Response: Clinical wisdom and evidence-based medicine are complementary

A long-debated question in the philosophy of health, and contingent disciplines, is the extent to which wise clinical practice ("clinical wisdom") is, or could be, compatible with empirically validated medicine ("evidence-based medicine"--EBM). Here we respond to Baum-Baicker and Sisti, who not only suggest that these two types of knowledge are divided due to their differing sources, but also that EBM can sometimes even hurt wise clinical practice. We argue that the distinction between EBM and clinical wisdom is poorly defined, unsupported by the methodology employed, and ultimately incorrect; crucial differences exist, we argue, not in the source of a particular piece of clinical knowledge, but in its dependability. In light of this subtle but fundamental revision, we explain how clinical wisdom and EBM are--by necessity--complementary, rather than in conflict. We elaborate on how recognizing this relationship can have far-reaching implications for the domains of clinical practice, medical education, and health policy.     

The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.     

Does Multitasking Impair Studying? Depends on Timing

It is often said that contemporary students frequently study while ‘multitasking’. However, this rather diffuse term encompasses situations that vary as to the whether the learner controls the pace at which educational materials are provided. On the basis of prior cognitive research, we hypothesize that this may well be a critical determinant of interference. Three studies required students to read or listen to several short historical narratives and also to engage in five to eight very short conversations (akin to an instant messaging conversation). In Experiment 1, subjects read the narratives; here, multitasking marginally increased total time spent reading the narratives, especially when it occurred at random times. However, final memory for the narratives was not significantly affected. Similar results were obtained when the narratives were presented in audio format and the learner could pause them while conversing (Experiment 2). By contrast, when audio narratives did not pause, interruptions reduced comprehension performance (Experiment 3). Copyright © 2013 John Wiley & Sons, Ltd.     

Measuring Intrinsic Religiosity: scales for use in mental health studies in China – a research report

While Hoge Intrinsic Religiosity Scale and the Duke University Religion Index have gained popularity in the field of religion and mental health, it remains unknown whether these scales are optimal measures of religiosity in the Chinese culture. This study is to provide some evidence to support the use of the Chinese versions of Hoge Intrinsic Religiosity Scale and the Duke University Religion Index. The data were from a community-based sample of 1039 Chinese women, 18–34 years old, in rural China. Reliability tests were performed on the two religiosity scales. Internal consistency analysis showed excellent correlation coefficients for most of the items. In addition, factor analysis produced two factors for the Hoge Intrinsic Religiosity Scale, a result consistent with previous findings in the Western, predominantly Christian cultures and societies. Moreover, our findings showed statistically significant correlations between the two religiosity scales and mental health outcomes, even though the strength of correlation between the Hoge Intrinsic Religiosity Scale and mental health outcomes appeared to be stronger. In sum, this study suggests that both the Hoge Intrinsic Religiosity Scale and the Duke University Religion Index should be appropriate instruments for detecting and measuring religiosity in the Chinese context.     

Infected by evil

In this paper I argue that there is good reason to believe that we can be influenced by fictions in ways that matter morally, and some of the time we will be unaware that we have been so influenced. These arguments fall short of proving a clear causal link between fictions and specific changes in the audience, but they do reveal rather interesting and complex features of the moral psychology of fiction. In particular, they reveal that some Platonic worries about the dangers of art cannot be dismissed lightly.     

Gender differences in sport involvement: Applying the eccles' expectancy-value model

Abstract

With the growth of the field of sport psychology has come a growing interest and concern over gender differences in achievement and participation in various sports. Why do girls and boys differ from one another in their participation rates and participation patterns in sports? Over the past 10 years, Eccles and her colleagues have put together a theoretical model for analyzing the motivational factors underlying individuals' decisions regarding achievement-related choices. This paper describes this theoretical model and uses data from two studies, one focusing on adolescents, and one focusing on elementary school-aged children, to evaluate the utility of this model for understanding gender differences in sport participation. It reaches the following conclusions: (a) the Eccles et al. model holds for sport as well as, if not better than, it does for academic subjects; (b) gender differences in children's attitudes toward sport are quite strong and emerge at a very young age; and (c) these gender differences seem to be a consequence more of gender-role socialization than of “natural” aptitudinal differences.     

Predicting Supervisor Ratings of Job Performance Using the NEO Personality Inventory

The resurging interest in identifying personality predictors of job performance has led researchers to use the five-factor model of personality as an important conceptual tool. Two recent meta-analyses illustrated the potential predictive power of the model within an employment context. In this study, we evaluated the relations between a well-validated self-report measure of the five-factor model and supervisor ratings of performance. Fifty-two women and 159 men completed the NEO Personality Inventory (Costa & McCrae, 1985) and were independently rated on various performance dimensions by their supervisors. Scores on the Conscientiousness scales correlated with all the performance ratings over this diverse number of occupational groups. Low Neuroticism and high Extraversion scores also predicted high performance. Low straightforwardness (a facet of agreeableness) was associated with ability to accomplish work-related goals and to adapt to changing work conditions. The results support the utility of the five-factor model as a predictor of job performance.