Silence is golden

Abstract

Your participation in your alma mater's admission committee has been a way for you to give back to your specialty and the institution that accepted you, educated you, and gave you the opportunity to remain involved in the academic arena. The admissions process might be an imperfect one, but it's a time-honored attempt to identify those who will flourish and hopefully contribute to our specialty. But now and then, an applicant who is not as deserving as the rest of the class slips into the ranks. You want to be sure that won't be Jim. He is well-credentialed, except for a single serious breach of integrity during dental school. But his advocates are quick to point out that his charismatic personality, articulate verbal style, and clinical competence make him worth a look by your admissions committee. Soon after all interviews are completed, the committee's decision on Jim's ranking status is divided evenly. As you drive home from the meeting, you wonder why 2 out of the 4 committee members would consider accepting him, given that breach of integrity. You've always considered integrity to be a salient issue in an applicant's character. You realize that each of the committee members had the opportunity to review Jim's academic activity record, and all were simultaneously present at his interview. The entire committee understood the exact same details of Jim's professional profile. One would expect that equally credentialed applicants should be judged with consistency. However, within many endeavors, vast discrepancies in judgment often prevail. Corporate decisions and court verdicts often vary significantly among equally qualified evaluators. One study revealed that a factor as mundane as the weather—be it cloudy or sunny—can influence the decisions of admission committee members. In an assessment of 682 university applicants, academic performance was weighted heavier on cloudy days, and nonacademic activities were weighted more heavily on sunny days. This reflected an approximate 12% increase in the ability to predict the probability of acceptance.1Simonsohn U. Clouds make nerds look good: field evidence of the impact of incidental factors on decision making.J Behav Decis Mak. 2007; 20: 143-152Crossref Scopus (35) Google Scholar In another study, pathologists reviewing the same biopsy findings found agreement in diagnosis only 61% of the time.2Kahneman D. Rosenfield A. Gandhi B. Blaser T. Noise: how to overcome the high, hidden cost of inconsistent decision making. Harv Bus Rev 2016.hbr.org/2016/10/noiseGoogle Scholar Discrepancies in judgment within orthodontics abound. Disparities in issues such as appropriate treatment fees for the same case or inconsistencies in treatment length permeate the clinical arena. Strategies for temporomandibular disorder therapy, the applicability of aligner correction, or the need for early treatment among clinicians examining the same patients can vary greatly. Disputes involving the quality of a research project or academic presentation are common. The emphasis on calibration exercises by the American Board of Orthodontics is intended to minimize variation in judgment between equally qualified examiners. The objective is to keep the playing field level regardless of the examiner assigned to the testing process. And the pursuit of evidence-based information in orthodontics continues as a step toward decreasing discrepancies in clinical decision making. Psychologists label inconsistencies of judgment between equally qualified applicants as noise. Noise is “a variability in judgment” and differs from bias.2Kahneman D. Rosenfield A. Gandhi B. Blaser T. Noise: how to overcome the high, hidden cost of inconsistent decision making. Harv Bus Rev 2016.hbr.org/2016/10/noiseGoogle Scholar In contrast, noise arises when identical subjects are judged by several reviewers with inconsistency; bias involves stereotyping by assigning preconceived notions or a systematic, subjective perception of reality.1Simonsohn U. Clouds make nerds look good: field evidence of the impact of incidental factors on decision making.J Behav Decis Mak. 2007; 20: 143-152Crossref Scopus (35) Google Scholar All dogs bite is an expression of bias against dogs. The admission committee's deadlock regarding whether to accept Jim challenges the best of fortune-tellers, as only time will tell which committee members were right and which were wrong. But there should be no noise—that is, total silence—when it comes to ethics and morality. Values about those issues need to be universal. But if the value of integrity is as silent as the night—that is, fully noise-free with utmost consistency—your admission committee should have no dissension regarding whether Jim should be admitted to your program. No earplugs are needed this time.