Validation of a GP’s gut feelings questionnaire

Abstract for the EGPRN conference October 2010 at Zurich

Background: Research shows that gut feelings, i.e. a sense of alarm or a sense of reassurance, play a substantial role in the diagnostic reasoning of general practitioners (GPs). A consensus on a definition of gut feelings enabled us to operationalise the gut feelings’ concept by designing a questionnaire to record (the use of) gut feelings.

Research objective: Assessing the validity of this questionnaire in a Dutch population of experienced GPs.

Methods: No reference standard for gut feelings is available. We used the concept of construct validity, and designed 16 vignettes, based on real practice cases where a sense of alarm (n=10) or a sense of reassurance (n=6) played a major role in the policy of the attending GP, whether a clear role (group A) or an unclear role (group B). We postulated four major hypotheses and several subordinate hypotheses about the questionnaire scores in different vignettes, e.g. ‘There is a moderate to strong correlation between the group A vignettes and questions relating to a sense of reassurance or sense of alarm’ and ‘The correlation between the group B vignettes and questions relating to a sense of reassurance or sense of alarm is weak or absent’. Fifty GPs were invited to evaluate 10 of the randomly assigned vignettes and to complete questionnaires. Kappa, with quadratic weighting, was calculated for the agreement between the intended outcome of the vignettes and the gut feeling ratings.

Results: Forty-nine participants completed the questionnaires. The majority of the hypotheses were confirmed. The Kappa was 0.62. The vignettes seemed to be a useful reference standard.

Conclusion: The construct validity of the questionnaire was found to be moderate to good. The Dutch GP’s gut feelings questionnaire can be used to record the use of gut feelings in general practice and the effect of educational interventions about gut feelings.