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.     

Active Coping and Perceived Social Support Mediate the Relationship Between Physical Health and Resilience in Liver Transplant Candidates

Without a transplant, end-stage liver disease is associated with significant morbidity and mortality. Transplant candidates endure physical and psychological stress while awaiting surgery, yet little is known about the relationship between physical health and psychological resilience during the wait-list period. This study examined predictors of psychological resilience and mediators of the relationship between physical health and psychological resilience in liver transplant candidates. Wait-listed candidates (N?=?120) from a single Northeast transplant center completed assessments of physical functioning, coping, perceived social support, and resilience. Findings revealed that physical functioning, active coping, and perceived social support were positively associated with resilience; maladaptive coping was negatively associated with resilience. Perceived social support and active coping partially mediated the relationship between physical functioning and resilience. Transplant center care providers should promote active coping skills and reinforce the importance of effective social support networks. These interventions could increase psychological resilience among liver transplant candidates.     

Metaphors can give life meaning

Conceptual metaphor theory offers a perspective on how and when people find meaning in life. Whereas life’s meaning can be difficult to grasp, metaphor compares life to a relatively more concrete and structured concept. Supporting this account, American adults (Study 1) and German undergraduates (Study 2) who framed life as a journey reported more meaning in life. The journey metaphor was particularly beneficial for individuals with low levels of perceived coherence in life (Study 2). Study 3 further explored this pattern of moderation: An accessible metaphor, compared to other life framings, benefited participants who lack a strong meaning framework. Study 4 focused on the mechanism behind metaphor’s influence. Participants who imagined events from their life journey perceived stronger interrelatedness among those events as measured with an analog spatial organization task. Perceived interrelatedness in turn predicted meaning in life, particularly for individuals with a strong preference for well-structured knowledge. Finally, participants who applied their own metaphor to life expressed greater meaning (Study 5), especially those high in personal need for structure (Study 6). An internal meta-analysis of these findings provides cumulative evidence for metaphor’s influence on perceived meaning in life and reveals moderating features of the individual.     

Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed.     

Interpreter and Spanish administration effects on the WISC performance of Mexican-American children

A study was conducted to ascertain whether the use of an interpreter and/or a regular examiner in administering the WISC would affect the test results of a group of Mexican-American children. A covariance analysis of the results indicated that the use of English in the administration of some subtests of the Verbal Scale and a Spanish administration of some scales of the performance test are likely to elicit optimum performance of Mexican-American children.     

Effects of methylphenidate (Ritalin) on selective attention in hyperactive children

This study investigated the effect of methylphenidate (Ritalin) on the selective attention of hyperactive children designated as favorable or adverse responders to stimulant medication. Using a type II incidental learning paradigm, it was found that children in the drug condition recalled more central and less incidental stimuli than those children in the placebo condition. While no differential effects on recall were found for responder type, methylphenidate did affect the spontaneous overt labeling of central stimuli by the favorable responder group. Results were interpreted in terms of the role of methylphenidate in narrowing the focus of attention. Implications for the classification of hyperactive children as favorable and adverse responders were also discussed.This paper is based on a master's thesis completed by the first author in the Department of Psychology, University of Guelph, under the supervision of the second author. The authors wish to thank J. Thomas Dalby for his assistance in the conducting of this experiment.     

The effects of unequal competence and sex on achievement and self-presentation

Female and male college students were divided into high ability and low ability groups on the basis of scores on a problem-solving task. In a second problem-solving session, they worked with a same- or opposite-sex partner whose performance they were accurately informed had been much more or much less competent than their own at the first session. The achievement of highly competent females was higher when their partner was a less competent female than a less competent male. The performance of less competent males and females was lower when their partner was a highly competent female rather than a highly competent male. Results suggested that self-presentation concerns aroused by sex of partner and relative ability can inhibit achievement.This article is based on the first author's master's thesis, submitted to Department of Educational Psychology at Pennsylvania State University. Parts of this study were presented at the American Psychological Association Convention, San Francisco, August 1977. The authors thank Nora Newcombe and Nancy Thurshwell for their helpful comments on an earlier draft of this article.     

Differences in Supervisory Needs and Expectations by Trainee Experience,Cognitive Style,and Program Membership

In this study the authors examined relationships between trainees' cognitive style, program membership, amount of practicum experience, and needs and expectations for supervision. Participants were 57 trainees in three graduate programs at a midwestern university. All respondents completed the Myers-Briggs Type Indicator (MBTI; Myers & McCaulley, 1985), the trainee version of the Supervisor Perception Form (SPF-T; Heppner & Roehlke, 1984), and the Supervisory Needs subtest of the Counselor Development Questionnaire (CDQ-SN; Reising & Daniels, 1983). Results suggested that trainees' expectations and needs regarding the supervisory experience differed by amount of practicum experience, cognitive style, and program membership. Differences due to amount of experience were more prevalent than were those due to cognitive style or to program membership.     

Community health nurses' knowledge of, attitudes toward, and involvement with adolescent contraceptive services

A national sample of community health nurses were surveyed to assess their knowledge of, attitudes toward, and involvement with reproductive health services. Results indicated that slightly more than half of the nurses provided or administered contraceptive services to adolescents, although 73% worked in settings where contraceptive services were provided to adolescents. However, only 3.6% indicated that adolescents were their primary client population. The majority (64.3%) stated that they felt as prepared to work with adolescents as they did with adult clients. While 98% were aware that most adolescents are sexually active before seeking family planning services, a minority correctly answered questions about pregnancy and contraception among adolescents. Ninety-five percent agreed that contraceptives should be available to adolescents, and 90% agreed that parental consent should not be required for adolescents seeking contraceptive services. Yet only 21.5% were aware of the implications of the Adolescent Family Life Act.     

Naturalistic memory in learning-disabled and skilled readers

Three experiments compared learning-disabled and skilled readers' performance on naturalistic memory measures, as well as investigated the relationship between memory performance on everyday and laboratory tasks. In Experiment 1, the laboratory task (sentence span task) and everyday memory measures were correlated moderately for both ability groups. Compared to skilled readers, disabled readers performed poorly on the sentence span task, and were less likely than skilled readers to remember information related to common objects and consequential events. Disabled readers were also less likely to rely on external prompts to help them recall everyday information. Experiment 2 extended the previous findings to older subjects and found that the majority of significant correlations between the laboratory (word span task) and everyday memory tasks were isolated to disabled readers. When compared to chronological-age-matched subjects, disabled readers were inferior in recency performance on the laboratory (word span) and natural serial recall (e.g., recall of U.S. presidents) tasks. Experiment 3 showed that under conditions that facilitate item accessibility, ability group differences in recall were comparable. Taken together, the findings indicate that disabled readers' memory deficits are pervasive across naturalistic and laboratory measures at the younger age, but these deficits diminish for older students. Further, the deficits that occur at the older age are due to problems in accessing knowledge.