Genetics Education for Health Professionals: Strategies and Outcomes from a National Initiative in the United Kingdom

The National Health Service (NHS) National Genetics Education and Development Centre was established by the Department of Health in 2004 to help drive and co-ordinate genetics education for health professionals working outside specialist genetic services. This paper reviews the experiences and lessons learned to date. At the outset, it was clear that understanding the learning ethos, preferred delivery methods and attitudes towards genetics of different NHS healthcare groups was vital. We collected evidence by undertaking needs assessments with educators, practitioners and patients. We have determined the genetics knowledge, skills and attitudes which they said were needed and translated these into learning outcomes and workforce competences in a continuum of education. Beginning with core concepts introduced (and examined) pre-registration, the continuum continues with development of concepts post-registration as appropriate for role, leading to practical application and assessment of competences in the workplace. These are supported by a portfolio of resources which draw heavily on patient based scenarios to demonstrate to staff that genetics is relevant to their work, and to convince educators and policy makers that genetic education is likely to result in real clinical benefit. A long term educational policy, inclusive of learners, educationalists and their institutions must be evidence based, flexible and responsive to changes in workforce structure, provision of clinical services and conceptual and financial commitments to education. The engagement of national policy, regulatory and professional bodies is vital ().     

Children's subjective identification with social groups: a self-stereotyping approach

We contend that previous work on children's identification with social groups has looked at the mere categorization of the self in group terms and not subjective identification properly conceived. Drawing upon self-categorization theory, the present research operationalizes identification as self-stereotyping (i.e. the ability to conceive of the self in group-relevant terms). Children's self-stereotyping was explored in two studies using gender as the relevant ingroup. Study 1 required 5-, 7- and 10-year-old children, on two separate occasions, to rate their similarity to, and difference from, same-sex peers. Relative to the control condition, when gender had been made salient, children perceived significantly greater similarity, and smaller difference, between themselves and same-sex peers, thus providing evidence of a capacity for self-stereotyping and, hence, for subjective identification with a social category. Similarly, Study 2 sought trait ratings of the self both when gender had been made salient and when it had not. Boys of all ages (though not girls) rated ingroup-stereotypical traits (such as bravery and strength) to be more characteristic of the self when gender was salient than when it was not. Together, these findings suggest that the capacity for subjective identification with social groups is present at least by the age of 5 years. Moreover, they demonstrate that children's self-conceptions are contextually variable.     

Plural Agents

Genuine agents are able to engage in activity because they find it worth pursuing—because they care about it. In this respect, they differ from what might be called “mere intentional systems”: systems like chess‐playing computers that exhibit merely goal‐directed behavior mediated by instrumental rationality, without caring. A parallel distinction can be made in the domain of social activity: plural agents must be distinguished from plural intentional systems in that plural agents have cares and engage in activity because of those cares. In this paper, I sketch an account of what it is for an individual to care about things in terms of her exhibiting a certain pattern of emotions. After extending this account to make sense of an individual's caring about other agents, I then show how a certain sort of emotional connectedness among a group of people can make intelligible the group's having cares and thereby constitute that group as a plural agent. Alternative accounts of social action, by ignoring the difference between mere intentional systems and genuine agents, and so by leaving out these emotional entanglements from their accounts of social action, thereby fail to capture a whole range of social phenomena involving plural agents.     

Proxy “Actualism” *

Bernard Linsky and Edward Zalta have recently proposed a new form of actualism. I characterize the general form of their view and the motivations behind it. I argue that it is not quite new – it bears interesting similarities to Alvin Plantinga’s view – and that it definitely isn’t actualist. * I would like to thank Rae Langton, Jim Pryor, Robert Stalnaker, Ed Zalta, and, especially, an anonymous referee for Philosophical Studies for very helpful comments. Thanks also to Andrew Cortens, Michael Jubien, and an audience at the ANU for helpful discussion of an early version of this paper.     

