{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:47:13Z","timestamp":1753883233169,"version":"3.41.2"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Education and Curricular Development"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Purpose:<\/jats:title><jats:p> Recently, the American College of Graduate Medical Education included medical decision-making as a core competency in several specialties. To date, the ability to demonstrate and measure a pedagogical evolution of medical judgment in a medical education program has been limited. In this study, we aim to examine differences in medical decision-making of physician groups in distinctly different stages of their postgraduate career. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> The study recruited physicians with a wide spectrum of disciplines and levels of experience to take part in 4 medical simulations divided into 2 categories, abdominal pain (biliary colic [BC] and renal colic [RC]) or chest pain (cardiac ischemia with ST-segment elevation myocardial infarction [STEMI] and pneumothorax [PTX]). Evaluation of medical decision-making used the Medical Judgment Metric (MJM). The targeted selection criteria for the physician groups are administrative physicians (APs), representing those with the most experience but whose current duties are largely administrative; resident physicians (RPs), those enrolled in postgraduate medical or surgical training; and mastery level physicians (MPs), those deemed to have mastery level experience. The study measured participant demographics, physiological responses, medical judgment scores, and simulation time to case resolution. Outcome differences were analyzed using Fisher exact tests with post hoc Bonferroni-adjusted z tests and single-factor analysis of variance F tests with post hoc Tukey honestly significant difference, as appropriate. The significance threshold was set at P\u2009&lt;\u2009.05. Effect sizes were determined and reported to inform future studies. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> A total of n\u2009=\u200930 physicians were recruited for the study with n\u2009=\u200910 participants in each physician group. No significant differences were found in baseline demographics between groups. Analysis of simulations showed a significant ( P\u2009=\u2009.002) interaction for total simulation time between groups RP: 6.2\u2009minutes (\u00b11.58); MP: 8.7\u2009minutes (\u00b12.46); and AP: 10.3\u2009minutes (\u00b12.78). The AP MJM scores, 12.3 (\u00b12.66), for the RC simulation were significantly ( P\u2009=\u2009.010) lower than the RP 14.7 (\u00b11.15) and MP 14.7 (\u00b11.15) MJM scores. Analysis of simulated patient outcomes showed that the AP group was significantly less likely to stabilize the participant in the RC simulation than MP and RP groups ( P\u2009=\u2009.040). While not significant, all MJM scores for the AP group were lower in the BC, STEMI, and PTX simulations compared with the RP and MP groups. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> Physicians in distinctly different stages of their respective postgraduate career differed in several domains when assessed through a consistent high-fidelity medical simulation program. Further studies are warranted to accurately assess pedagogical differences over the medical judgment lifespan of a physician. <\/jats:p><\/jats:sec>","DOI":"10.1177\/2382120520925061","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T11:59:45Z","timestamp":1593691185000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Medical Decision-Making in the Physician Hierarchy: A Pilot Pedagogical Evaluation"],"prefix":"10.1177","volume":"7","author":[{"given":"John","family":"Rosasco","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0950-8882","authenticated-orcid":false,"given":"Michele L","family":"McCarroll","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M David","family":"Gothard","sequence":"additional","affiliation":[{"name":"Biostats, Inc., East Canton, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerry","family":"Myers","sequence":"additional","affiliation":[{"name":"HRP Cross Cutting Computational Modeling Project, NASA John H. Glenn Research Center, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard L","family":"George","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Program, Summa Health System \u2014Akron Campus, Akron, OH, USA"},{"name":"Department of Surgery, Northeast Ohio Medical University, Rootstown, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rami A","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,7,2]]},"reference":[{"key":"bibr1-2382120520925061","unstructured":"Merriam-Webster Dictionary. https:\/\/www.merriam-webster.com\/dictionary\/pedagogy. Accessed December 9, 2018."},{"key":"bibr2-2382120520925061","unstructured":"The Free Dictionary. https:\/\/medical-dictionary.thefreedictionary.com\/pedagogy. Accessed December 9, 2018."},{"key":"bibr3-2382120520925061","unstructured":"American College of Graduate Medical Education (ACGME). http:\/\/www.accme.org\/accreditation-rules\/policies\/cme-content-definition-and-examples. Accessed December 9, 2018."},{"key":"bibr4-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1353\/pbm.2011.0010"},{"key":"bibr5-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1097\/SIH.0000000000000073"},{"volume-title":"Medical Decision Making","year":"2013","author":"Sox Harold C","key":"bibr6-2382120520925061"},{"key":"bibr7-2382120520925061","first-page":"304","volume":"9","author":"Roter D","year":"2006","journal-title":"J Health Care L & Pol\u2019y"},{"key":"bibr8-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3181a82426"},{"key":"bibr9-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2014.01.014"},{"key":"bibr10-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1007\/s10459-014-9576-7"},{"key":"bibr11-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1353\/pbm.2011.0008"},{"key":"bibr12-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000121"},{"key":"bibr13-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1002\/msj.20127"},{"key":"bibr14-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-498X.2011.00501.x"},{"key":"bibr15-2382120520925061","doi-asserted-by":"publisher","DOI":"10.4137\/JMECD.S20377"},{"key":"bibr16-2382120520925061","first-page":"721","volume":"43","author":"Morrow CE","year":"2011","journal-title":"Fam Med"},{"volume-title":"Brief History of Flight Simulation","year":"2000","author":"Page RL","key":"bibr17-2382120520925061"},{"key":"bibr18-2382120520925061","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2700.70743"},{"key":"bibr19-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-0131"},{"key":"bibr20-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1097\/SIH.0b013e318222fde9"},{"key":"bibr21-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181a57bc1"},{"key":"bibr22-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1177\/2381468317715262"},{"key":"bibr23-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1136\/bmjstel-2017-000210"},{"key":"bibr24-2382120520925061","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J","year":"1988","edition":"2"},{"key":"bibr25-2382120520925061","unstructured":"American College of Graduate Medical Education (ACGME). https:\/\/www.acgme.org\/What-We-Do\/Accreditation\/Common-Program-Requirements. Accessed May 1, 2019."},{"key":"bibr26-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1111\/medu.12678"},{"volume-title":"Unequal Distribution of the U.S. Primary Care Workforce","year":"2013","author":"Petterson SM","key":"bibr27-2382120520925061"},{"key":"bibr28-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-498X.2005.00042.x"},{"key":"bibr29-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.2342"},{"key":"bibr30-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2009.08.020"},{"key":"bibr31-2382120520925061","doi-asserted-by":"publisher","DOI":"10.5694\/mja11.11579"},{"key":"bibr32-2382120520925061","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017650"}],"container-title":["Journal of Medical Education and Curricular Development"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2382120520925061","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2382120520925061","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2382120520925061","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T13:25:12Z","timestamp":1740749112000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2382120520925061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":32,"alternative-id":["10.1177\/2382120520925061"],"URL":"https:\/\/doi.org\/10.1177\/2382120520925061","relation":{},"ISSN":["2382-1205","2382-1205"],"issn-type":[{"type":"print","value":"2382-1205"},{"type":"electronic","value":"2382-1205"}],"subject":[],"published":{"date-parts":[[2020,1]]},"article-number":"2382120520925061"}}