Training the Millennial Learner Through Experiential Evolutionary Scaffolding: Implications for Clinical Supervision in Graduate Education Programs

They are the Millennials – Generation Y. Over the next few decades, they will be entering genetic counseling graduate training programs and the workforce. As a group, they are unlike previous youth generations in many ways, including the way they learn. Therefore, genetic counselors who teach and supervise need to understand the Millennials and explore new ways of teaching to ensure that the next cohort of genetic counselors has both skills and knowledge to represent our profession well. This paper will summarize the distinguishing traits of the Millennial generation as well as authentic learning and evolutionary scaffolding theories of learning that can enhance teaching and supervision. We will then use specific aspects of case preparation during clinical rotations to demonstrate how incorporating authentic learning theory into evolutionary scaffolding results in experiential evolutionary scaffolding, a method that potentially offers a more effective approach when teaching Millennials. We conclude with suggestions for future research.     

Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents

Psychological functioning can be adversely impacted after a mild traumatic brain injury (mTBI) and may be a potential target for intervention. Despite the use of symptom ratings or structured diagnostic interview to assess long-term anxiety and depression symptoms in children and adolescents post-injury, no known studies have considered the agreement between different assessment methods and between respondents. The objectives of this study were to investigate the agreement between symptom ratings and structured diagnostic interview and between children and parents’ symptom reporting. Participants (N = 33; 9–18 years old) were recruited from the Emergency Department and assessed on average 22.8 months (SD = 5.6) after their mTBI. Anxiety and depression symptoms were evaluated via subscales of a questionnaire (Behavior Assessment System for Children) and parts of a computerized structured diagnostic interview (generalized anxiety disorder and major depressive episode; Diagnostic Interview Schedule for Children – C-DISC-IV) administered individually to children and their parents. Results showed that the inter-method agreement to identify high levels of anxiety and depression was moderate to perfect in children while it was lower in parents. Although a similar percentage of participants with elevated anxiety or depression were identified by both children and parents, the agreement between youth and parents was variable, ranging from poor to good for anxiety and poor to moderate for depression. These results highlight the importance of collecting youth and parents’ reports of anxiety and depression symptoms and considering potential discrepancies between informants’ answers.     

Pancreatic Cancer Surveillance Among High-Risk Populations: Knowledge and Intent

Pancreatic cancer is the fourth most common cancer in both men and women in the United States. It has the lowest survival rate of all cancers, largely due to the presence of non-specific symptoms, leading to diagnosis at advanced stages. While the majority of cases of pancreatic cancer are sporadic, up to 10% may be associated with an inherited predisposition. Currently, there is no standard screening protocol for pancreatic cancer, although this will change in the future as technology improves. Additionally, there is little information regarding the perceptions and intent to screen for pancreatic cancer among those with an increased risk due to a hereditary cancer predisposition syndrome, which was the objective of this study. Focus groups and individual telephone interviews were conducted, with questions focused on knowledge about pancreatic cancer and screening, perceived motivators, and perceived barriers related to each of the screening techniques currently available. Participants were recruited from the High Risk Breast Cancer and Pancreatic Cancer Registries at Huntsman Cancer Institute. The findings of this study indicated that individuals from these high-risk groups have low knowledge levels of pancreatic cancer screening, despite their desire for this information. Motivation to undergo a particular screening technique is related to whether the test is recommended by a physician, cost, degree of invasiveness, and comfort level. This information is useful to genetics professionals who counsel at-risk individuals, physicians who formulate patient care plans, and translational researchers who are developing pancreatic screening methods.     

Efficacy of the Theory of Reasoned Action in Predicting AIDS-Related Sexual Risk Reduction Among Gay Men1

This study evaluates the utility of a social psychological theory, Ajzen and Fishbein's (1980) Theory of Reasoned Action, in explicating attitude-behavior relationships concerning the practice of “safer sex” in a sample of 297 gay men. As the theory predicts, results indicate that a positive attitude toward “safer sex” and a belief that important, influential referents encouraged such behavior covaried with intention to practice sexual behaviors that minimize risk of infection with Human Immunodeficiency Virus (HIV). In turn, intention predicted levels of sexual risk-taking and employment of HIV-risk reducing strategies. Results provide support for the theory of reasoned action as a viable model of attitude-behavior relationships in AIDS-related risk reduction behaviors of gay men.     

