1ST-YEAR RESIDENTS CARING, MEDICAL KNOWLEDGE, AND CLINICAL JUDGMENT IN RELATION TO LABORATORY UTILIZATION

Purpose. To investigate first-year residents' levels of caring (concer n for others' well-being), medical knowledge, and clinical judgment in relation to their levels of laboratory utilization. Method. Self-repo rt questionnaires about caring, knowledge, and judgment were given in 1986-87 to 36 first-year residents in a three-year internal medicine r esidency program of the McGaw Medical Center of Northwestern Universit y. Inpatient laboratory utilization data obtained from structured char t audits over a one-year period were used to construct comparable diag nosis- and severity-specific physician practice profiles, from which t he residents received overall utilization scores for laboratory test c harges. Statistical methods included Cronbach's alpha reliability coef ficient and multiple regression analysis. Results. The multiple regres sion analysis showed that medical knowledge was an independent predict or 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 R 2 = .06); and caring was unrelated to utilization (standardized beta = .15, ns, partial R2 = .01). Conclusion. The finding that clinical jud gment was related to less laboratory utilization suggests that future research should investigate the decision-making concomitants of judgme nt to better understand its translation into resource utilization. It is possible that the relationship between medical knowledge and labora tory utilization is developmentally specific, and thus the knowledge o f more experienced physicians, who would likely be more precise decisi on makers than first-year residents, may be related to decreased rathe r than increased utilization.