Moral growth in medical students

Although students bring to medical school a fairly well established value system, the potential for moral growth through the medical school environment and experience is substantial. The educational environment poses a succession of developmental and adaptive tasks to be accomplished. Several of these tasks are discussed here, tasks that are value-laden and involve, directly or indirectly, the interplay of ethical theory and practice. During the past quarter century, the two influences that have had the greatest impact on the moral growth and moral reasoning capacity of medical students have been the incorporation into the medical school curriculum of courses in medical humanities and the admission to medical school of an increasing number of female students. The female students have brought to medical school a level or dimension of moral reasoning (morality as care or responsibility for others) to augment the male students' focus on rights and justice considerations.     

A model of short-term counselling in primary care

Counselling in prima y care settings has received much interest throughout Britain. Many surgeries employ counsellors or psychologists as part of the primay health care team. This paper describes a model of primary care counselling using an example of a case encountered in general practice. It emphasizes the advantages of offering on-site counselling services, such as better possibilities of liaison with the referring doctor and coordination of patient care. Progress was made in seven sessions of short-term cognitive-behavioural treatment and a more stigmatizing referral (for example, to psychiatric services) was avoided. The case can be seen as an appropriate referral in the context of primay care counselling and illustrates the benefit of this approach to the treatment of psychological and social problems in general practice. Names and details have been changed to preserve confidentiality.     

Correlation between Changes in Stress-Induced Corticosterone Secretion and GR mRNA Levels

The current study was conducted to determine the potential relationship between stress-induced corticosterone secretion and corticosteroid receptor mRNA levels after 5 days of intermittent stress. In particular, we were interested in the rate at which animals terminate a stress response, and how this termination may be altered by repeated stress. Adult male Sprague-Dawley rats were subjected to either 5 days of restraint stress or 5 days of an unpredictable stress paradigm. Restraint-stress induced corticosterone secretion was measured on Days 1 and 5 in both groups, and animals were killed on Day 6. Glucocorticoid receptor (GR), and mineralocorticoid (MR) mRNA levels were determined using in-situ hybridization techniques. Five days of restraint stress caused an habituation of the plasma corticosterone response to stress measured 60 and 90 min post-stress initiation; this pattern of corticosterone secretion was not observed in the animals subjected to unpredictable stress. Five days of either stress paradigm did not alter MR mRNA levels measured within the hippocampus or GR mRNA levels within the hippocampus or the medial parvocellular division of the paraventricular nucleus of the hypothalamus (mpPVN). However, an individual's GR mRNA levels measured within the CA1/2 region of the hippocampus and the mpPVN were significantly correlated with the degree of habituation of the corticosterone response to stress measured on Day 5. This suggests that an increase in the rate of termination of the stress response and levels of GR within the hippocampus and mpPVN may be functionally related.     

Reviews of current books

Pastoral Psychology -     

Action and emotion in everyday life

This study of naturally occurring behaviour employed a "beeper technique" to investigate the actions carried out by 152 subjects in eight different groups, viz. adult students, employed students who were also parents, unemployed, art students, doctoral students, alcoholics, retired people and a control group. Actions were sampled for seven subsequent days, five times per day between 8 a.m. and 10 p.m. at randomly selected occasions. Each action was rated on a number of variables, shortly after it was sampled (median delay approximately 10 min). Some of the findings were: Time allocation corresponded well with national estimates. Being under situational control was highly aversive. Instrumental and consummatory orientations correlated positively. The background variables were, on the whole, only rather weakly related to action ratings, but it was found that women and retired persons tended to report a higher level of well-being.     

Learned helplessness versus reactance: The effects of sex-role stereotypy

Both learned helplessness and reactance theories hypothesize that the effects of noncontingent reinforcement on later performance are related to the amount of experience with noncontingent reinforcement and to the subjects' expectations of control. In addition, learned helplessness theorists have suggested that performance may depend upon the causes to which subjects ascribe failure. The present study investigated these hypotheses by defining expectation of control as the degree of sex-role stereotypy and by assessing causal attributions. Forty men and 40 women were given either zero, three, four, five, or six discrimination problems for which they received noncontingent reinforcement; they were subsequently tested on anagrams and math problems. Causal attributions were rated after each set of tasks. The data suggested the following. (1) In general, under conditions of noncontingency, high masculinity subjects performed better on anagrams and low masculinity subjects performed worse on anagrams than subjects in the control conditions; stereotypic femininity was not related to performance. (2) Ratings of attributions for failing the discrimination problems were generally unrelated to performance, although there was weak support for the facilitating effects of effort attributions. (3) Subsequent to anagram and math performance, women rated external attributions higher following success and internal attributions higher following failure than did men. The implications for learned helplessness and reactance theories are discussed.The authors would like to thank Stephen Haynes and Jack McKillip for their helpful comments on earlier versions of this paper.     

THE EFFICACY OF WOMEN'S RESISTANCE STRATEGIES IN RAPE SITUATIONS

The effectiveness of women's resistance strategies for reducing the severity of sexual abuse and physical injury during sexual assaults was analyzed in a variety of assault circumstances. Data were obtained from police reports and court testimonies of 274 women (96% White, 4% Black) who either were raped or avoided rape by subsequently incarcerated violent stranger rapists. Statistical analyses showed that particular resistance strategies were effective in specific situations. Women who fought back forcefully were more likely to avoid rape than women who did not fight back, regardles of whether a waepon was present. Forceful fighting resistance was related to increased physical injury when a weapon was present, but most physical injury was caused by nonlethal weapons. Women who screamed or fled when confronted with weapons experienced less severe sexual abuse. Increased physical injury was associated with pleading, crying, or reasoning indoors. Women who used drugs or alcohol experienced more severe sexual abuse and physical injury.