Does Neighborhood Social Capital Buffer the Effects of Maternal Depression on Adolescent Behavior Problems?

Neighborhood characteristics have been shown to impact child well-being. However, it remains unclear how these factors combine with family characteristics to influence child development. The current study helps develop that understanding by investigating how neighborhoods directly impact child and adolescent behavior problems as well as moderate the influence of family characteristics on behavior. Using multilevel linear models, we examined the relationship among neighborhood conditions (poverty and social capital) and maternal depression on child and adolescent behavior problems. The sample included 741 children, age 5–11, and 564 adolescents, age 12–17. Outcomes were internalizing (e.g. anxious/depressed) and externalizing (e.g. aggressive/hyperactive) behavior problems. Neighborhood poverty and maternal depression were both positively associated with behavior problems for children and adolescents. However, while neighborhood social capital was not directly associated with behavior problems, the interaction of social capital and maternal depression was significantly related to behavior problems for adolescents. This interaction showed that living in neighborhoods with higher levels of social capital attenuated the relationship between maternal depression and adolescent behavior problems and confirmed the expectation that raising healthy well-adjusted children depends not only on the family, but also the context in which the family lives.     

A Cross-Language Study of Perception of Lexical Stress in English

This study investigates the question of whether language background affects the perception of lexical stress in English. Thirty native English speakers and 30 native Chinese learners of English participated in a stressed-syllable identification task and a discrimination task involving three types of stimuli (real words/pseudowords/hums). The results show that both language groups were able to identify and discriminate stress patterns. Lexical and segmental information affected the English and Chinese speakers in varying degrees. English and Chinese speakers showed different response patterns to trochaic vs. iambic stress across the three types of stimuli. An acoustic analysis revealed that two language groups used different acoustic cues to process lexical stress. The findings suggest that the different degrees of lexical and segmental effects can be explained by language background, which in turn supports the hypothesis that language background affects the perception of lexical stress in English.     

Decision Making with Uncertain Information: Learning from Women in a High Risk Breast Cancer Clinic

Patients and practitioners may believe that clinically validated laboratory tests provide definitive information. Genetic counselors know this is not always so, and the possibility of inconclusive genetic test results is often discussed in the pretest counseling session. This added discussion topic prolongs the process of genetic counseling, but if there is inadequate patient understanding, patient frustration may be high when receiving a result of uncertain significance, and patients may make decisions about subsequent medical management based on incorrect assumptions. For patients/participants in a research setting, where the clinical validity of testing may be unclear, some patients/participants may still want to use test results to influence their medical management. This paper presents findings from a qualitative study wherein 15 women from the High Risk Breast Cancer Clinic at Utah's Huntsman Cancer Institute discussed how uncertainty regarding results affected their decision making. The women were randomly selected from 3 categories--women with test results of uncertain significance; women without cancer who have a mutation; and women who are members of high-risk families, but for whom no mutation was found. Study findings will be used in future studies to better understand how to improve communication regarding uncertain results, especially in a research environment.     

Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence‐based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the “active” treatment stage after the 3–4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non‐Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non‐Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment.     

Who Cares? The Role of Job Involvement in Psychological Contract Violation

This study examined survey data from full‐time employees employed in a variety of occupations. We empirically examined how psychological involvement with one's job affects reactions to psychological contract violation. Data for control variables (i.e., age, gender, organizational tenure), the independent variable (i.e., psychological contract violation), and the moderator (i.e., job involvement) were taken at Time 1; and dependent variables (i.e., depressed mood at work, turnover intention) were taken at Time 2. Results illustrated that job involvement was an important construct in understanding individuals' negative reactions to psychological contract violations. Implications and limitations are discussed, and suggestions for future research are offered.