Components of the ARDS recognition metric. A) Observed Recognition: we designate an ARDS patient as recognized if their standardized tidal volume falls below the recognition line for their predicted body weight. B) Expected Recognition: we use a stepwise function relating hypoxemia and recognition probability in eq. 1 to calculate an expected baseline recognition rate for each physician. C) Recognition Metric: we compare the observed and expected recognition for each physician to account for patient presentation variability.