWe 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.ResultsAs 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.ConclusionsThe questionnaire appears to be valid. It enables quantitative research into the role of gut feelings and their diagnostic value in family physicians’ diagnostic reasoning.

【 授权许可】

CC BY   
© Stolper et al.; licensee BioMed Central Ltd. 2013