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This study determined the extent to which medical faculty agreed when rating options in two written patient management problems in diabetes mellitus. Another purpose was to determine whether option weights (used for scoring) based on the consensus ratings of faculty actually predict the choices of well-qualified physicians. Experts showed better-than-chance agreement but with considerable variation from one part of a problem to another (31% to 73%). Nevertheless, consensus ratings were very accurate predictors of the decisions of endocrinology fellows (correlations from .60 to .97). When scoring weights are assigned to options in patient management problems, consensus (average) ratings of experts are likely to demonstrate high concurrent validity for well-qualified clinicans.

To determine the extent to which different sources of information are perceived to influence common medical decisions, 10 interns, 22 senior residents and 9 faculty general internists rated the degree of influence of house staff, general internists, subspecialists, conferences, journal reading and past experience on their decisions concerning primary prevention (vaccination), secondary prevention (screening) and drug therapy. Analysis of variance of their questionnaire data supports the following conclusions: physicians at different stages of training rely on different sources of information; as physicians advance in training the influence of generalists wanes while that of subspecialists increases; subspecialists and past experience are perceived as primarily affecting therapeutic decisions; primary prevention appears least subject to influence by prevailing information sources; and the preference for reading begins early and increases as physicians advance in training. These data suggest that designing effective medical education requires considering the level of the physician's training and the nature of the medical decision.