Code of Ethics of the National Society of Genetic Counselors: Explication of Revisions

The Code of Ethics (COE) of the National Society of Genetic Counselors (NSGC) was adopted in 1992. In 2004, the NSGC leadership appointed the Code of Ethics Work Group (COEWG) to consider revisions to the NSGC COE based on advice from the NSGC legal counsel, and to consider additional changes given growth in the scope of genetic counseling practice since the adoption of the original COE. After input from the NSGC membership, changes to the COE addressing the recommendations of the NSGC legal counsel were approved in December 2004. The COEWG then reviewed ethical codes and codes of professional conduct from 22 professional organizations, deemed to have similar goals and philosophies to the NSGC, searching for themes that encompassed genetic counseling practice that might not yet be addressed in the NSGC COE. Additional revisions to the COE were proposed, and after feedback from the NSGC membership, the revised COE was approved in January 2006 by majority vote of full members of the NSGC. The explications for the 2004 and 2006 revisions are presented.     

Dissociation between the cognitive process and the phenomenological experience of TOT: effect of the anxiolytic drug lorazepam on TOT states

TOT states may be viewed as a temporary and reversible microamnesia. We investigated the effects of lorazepam on TOT states in response to general knowledge questions. The lorazepam participants produced more commission errors and more TOTs following commission errors than the placebo participants (although the rates did not change). The resolution of the TOTs was unimpaired by the drug. Neither feeling-of-knowing accuracy nor recognition were affected by lorazepam. The higher level of incorrect recalls produced by lorazepam participants may be due to the fact that they were more frequently temporarily unable to access a known item. For some of these items, the awareness of the retrieval failure resulted in a commission TOT (phenonemological TOT after a commission error). The resolution of the TOT conflict is discussed in the light of the anxiolytic and anticonflict effects of lorazepam. The data are discussed in terms of contemporary theories of TOTs and the effects that benzodiazepines have on semantic memory.     

A negative compatibility effect in priming of emotional faces

The negative compatibility effect (NCE) is the surprising result that low-visibility prime arrows facilitate responses to opposite-direction target arrows. Here we compare the priming obtained with simple arrows to the priming of emotions when categorizing human faces, which represents a more naturalistic set of stimuli and for which there are no preexisting response biases. When inverted faces with neutral expressions were presented alongside emotional prime and target faces, only strong positive priming occurred. However, when the neutral faces were made to resemble the target faces in geometry (upright orientation), time (flashing briefly), and space (appearing in the same location), positive priming gradually weakened and became negative priming. Implications for theories of the NCE are discussed.     

How can We Reduce the Distress Associated with Health Screening? From Psychological Theory to Clinical Practice

Health screening involves the early identification of risk factors for disease or early‐stage disease. There is clear evidence of a health benefit following many screening programs. However, these programs may also contribute to significant psychological distress in a significant minority of vulnerable individuals. This paper considers the impact of screening in relation to breast cancer, focusing on assessment of genetic risk for breast cancer and mammography. It then reviews how these programs presently try to minimize any distress among participants before examining how health and clinical psychological theory can contribute to the development of new interventions, focusing on the use of cognitive challenge and teaching appropriate emotion‐focused coping strategies such as mindfulness and distraction. Future research developments are then addressed.     

Health Consequences of Organizational Injustice: Tests of Main and Interactive Effects

I report the results of two studies that explored relationships between employees' justice perceptions and their psychological well-being. In both studies, the main and interactive effects of distributive justice and procedural justice accounted for significant, unique variance in employees' psychological distress. Consistent with predictions derived from a framework that integrates stress and coping theory with justice theory, relationships between procedural justice and psychological distress were stronger when distributive justice was lower. I discuss theoretical implications for the organizational justice literature and identify the studies' limitations and practical implications.     

A connectionist implementation of the theory of planned behavior: association of beliefs with exercise intention.

The theory of planned behavior suggests attitudes are a product of salient beliefs. This study examined whether aggregating salient beliefs was plausible within a more biologically centered information-processing environment. A neural network was used to examine associations among beliefs relating to exercise intention. Data on intentions and behavioral, normative, and control beliefs from 114 respondents were used to train (by error backpropagation) a neural network to associate beliefs with intention. The R-sup-2 between the network's estimated and self-reported intention was.66. The network's representation comprised 6 belief profiles associated with high, moderate, or low behavioral intention. The neural network accommodated complex relationships among beliefs and belief-intention associations and indicated how high-level constructs such as attitudes may be viewed as the best fit (compromise state) between aroused beliefs.