The Health Professional Ethics Rubric: Practical Assessment in Ethics Education for Health Professional Schools

A barrier to the development and refinement of ethics education in and across health professional schools is that there is not an agreed upon instrument or method for assessment in ethics education. The most widely used ethics education assessment instrument is the Defining Issues Test (DIT) I & II. This instrument is not specific to the health professions. But it has been modified for use in, and influenced the development of other instruments in, the health professions. The DIT contains certain philosophical assumptions (??Kohlbergian?? or ??neo-Kohlbergian??) that have been criticized in recent years. It is also expensive for large institutions to use. The purpose of this article is to offer a rubric??which the authors have named the Health Professional Ethics Rubric??for the assessment of several learning outcomes related to ethics education in health science centers. This rubric is not open to the same philosophical critiques as the DIT and other such instruments. This rubric is also practical to use. This article includes the rubric being advocated, which was developed by faculty and administrators at a large academic health science center as a part of a campus-wide ethics education initiative. The process of developing the rubric is described, as well as certain limitations and plans for revision.     

Social Exclusion and the Desire to Reconnect

People have a fundamental need to belong that, when satisfied, is linked to a variety of indicators of well‐being. The current article discusses what happens when social relationships go awry, namely through social exclusion. It seeks to resolve discrepancies in the literature by proposing that responses to social exclusion depend primarily on the prospect of social acceptance. When people feel socially excluded, they want to regain acceptance and thus may respond in ways that can help them do so. When the possibility of acceptance is not forthcoming, however, socially excluded people become selfish and antisocial. Evidence for this pattern was found at behavioral, cognitive, and biological levels. The motivation to gain acceptance may drive people to engage in negative health behaviors, such as smoking. Thus, excluded people demonstrate sensitivity to possible social acceptance, but they can exude an air of selfishness and hostility when there is no possibility of satisfying their need to belong.     

The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial

Randomised controlled studies in research environments have demonstrated dialectical behaviour therapy (DBT) to be more efficacious than treatment as usual in reducing suicidal behaviour in patients with borderline personality disorder (BPD). Limited evidence exists for the effectiveness of DBT in the treatment of BPD within routine clinical settings. This study examines the clinical and cost effectiveness of providing DBT over treatment as usual in a routine Australian public mental health service. Forty-three adult patients with BPD were provided with outpatient DBT for six months with patient outcomes compared to those obtained from patients in a wait list group receiving treatment as usual (TAU) from the same service. After six months of treatment the DBT group showed significantly greater reductions in suicidal/non-suicidal self-injury, emergency department visits, psychiatric admissions and bed days. Self-report measures were administered to a reduced sample of patients. With this group, DBT patients demonstrated significantly improved depression, anxiety and general symptom severity scores compared to TAU at six months. Average treatment costs were significantly lower for those patients in DBT than those receiving TAU. Therapists who received intensive DBT training were shown to produce significantly greater improvements in patients’ suicidal and non-suicidal self-injury than therapists who received only 4 day basic training. Further clinical improvements were achieved in patients offered an additional six months of DBT. This study demonstrates that providing DBT to patients within routine public mental health settings can be both clinically effective and cost effective.     

Susan Myers-Shirk’s <Emphasis Type="Italic">Helping the Good Shepherd</Emphasis>: A Review Essay

In this essay, I review a recent book that deals with the history of pastoral counseling. I offer an overview of the book, some criticism of the book, and a discussion of how this book relates to my own work. I argue that what Susan Myers-Shirk has identified as a “liberal moral sensibility” among pastoral counselors seems to have certain affinities with Peter Homans’s “mourning religion” thesis. I suggest that this thesis can shed light on the divide between liberal and conservative pastoral counselors, a divide that Myers-Shirk identifies, and that this thesis can build on Myers-Shirk’s historical work by providing a rubric for understanding the relationship between private experience and public theory among liberal pastoral counselors. I also suggest that Myers-Shirk should write a sequel to this book.     

Freud’s Wolf Man: A Case of Successful Religious Sublimation

This article focuses on Freud’s view that the case of Sergei Pankejeff, commonly known as Wolf Man, is an example of an unsuccessful religious sublimation. Freud focuses on the efforts by Sergei’s mother and his nurse to educate him in the Christian faith. He points out that, although these efforts were successful in making him into a piously religious boy, they contributed to the repression of his sexual attraction to his father, the arrest of his psychosexual development, and to an obsessional neurosis reflected in blasphemous thoughts and compulsive acts of religious piety. The authors suggest, however, that there was one feature of his early religious behavior that reflected a successful religious sublimation and explain why it was successful. They conclude that even small children may experience a successful religious sublimation.     

