An empirical evaluation of three components of the tetrahedron model of clinical judgment.

The tetrahedron model of clinical judgment (Rock, Bransford, Maisto, and Morey, Clin. Psychol. Rev. 7:645-661, 1987; Rock, Bransford, Morey, and Maisto, Clin. Psychol. Rev. 8:411-416, 1988) provides a framework for identifying factors that may influence the judgments of psychotherapists (e.g., clinical and counseling psychologists, psychiatrists, social workers, etc). Three parameters of the model were experimentally manipulated: mode of of presentation of clinical information, patient, and judgment task. Sixteen clinical psychology graduate student therapists evaluated two patients on axis I and axis II of the DSM-III. Judgmental accuracy was influenced by main effects and two- and three-way disordinal interactions among the three model parameters. Additionally, we found that judgemental accuracy was positively related to experience and training. This relationship was evident only when experience was assessed with specific rather than general measures, and when the clinical materials were presented in an audiovideo format and hence resembled the conditions under which the clinicians in the study acquired that training and experience. Implications for the design of training programs that facilitate competency in clinical judgment are discussed.