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This research was a study of the reliability of clinical judgment findings (multitrait) across three different information sources (psychometric tests, structured interview, and psychometric tests and interview). Subjects (N = 74) were middle and senior executives of Western Canadian technical companies; clinicians (N = 3) were trained and experienced industrial psychologists. The study investigated the similarity of clinical evaluation of personological characteristics (based on an 18-factor multitrait paradigm) across the three different information sources. Subjects were independently rated by a single clinician on 18 criterion factors in each of the three information source categories. Test information source categories required the administration of approximately 12 hrs of standardized psychological assessment questionnaires to each of the 74 subjects. Interview source category involved a 1.5-hr structured interview per subject. Combined condition pooled both test and interview conditions. Generalizability of the findings was maximized by the undertaking of the experiment in a natural situation thus increasing ecological validity. Statistical treatments used were designed to assess the similarity of a clinician's evaluation of a subject based on the different category of information available about that client. Convergence (intrarater reliability) indexes range from a high of .64 to a low of .05. Results indicate a varying degree of convergence of multitrait clinical ratings dependent on clinician and trait being rated. Results are discussed in terms of implications for practitioners involved in executive personnel selection.  相似文献   

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Alasdair MacIntyre's recent thinking both about the concept of a practice and the existence of narrative unity in human life raises important questions about how we should view clinical medicine today. Is it possible for clinical medicine to pursue patient well-being in a society (allegedly) afflicted with what he calls ‘modernity’? Here it is argued that MacIntyre's pessimistic view of the individual in contemporary society makes his call for patient autonomy in the clinical setting pointless. Finally, recent work in gerontology is cited to make three points: first, MacIntyre's pessimism about us is too extreme; second, the concept of a ‘fictionalized’ personal history is closer to reality than either MacIntyre's notion of narrative unity or the ideas of his imagined opponent (Sartre); and finally, we should not expect clinical medicine to produce patient well-being, when this is understood narratively.  相似文献   

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A framework for rationing by clinical judgment   总被引:1,自引:0,他引:1  
Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference to published population based thresholds. Notions of procedural justice are applied along with an analytical framework of six minimal requisites in order to facilitate fair bedside rationing: (1) a closed system that offers reciprocity, (2) attention to general concerns of justice, (3) respect for individual variations, (4) application of a consistent process, (5) explicitness, and (6) review of decisions. The process could be monitored for its applicability and appropriateness.  相似文献   

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The purpose of this investigation was to submit the claim of sex-related bias in clinical judgment to more thorough empirical testing than had been the case in previous research. Patient sex and stereotypic sex-role were factorially varied in a clinical protocol that was sent with related materials to 640 sex-stratified, randomly selected Members and Fellows of APA Division 29 (Psychotherapy). Approximately 30% (N=182) of those contacted returned usable data, including information about their own sex-role traditionalism and evaluation of the hypothetical patients' psychological well-being. Results confirmed the effectiveness of the stereotypic sex-role manipulation. However, no consistent effects were found for any of the four variables of interest considered in isolation or in combination, thereby refuting allegations of covert sex-related discrimination perpetrated under the aegis of psychological appraisal. Favorableness of clinical impressions was not mediated by therapists' self-reported attitudes toward the patients. The study's generally unexpected outcome was tentatively attributed to enhanced professional sensitization to the sociocultural barriers to full psychological functioning in women.This report is based on a master's thesis written by the first author under the sponsorship of the second and submitted in partial fulfillment of the requirements for the MA degree at Vanderbilt University, 1974. The research was supported in part by the Vanderbilt University Research Council. The contributions of Stephen Amira and Joseph M. Schwartz are gratefully acknowledged.  相似文献   

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Collectivism and individualism are cultural syndromes that have some common cores. Allocentrism and idiocentrism are constructs at the individual level that correspond to collectivism and individualism respectively at the cultural level. In two studies, the first with American (from Illinois) and the second with Japanese subjects, we examined the best way to measure these common cores. We also present the recommended items in two appendices, and provide information about the reliability and convergent validity of the items in these appendices. Finally, we tested the hypothesis that women will be more allocentric than men. We obtained only directional support in the US but fairly good support of this hypothesis in Japan.  相似文献   

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Clinical judgment, clinical training, and professional experience   总被引:1,自引:0,他引:1  
Reviews studies on training, experience, and clinical judgment. The results on the validity of judgments generally fail to support the value of on-the-job experience in mental health fields. The validity results do provide limited support for the value of training. Other results suggest that experienced clinicians are better than less experienced judges at knowing which of their judgments are likely to be correct and which are likely to be wrong. Reasons why clinicians have trouble learning from experience are given. Recommendations are made for improving training and clinical practice.  相似文献   