View combination: a generalization mechanism for visual recognition

We examined whether view combination mechanisms shown to underlie object and scene recognition can integrate visual information across views that have little or no three-dimensional information at either the object or scene level. In three experiments, people learned four “views” of a two dimensional visual array derived from a three-dimensional scene. In Experiments 1 and 2, the stimuli were arrays of colored rectangles that preserved the relative sizes, distances, and angles among objects in the original scene, as well as the original occlusion relations. Participants recognized a novel central view more efficiently than any of the Trained views, which in turn were recognized more efficiently than equidistant novel views. Experiment 2 eliminated presentation frequency as an explanation for this effect. Experiment 3 used colored dots that preserved only identity and relative location information, which resulted in a weaker effect, though still one that was inconsistent with both part-based and normalization accounts of recognition. We argue that, for recognition processes to function so effectively with such minimalist stimuli, view combination must be a very general and fundamental mechanism, potentially enabling both visual recognition and categorization.     

Effects of organizational citizenship behaviors on selection decisions in employment interviews

This article reports on an experiment examining the effects of job candidates' propensity to exhibit organizational citizenship behaviors (OCBs) on selection decisions made in the context of a job interview. We developed videos that manipulated candidate responses to interview questions tapping task performance and citizenship behavior content in 2 administrative positions. Results obtained from 480 undergraduates provided support for our hypotheses that job candidates who exhibited higher levels of helping, voice, and loyalty behaviors were generally rated as more competent, received higher overall evaluations, and received higher salary recommendations than job candidates who exhibited lower levels of these behaviors. These effects held even after taking into account candidate responses regarding task performance. We also found that candidate responses to OCB-related questions tended to have a greater effect on selection decisions for the higher level position (supervisor of administrative personnel) than for the lower level one (administrative assistant). Finally, content analyses of open-ended responses indicated that participants' selection decisions were particularly sensitive to candidates who exhibited low levels of voice and helping behaviors. Implications and future research are discussed.     

Approach-withdrawal and the role of the striatum in the temperament of behavioral inhibition

Behavioral inhibition is a temperament characterized in infancy and early childhood by a tendency to withdraw from novel or unfamiliar stimuli. Children exhibiting this disposition, relative to children with other dispositions, are more socially reticent, less likely to initiate interaction with peers, and more likely to develop anxiety over time. Until recently, a dominant model attributed this disposition to reductions in the threshold for engaging the circuitry supporting fear learning, particularly the amygdala. Recent work, however, also has implicated striatal circuitry and other regions that constitute components of a presumed reward system. A series of studies found that behaviorally inhibited adolescents display heightened activation of striatal structures to cues indicating an opportunity to receive reward. This article reviews evidence implicating dual roles for fear and reward circuitry in the expression of behavioral inhibition.     

Effects of message, source, and context on evaluations of employee voice behavior

The article contained a production-related error. In Table 5, the four values in the rows for Study 1 Prosocial motives and Study 1 Constructive voice should have been shifted one column to the right, to the Direct and Total Performance evaluations columns. All versions of this article have been corrected.] Although employee voice behavior is expected to have important organizational benefits, research indicates that employees voicing their recommendations for organizational change may be evaluated either positively or negatively by observers. A review of the literature suggests that the perceived efficacy of voice behaviors may be a function of characteristics associated with the (a) source, (b) message, and (c) context of the voice event. In this study, we manipulated variables from each of these categories based on a model designed to predict when voice will positively or negatively impact raters' evaluations of an employee's performance. To test our model, we conducted 3 laboratory studies in which we manipulated 2 source factors (voicer expertise and trustworthiness), 2 message factors (recommending a solution and positively vs. negatively framing the message), and 2 context factors (timing of the voice event and organizational norms for speaking up vs. keeping quiet). We also examined the mediating effects of liking, prosocial motives, and perceptions that the voice behavior was constructive on the relationships between the source, message, and context factors and performance evaluations. Generally speaking, we found that at least one of the variables from each category had an effect on performance evaluations for the voicer and that most of these effects were indirect, operating through one or more of the mediators. Implications for theory and future research are discussed.     

Luck and interests

Recent work on the nature of luck widely endorses the thesis that an event is good or bad luck for an individual only if it is significant for that individual. In this paper, I explore this thesis, showing that it raises questions about interests, well-being, and the philosophical uses of luck. In Sect. 1, I examine several accounts of significance, due to Pritchard (2005), Coffman (2007), and Rescher (1995). Then in Sect. 2 I consider what some theorists want to ‘do’ with luck, taking important examples from epistemology (explaining Gettier-style examples) and political philosophy (offering a rationale for the just distribution of resources in society), while suggesting implications for significance. Drawing together lessons from Sects. 1 and 2, I develop a new account of significance in Sect. 3 before concluding with reflections on the debate in Sect. 4.