On the Role of Biomedical Knowledge in Clinical Reasoning by Experts,Intermediates and Novices

In two studies the role of biomedical knowledge in the diagnosis of clinical cases was explored. Experiment 1 demonstrated a decrease in the use of biomedical knowledge with increasing expertise. This result appeared to be at variance with some findings reported in the literature (e.g., Lesgold, 1984), but supported those of others (e.g., Patel, Evans, & Groen, 1989). In Experiment 2, three possible explanations for this phenomenon were investigated: (1) rudimentation of biomedical knowledge, (2) inertia, and (3) encapsulation of biomedical knowledge under higher order concepts. Using a combined think-aloud and post-hoc explanation methodology, it was shown that experts have more in-depth biomedical knowledge than novices and subjects at intermediate levels of expertise. The findings generally support a three-stage model of expertise development in medicine consisting of acquisition of biomedical knowledge, practical experience, and integration of theoretical and experiental knowledge resulting in knowledge encapsulation.     

Prevalence of renewal of problem behavior: Replication and extension to an inpatient setting

Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.’s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive‐controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.     

The Effects of Team Context on Peer Ratings of Task and Citizenship Performance

Recent trends indicate that organizations will continue their strategic pursuit of teamwork for the foreseeable future, which will create a need for accurate assessments of individuals’ performance in teams. Although individual behaviors can be perceived and assessed by fellow team members (i.e., peers), the extent to which the team shapes perceivers’ judgments versus the target’s behavior is unclear. We conducted two studies to understand how and why team context influences peer ratings of individual performance. In study 1, we conducted cross-classified modeling on a sample of 7160 performance observations of 568 targets made by 567 perceivers, who were each members of four separate teams. Results indicated that team membership accounted for a substantially higher proportion of perceiver, relative to target, variance. In study 2, we conducted social relations modeling with a sample of 679 performance observations collected from 217 individuals nested in 46 teams to test the effects of psychological safety on perceiver, target, and team variance components. Perceptions of psychological safety accounted for proportionally larger perceiver, relative to target, variance in OCB, and task performance ratings. Altogether, team context appears to affect perceivers’ judgments of behavior more than the target’s behavior itself, implying that peer ratings sourced from different teams may not be comparable. We consider the implications for the collection and interpretation of peer performance ratings in teams and the potential implications for social cognitive theory, such that certain aspects of the team context, including psychological safety, may act as a cognitive heuristic by molding perceiver judgments of targets.

     

Are Lovers Ever One? Reconstructing the Union Theory of Love

Current analytical philosophies of romantic love tend to identify the essence of such love with one specific element, such as concern for the beloved person, valuing the beloved person or the union between the lovers. This paper will deal with different forms of the union theory of love which takes love to be the physical, psychic or ontological union of two persons. Prima facie, this theory might appear to be implausible because it has several contra-intuitive implications, and yet, I submit, it is more coherent and attractive than it seems to be. I shall distinguish three specific models and thereby offer a differentiated account of the union theory which has not previously been provided in the literature (1). I will claim that two of these models (the strong ontological model and the striving model) should be rejected (2). I shall then defend the third model (the moderate ontological model) against certain possible objections (3); but nevertheless, I shall conclude by showing how this model, too, faces further significant objections which ultimately expose the limits of the union theory of love (4). In conclusion, I will sketch the outlines of a non-reductive cluster theory of love.     

A Multimethod Examination of the Effect of Insomnia Symptoms on Anxious Responding to a Social Stressor

A growing number of studies identify insomnia symptoms as a potential risk factor for the development of anxiety disorders. However, little research has examined potential mechanisms through which insomnia could confer increased risk for anxiety. A separate line of literature suggests sleep is necessary for adaptive emotional and behavioral responding to stressors, a potential mechanism linking insomnia symptoms to anxiety risk. To test whether insomnia symptoms affect emotional and behavioral responding to an anxiety-relevant stressor, the current study recruited a sample of 99 undergraduates with varying levels of insomnia symptoms. Participants completed self-report and psychophysiological measures before, during, and after an impromptu speech task. Results indicated that, after covarying for negative affectivity, increased insomnia symptoms were significantly associated with elevated anticipatory anxiety and skin conductance response prior to the speech, and increased skin conductance response, emotion regulation difficulties, and safety aid use during the speech. Taken together, results provide evidence for the notion that insomnia symptoms are associated with maladaptive emotional and behavioral responding to an anxiety-relevant stressor.     

Christian ethics and empirical research

What significance might empirical research have for a constructive theory of Christian ethics? This article discusses this question by bringing results from a concrete empirical study of aspects of Christian ethics into conversation with two theories of the same phenomenon: those of William Schweiker and Stanley Hauerwas/Samuel Wells. After mapping the results of the empirical study to the views offered by the two constructive accounts, I discuss more generally whether empirical studies of this kind can have significance for constructive ethical theory. I discuss three possible objections against such a position: that introducing empirical research to constructive theory of Christian ethics undermines normativity, that it blocks criticism, and that its contributions are likely to be divergent, incoherent and unsystematic, thus adding little of significance to constructive theory. I argue that none of these objections can definitively exclude empirical research from constructive theory. But they certainly have implications concerning not only how empirical research might have significance, but also regarding criteria it must meet in order to legitimately claim constructive relevance. Some concrete suggestions to this effect are launched in a final argumentative move.     

A Process Model of Goal Orientation and Feedback Seeking

This study investigated antecedents of seeking different types of feedback. Individual differences in goal orientation and cost and value perceptions were proposed as antecedents of seeking different types of feedback. We hypothesized that 4 dimensions of cost and value perceptions of feedback seeking (expectancy value, appraisal value, ego cost, and self-presentation cost) are related to an individual's goal orientation. Furthermore, moving beyond a focus on the frequency of feedback seeking, we proposed that the perceptions of costs and values of feedback seeking influence the preference for and choice among 4 distinct feedback types (diagnostic, normative, assurance, and no feedback). A total of 240 students participated in a computer-simulated work setting. Results were largely consistent with the hypotheses; each goal orientation had a unique pattern of relations with the perceptions of costs and values. Cost and value perceptions, in turn, influenced preference and choice for feedback type. The theoretical implications of the research are discussed.     

Knowledge restructuring in expertise development: Evidence from pathophysiological representations of clinical cases by students and physicians

The present study was conducted to investigate qualitative changes that occur in the structure of knowledge in acquiring medical expertise. Therefore, the representation of pathophysiological knowledge was compared in subjects at four different levels of expertise. Subjects studied four clinical cases under three different time constraints, and provided a diagnosis and a pathophysiological explanation for the signs and symptoms in each case. Both diagnostic accuracy and quality of explanations increased with level of expertise. The explanations of experts, however, were less elaborate and less detailed than those of students. Constraining processing time affected the quality of explanations of advanced students, but not that of experts; conversely, the elaborateness and level of detail of explanations was affected in experts but not in students. The findings are explained by a network model integrating the two-world hypothesis in which biomedical and clinical knowledge are organised as two worlds apart (Patel, Evans, & Groen, 1989a, b) and the hypothesis of knowledge encapsulation in which biomedical knowledge becomes encapsulated into clinical knowledge (Schmidt & Boshuizen, 1992).