Randy Keyworth Jack States Ronnie Detrich The Wing Institute

1. Randy Keyworth Jack States Ronnie Detrich The Wing Institute

2. What is professional judgment?

3. What is professional judgment? Critical interface between input and output when making clinical decisions. Input information data research Output strategies interventions treatment

4. What is professional judgment? It is also���� a complex set of behaviors governed by individual learning histories subject to complex contingencies

5. Why is professional judgment part of the hierarchy of evidence? Medicine Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values. David L. Sacket Centre for Evidence Based Medicine Psychology Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. American Psychological Association Education The integration of professional wisdom with the best available empirical evidence in making decisions about how to deliver instruction. Grover J. Whitehurst, Assistant Secretary, United States Department of Education

6. Why is professional judgment part of the hierarchy of evidence? social validity Professional judgment is ingrained in virtually all professional standards and is a universally accepted component of professional skills. Professional judgment is the age old �trusted method�, generally accepted, and expected by consumers. Professional judgment has tremendous influence in shaping behavior.

7. Why is professional judgment part of the hierarchy of evidence? Everyone relies upon professional judgment when making clinical decisions� when scientific research evidence is absent, incomplete or conflicting in conclusions when scientific research evidence is present (review and interpretation� single subject research) when responding to the complexity and uniqueness of behavior

8. Why is professional judgment part of the hierarchy of evidence? inevitability

9. Why is professional judgment part of the hierarchy of evidence? Experience with types of interventions, problems, strategies with specific environments, individuals Flexibility when the data is limited or absent when dealing with unique situations Inexpensive compared to costs of research Immediate often can�t wait for research to be conducted

10. The fallibility of professional judgment: Professional Arrogance: ignoring the fact that mistakes are inevitable Art vs. Science: under and over-reliance on science Lack of Feedback: absence of accurate feedback

11. The fallibility of professional judgment: a false sense of accuracy �art vs. science� decisions made on the basis of intuition empirical data not only waste of time, diminishes quality of service�it limits creativity and spontaneity professionals �trust� their professional judgment

12. The fallibility of professional judgment: a false sense of accuracy

13. The fallibility of professional judgment: a false sense of accuracy �science vs. art� failure to recognize the limitations of existing scientific research failure to recognize the role and fallibility of professional judgment

14. The fallibility of professional judgment: a false sense of accuracy Lack of Feedback lack of systematic feedback from peers or colleagues lack of organizational systems for providing feedback on outcomes related to decisions difficulty with �complex systems� to ascertain cause and effect

15. The fallibility of professional judgment: Decision makers are subject to contingencies that shape behavior lack of time, resources to stay up on literature and research individual cases external contingencies (culture, organization, systems, consumers, professionals, regulations) lack of standards for professional judgment

16. The fallibility of professional judgment: Biases that can interfere with judging progress and causation Being swayed by hindsight Being overconfident Engaging in wishful thinking Having an illusion of control Critical Thinking in Clinical Practice : Improving the Quality of Judgements and Decisions, Eileen Gambrill

17. The fallibility of professional judgment: bias Biases that can interfere with judging progress and causation Overlooking the role of chance (coincidences) Overlooking confounding causes, such as regression effects Attributing our success to our own attributes and failure to other factors Seeking only data that support preferred views Critical Thinking in Clinical Practice : Improving the Quality of Judgements and Decisions, Eileen Gambrill

18. The fallibility of professional judgment: bias Biases that can interfere with judging progress and causation Relying on observed rather than relative frequency Overlooking the interaction between predictions and their consequences Mistaking correlation for causation Relying on misleading criteria such as testimonials Critical Thinking in Clinical Practice : Improving the Quality of Judgements and Decisions, Eileen Gambrill

19. The fallibility of professional judgment: errors in reasoning

20. The fallibility of professional judgment: propaganda Systematic manipulation of information

21. The management of professional judgment: raising your batting average learn about sources of error develop strategies for minimizing mistakes track outcomes from your decisions modify decisions according to data create environmental contingencies for feedback,continuous learning, and reviewing research maintain a healthy sense of skepticism ��

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25. Evidence-based special education: Why now?

26. Evidence-based special education: Why now?

27. GAP Analysis: Adequate Research

28. Why is professional judgment part of the hierarchy of evidence? inevitability Professional judgment is critical in making sound decisions� when addressing client-centered outcomes (patient values) �by patient values we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient� David Sacket (not always �ideal solutions��context of �consumer� resources, biases, choices, preferences)

29. The fallibility of professional judgment: bias Questionable Criteria authority status is correlated with accuracy popularity and numbers acceptance of claims simply because many people accept them tradition what has been done in the past newness being swayed by the �latest intervention� manner of presentation swayed by style, persuasive style