Clinician judgments of functional outcomes: How bias and perceived accuracy affect rating

Objective: To evaluate the accuracy of clinician judgments of patient funct ion, the susceptibility of judges to bias, and the relation between a judge 's degree of belief in his/her accuracy of classification to observed accur acy when using the FIM(TM) instrument. Participants: Fifty rehabilitation professionals. Setting: 3 urban medical centers. Design: Four randomized experiments among subjects to examine the effect of potentially biasing information on FIM ratings of patient vignettes. Parti cipants answered 60 true/false questions regarding patient function and FIM score and indicated confidence in the accuracy of their answers. Interventions: Manipulation of patient information. Main Outcome Measures: The standard FIM 7-point scale, observed proportion of correct responses to the 60 true/false questions, and a 6-category confi dence scale for each of the 60 questions were used as dependent measures. Results: FIM ratings assigned to others biased participants' FIM ratings of patient vignettes. Functional ability was over estimated when ratings in o ther domains were high and underestimated when they were low. Participants were overconfident in their ability to answer FIM questions accurately acro ss all professional disciplines. Conclusion: Bias and poor judgment of level accuracy play a significant rol e in clinician ratings of patient functioning. Blind ratings and training i n debiasing are potential solutions to the problem.