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On the basis of the classic data of Meehl (1959), I examine how clinical psychologists use the MMPI scales to judge the degree of pathology of psychiatric patients by comparing linear models of the judgment to a linear model of the criterion (the actual diagnosis of the patients). This comparison reveals that excessively heavy weight is assigned to pathological information in comparison to non-pathological information. Additional analyses reveal that this biased weighing also influences the actual diagnosis and that it is a major determinant of the accuracy of clinical judgment. It is suggested that these effects arise from a confirmation bias associated with the hypothesis that a patient has severe, rather than mild, pathology.  相似文献   

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Mental health experts often justify diagnostic and predictive judgments on the basis of “years of experience” with a particular type of person. Justification by experience is common in legal settings, and can have profound consequences for the person about whom such judgments are made. However, research shows that the validity of clinical judgment and amount of clinical experience are unrelated. The role of experience in learning varies as a function of what is to be learned. Experiments show that learning conceptual categories depends upon: (1) the learner's having clear hypotheses about the possible rule for category membership prior to receiving feedback about which instances belong to the category, and, (2) the systematic nature of such feedback, especially about erroneous categorizations. Since neither of these conditions is satisfied in clinical contexts in psychology, the subsequent failure of experience per se to enhance diagnostic or predictive validity is unsurprising. Claims that “I can tell on the basis of my experience with people of a particular type (e.g., child abusers) that this person is of that type (e.g., a child abuser)” are simply invalid.  相似文献   

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This study measured depression in sexually abused Black girls using the Children's Depression Inventory (Kovacs & A. T. Beck, 1977), the Internalization scale of the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and the Rorschach Depression Index (Exner, 1986). There were no significant correlations between these self-report, behavior observation (by parental report), and projective measures. The abused subjects had high scores on the behavior observation and Rorschach scales. Consistent with past research, negative results were obtained with the self-report instrument. We suggest that the low scores on self-report measures of distress produced by sexually abused children may be the result of guardedness or defensiveness rather than a genuinely low level of dysphoria in this population. There were no significant relations between abuse characteristics and scores on the depression measures. Scores on Rorschach measures of organizational activity (Zf) and available coping resources (EA) were generally positively related to depression within the abuse group and negatively related to depression within the control group.  相似文献   

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This study measured depression in sexually abused Black girls using the Children's Depression Inventory (Kovacs & A. T. Beck, 1977), the Internalization scale of the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and the Rorschach Depression Index (Exner, 1986). There were no significant correlations between these self-report, behavior observation (by parental report), and projective measures. The abused subjects had high scores on the behavior observation and Rorschach scales. Consistent with past research, negative results were obtained with the self-report instrument. We suggest that the low scores on self-report measures of distress produced by sexually abused children may be the result of guardedness or defensiveness rather than a genuinely low level of dysphoria in this population. There were no significant relations between abuse characteristics and scores on the depression measures. Scores on Rorschach measures of organizational activity (Zf) and available coping resources (EA) were generally positively related to depression within the abuse group and negatively related to depression within the control group.  相似文献   

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The present study examined consistency of temperament across situations and time in early childhood. On two occasions, 7 months apart, we observed the responses of 94 four-year-olds to multiple standard laboratory procedures eliciting exuberance, fear, anger, sadness, or interest. In addition, fathers' and mothers' reports on children's temperament were obtained. Observed temperament showed substantial context specificity, varying across situations within dimensions. Structural equation models revealed separate observation and parental perception factors and factorial invariance and high stability for most dimensions. Stability coefficients based on correlations varied according to level of aggregation. Measurement convergence was generally moderate and was lowest for negative emotionality. Implications for the assessment of temperament are discussed in relation to differences in consistency across dimensions and convergence between measures.  相似文献   

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Previous research in the UK has suggested that cross-cultural bias in personality disorder diagnosis might partly account for the smaller proportion of Black, relative to White, patients with personality disorder in secure psychiatric hospitals. Using the case-vignette method, we investigated cross-cultural clinical judgment bias in the diagnosis of personality disorder in African Caribbean men by 220 forensic psychiatrists in the UK. In the vignette describing possible DSM-IV antisocial personality disorder, Caucasians were 2.8 times more likely to be given a diagnosis of personality disorder than African Caribbeans. Diagnosis also varied according to the ethnicity of the clinicians. No cross-cultural bias was found in the vignette describing possible DSM-IV borderline personality disorder. These findings are important in relation to recent policies for offenders and others with personality disorder, and to the current focus on delivering race equality in mental health services in the UK. Ongoing debates about the strengths and limitations of the case-vignette method are also discussed.  相似文献   

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