Behavioral science in medical education: a bibliography.

Since 1956, there have appeared 125 studies which focus on the issue of integrating behavioral science into undergraduate and graduate medical education.     

Effects of instructions and biofeedback on EEG-alpha production and the effects of EEG-alpha biofeedback training for controlling arousal in a subsequent stressful situation

In Phase One, 44 subjects participated in a 2 (instructions to increase alpha, no instructions to increase alpha) × 2 (alpha biofeedback, no alpha biofeedback) factorial experiment. Results indicated that increases in alpha production were due to instructions to increase alpha and that biofeedback had no effect on alpha production. In Phase Two, the 44 subjects from Phase One were exposed to a threat of shock whereas 11 additional subjects in a control condition were not. The design employed in Phase Two was a 2 (previous instructions and stress, no previous instructions and stress) × 2 (previous biofeedback and stress, no previous biofeedback and stress) plus 1 (no previous instructions/no previous biofeedback, no stress). Results indicated that the threat of shock was effective in increasing arousal (as measured by heart rate and skin resistance) but previous EEG-alpha biofeedback training was not effective in helping subjects decrease arousal while in the stressful situation. The results indicate that it is the instructions (and related information concerning alpha) rather than the biofeedback that is critical in alpha biofeedback training and that this training does not appear to have utility for controlling arousal under stress.     

Accessing ambiguous words during sentence comprehension

In five experiments visual processing of sentences containing either a more frequent or a less frequent usage of an ambiguous word was examined. When prior or subsequent context was pragmatically related to the relevant sense of the ambiguous word, sentences intending the more frequent sense produced longer ambiguity detection times and shorter immediate comprehension times than sentences intending the less frequent sense. This relative frequency effect was not obtained in comprehension of corresponding unambiguous sentences containing relatively high or low frequency unambiguous synonyms of the senses. These results suggest that access of ambiguous word-senses tends to occur in order of relative frequency, and that multiple access of senses tends only to occur for low frequency usages. When the preceding verb imposed selection constraints on which sense could follow, the frequency effect did not occur consistently; and it was virtually eliminated when biasing context took the form of a previous sentence containing an unambiguous synonym of the relevant sense. Implications for models of access of unambiguous words in sentences, as well as for models of processing ambiguous sentences, are considered.     

Effects of displacing aggression by annoyed and nonannoyed subjects

Low hostility-guilt subjects were either annoyed or not annoyed by an experimental confederate and given the opportunity to (a) displace aggression against a second confederate in a memory task, (b) go through a similar task but not aggress, or (c) sit quietly for a comparable period of time. All subjects were subsequently allowed to aggress against their annoyer in a “creativity” task. While displacement following annoyance did not reduce physiological arousal, it did reduce the amount of subsequent aggression against the annoyer. Conversely, the expression of aggression in subjects who were not annoyed resulted in an increase in physiological arousal, but not in subsequent aggression. No significant relationships were found between physiological arousal and subsequent aggression.     

Conditioned suppression with extinction as the signalled stimulus

The key pecking of pigeons that was maintained by a 60-sec random-interval schedule of food reinforcement was suppressed during a variable-duration warning stimulus that signalled a 5-min extinction period. The onset of the extinction period immediately followed the termination of the warning signal and was independent of the subject's responses. All subjects eventually showed nearly complete suppression of responding during the warning stimulus.     

Culturally Imposed Trauma: The Sleeping Dog Has Awakened. Will Psychoanalysis Take Heed?

This paper considers the scant attention psychoanalysis gives to cultural trauma. Three contributions to this deficiency are considered: (a) the continuing identification with our psychoanalytic forefathers’ silence regarding cultural trauma, (b) the authoritarian practices in psychoanalytic institutions that keep us overly focused on standard intrapsychic formulations to the near exclusion of cultural trauma, and (c) the fact that work with cultural trauma is difficult. To do this work requires us to “buck the system.” If we do so, we expose ourselves to toxic phenomena in a world still rife with cultural trauma. This paper, which includes clinical vignettes, is an invitation to do so.     

Factors Associated with Recruitment and Retention in Randomized Controlled Trials of Behavioral Interventions for Patients with Pediatric Type 1 Diabetes

The purpose of this study is to describe recruitment and retention experiences from three behavioral randomized controlled trials conducted among youth with type 1 diabetes. Eligibility, recruitment, and retention data were examined. Study-specific differential study participation and loss-to-follow-up analyses assessed the relations of patient characteristics with treatment completion and 6-month retention. Multivariable logistic regression identified factors independently associated with 6-month retention among all participants. Approximately 70–92 % of randomized participants completed treatment and 58–90 % were retained for follow-up. Older patients and non-Caucasian patients were less likely to enroll. Treatment completion and 6-month retention were less likely among youth who were older, had worse baseline glycemic control, lower household income, and/or unmarried parents. Some subgroups of patients are less likely to participate in research and are more susceptible to loss-to-follow-up. More work is needed to understand the facilitators and barriers to research participation.     

Rote memory and arithmetic fact processing

The goal of the study was to examine the part played by skill in memorizing arbitrary sequences in the efficiency with which normal young adults perform simple arithmetic fact problems. The first experiment showed a clear independent role for sequence memory in all arithmetic fact processing, but a lesser role for semantic retrieval. This result was particularly true for large-answer multiplication problems and subtraction and division problems with large first operands. In a second experiment, which included a visuomotor processing control task, sequence memory predicted processing of all arithmetic problems apart from small additions independently of semantic retrieval, with the most robust independent contribution being to large-answer multiplication problems. The results, which are compatible with Dehaene and colleagues' triple-code model, suggest that rote learning may be a successful way for some people to process arithmetic facts efficiently.     

Testing sociometer theory: Self-esteem and the importance of acceptance for social decision-making

The present study examined the sociometer’s role in guiding social behavior. The authors hypothesized that low self-esteem people (LSEs), but not high self-esteem people (HSEs), base their social decision-making on acceptance. Undergraduate participants were invited to join a social group and were led to believe that acceptance either was guaranteed, or was likely but not guaranteed. HSEs always were eager to join the group, whereas LSEs were keen to join the group only when acceptance was guaranteed. Furthermore, mediation analyses indicated that LSEs’ willingness to join the group was dependent on their anticipated social outcomes, which were contingent on acceptance from the group, whereas acceptance did not affect HSEs’ decision-making. These results support a sociometer account of social decision-making.