Multimethod study of clinical judgment

Expert and novice clinicians judged the likelihood of disease alternatives and gave thinking-aloud protocols as they evaluated simulated cases of congenital heart disease. Specific combinations of cues in the patient data were manipulated to create alternate versions of a single case so that the use of critical cues could be identified. Analyses of variance of subjects' disease judgments revealed differences between expert and novice clinicians in their use of critical cues and cue combinations. Analyses of the thinking-aloud protocols revealed that clinicians with different degrees of expertise employed different interpretations of patient data cues as well as qualitatively distinct "lines of reasoning" in reaching clinical judgments.     

Expertise and error in diagnostic reasoning

An investigation is presented in which a computer simulation model (DIAGNOSER) is used to develop and test predictions for behavior of subjects in a task of medical diagnosis. The first experiment employed a process-tracing methodology in order to compare hypothesis generation and evaluation behavior of DIAGNOSER with individuals at different levels of expertise (students, trainees, experts). A second experiment performed with only DIAGNOSER identified conditions under which errors in reasoning in the first experiment could be related to interpretation of specific data items. Predictions derived from DIAGNOSER's performance were tested in a third experiment with a new sample of subjects. Data from the three experiments indicated that (1) form of diagnostic reasoning was similar for all subjects trained in medicine and for the simulation model, (2) substance of diagnostic reasoning employed by the simulation model was parable with that of the more expert subjects, and (3) errors in subjects' reasoning were attributable to deficiencies in disease knowledge and the interpretation of specific patient data cues predicted by the simulation model.     

New students' psychological well‐being and its relation to first year academic performance in a UK university

Aims: This study (1) profiled the well‐being of first year students entering one UK university, and (2) explored whether initial well‐being and year end academic performance were correlated. Method: A total of 117 students (mean age 21, 67% female) completed the Rosenberg Self‐Esteem Scale, Clinical Outcomes in Routine Evaluation‐General Population, and Liebowitz Social Anxiety Scale; academic achievement data were collected from academic records. Results: Almost a quarter of the sample reported quasi‐clinical levels of psychological distress and moderate to very severe social anxiety. Quasi‐clinical levels of psychological distress were associated with low self‐esteem and social anxiety. No statistically significant links were found between well‐being as assessed at the beginning of the first year and academic achievement at the end of the first year. Discussion: The failure to find a link in this study between initial well‐being and academic performance at the end of the first year suggests that further investigation is required to understand how academic achievement is related to student well‐being.     

On the benefits of giving as well as receiving autonomy support: mutuality in close friendships

Two studies examined autonomy support within close friendships. The first showed that receiving autonomy support from a friend predicted the recipient's need satisfaction within the relationship and relationship quality as indexed by emotional reliance, security of attachment, dyadic adjustment, and inclusion of friend in self and that there was significant mutuality of receiving autonomy support and of each other variable. The relations of perceived autonomy support to need satisfaction and relationship quality held for both female-female and male-male pairs across the two studies. The second study replicated and extended the first, showing that receiving autonomy support also predicted psychological health. Furthermore, giving autonomy support to a friend predicted the givers' experience of relationship quality over and above the effects of receiving autonomy support from the friend. When both receiving and giving autonomy support competed for variance in predicting well-being, giving, rather than receiving, autonomy support was the stronger predictor.     

Neural correlates of "absence" in interactive simulator protocols.

While much has been written about the importance of the experience of presence in simulation protocols, the role of "absence" deserves closer attention. The role of subjective experience and neurophysiologic processes involved in fluctuating states of consciousness is a key issue in developing assessment and treatment tools using interactive immersive simulator tasks. This paper proposes that when engaging in an interactive simulator task, there are fluctuations of consciousness that determine both motivational engagement and measured performance. Rather than expecting a continuous experience, both in terms of perceptual and motor output flow, factors such as circadian fluctuations, fatigue, and actual intrusion of sleep into waking consciousness are relevant in assessments and treatments using virtual environment-based tasks. These factors are particularly relevant in treatment populations with neurological and psychiatric disorders, where such disturbances are more common. To illustrate this construct, a series of experiments examining these phenomena in relation to a standardized driving-simulation protocol to detect psychomotor impairment developed for clinical and diagnostic testing in a sleep laboratory setting are reviewed.     

Human embryonic stem cell research,justice, and the problem of unequal biological access

In 2003, Ruth Faden and eighteen other colleagues argued that a "problem of unequal biological access" is likely to arise in access to therapies resulting from human embryonic stem cell research. They showed that unless deliberate steps are taken in the United States to ensure that the human embryonic stem cell lines available to researchers mirrors the genetic diversity of the general population, white Americans will likely receive the benefits of these therapies to the relative exclusion of minority ethnic groups.     

The social-cognitive model of achievement motivation and the 2 x 2 achievement goal framework

Two studies examined hypotheses drawn from a proposed modification of the social-cognitive model of achievement motivation that centered on the 2 x 2 achievement goal framework. Implicit theories of ability were shown to be direct predictors of performance attainment and intrinsic motivation, and the goals of the 2 x 2 framework were shown to account for these direct relations. Perceived competence was shown to be a direct predictor of achievement goals, not a moderator of relations implicit theory or achievement goal effects. The results highlight the utility of attending to the approach-avoidance distinction in conceptual models of achievement motivation and are fully in line with the hierarchical model of achievement motivation.     

Antecedents of toddler gender segregation: Cognitive consonance,gender-typed toy preferences and behavioral compatibility

This study examined 3 possible antecedents of toddler gender segregation: segregating children were hypothesized to exhibit more gender awareness, gender-typed toy preferences, and gender-typed compatible play styles than their non-segregating peers. Fifty-seven, primarily White, toddlers (28 males, 29 females) with a mean age of 35 months were observed in free play to determine their degree of same-gender peer preferences and gender-typed toy preferences. Teacher ratings of the children's play styles, and the children's knowledge of gender identity, and gender role awareness were also examined. Forty-two (21% of males and 62% of females) children played with same-gender peers at above chance levels during free play, with more girls segregating than boys. There were no differences between gender segregating and non-segregating children regarding gender-typed toy preferences or gender awareness. There were differences in teachers' ratings such that the gender segregating girls were seen as the most socially sensitive, and gender segregating boys were seen as more active and disruptive then the other children. These findings are interpreted as providing support for the compatible play style explanation of gender segregation, but the gender awareness and gender-typed toy preference hypotheses were not supported.This research was partially supported by grants from the Social Sciences and Humanities Research Counsel of Canada and the Fonds Pour la Formation de Chercheures et L'aide a la Recherche of the Ministry of Education of Quebec.The authors would like to thank the staff, students and parents of the Rainbow Preschool and the St. Andrews Preschool for their cooperation, and also, Judi Gulko, Wendy Seifert, Lisa Bedard, Sharon McKeown, Ina Grey, Lorrie Sippola, and Ivan Fernandez for their help in collecting and coding the data. Kim Powlishta also provided helpful insights regarding statistical analyses. Also, we would like to thank the anonymous reviewer for helpful comments.