Construct validity of the medical specialty preference inventory: A critical analysis

The Medical Specialty Preference Inventory (MSPI; Zimny, G.H. (1979). Manual for the Medical Specialty Preference Inventory. St. Louis, MO: St. Louis University School of Medicine), a measure of medical students’ interests, was substantively and empirically examined to identify an underlying factor structure. A factor model for the original MSPI based on 38 factors in five general areas was evaluated on a national sample of 1014 medical students and yielded poor fit to the data. Exploratory factor analyses at the item level utilizing the full pool of MSPI items produced an 11 factor solution with 88 items. Sub-scales were identified within this model and an 11-18 higher-order model and an 18 sub-scale model also were proposed. The relative fits of the three models were evaluated by confirmatory factor analysis with the 18 sub-scale model shown to be superior. This model was cross-validated on a separate sample of 1016 medical students and fit the data well. All sub-scales exhibited adequate internal consistency across samples. These findings support the need for a revised MSPI based on 18 scales. Implications of these findings for MSPI scoring practices are discussed along with future directions.     

Predictive validity of the medical specialty preference inventory

Medical schools can assist students by providing them with quality career counseling to help them choose a medical specialty. Many schools use interest inventories to help identify students’ specialty interests. This study examined the predictive validity of one such inventory, the Medical Specialty Preference Inventory (MSPI). In a longitudinal design, we used discriminant function analysis to examine how well students’ scores on the MSPI fit their chosen medical specialty one year later. The MSPI correctly predicted students’ future medical specialty choice 58.1% of the time. These results can help career advisors interpret MSPI scores, and identify students’ most likely medical specialty choice, as well as their second most likely choice.     

The Problem of Integrating Behavioral Health in the Medical Home and the Questions It Leads to

Psychology and other behavioral health professions have amassed a broad empirical and clinical literature suggesting many medical presentations are best responded to with the addition of evidence based behavioral interventions. Despite this, psychology has not achieved a regular presence as part of medical practice. We suggest specific reasons for the current state of affairs including clinical, operational, societal labels, financial and training dimensions. Medical, psychological, administrative, and financial perspectives are reviewed. If the goals of health care system reform are to be reached then we must identify and challenge the current limitations of health care. This paper will identify the elements that need to be changed in order for psychology to be integrated into medicine rather than excluded from its policy, planning and operations.     

我国伦理委员会建设和发展的若干思考

伦理委员会进入我国近二十年,发展的速度非常快,也逐渐向国际接轨。简述了我国伦理委员会的发展趋势;重点列举了在实际内部工作中以及在访问其他省市伦理委员会时遇到的一些问题,提出了相关的建议;最后在宏观层面上阐述几个热点话题,提出了更高层面发展伦理委员会的建议。     

Privacy in the Shadow of Nanotechnology

One of the more salient concerns about nanotechnology is the fear that it will harm privacy by collecting personal information and distributing it. This sentiment is complicated by the fact that the specific nanotechnologies that might affect privacy are located more in the near future than in the present, so our knowledge of them is more speculative than empirical. To come to terms with these issues, we will need both knowledge of the science – what is realistic and what is not – and a sense of the on-going discourses on privacy and technology that are likely to frame feelings about nanotech.     

European Regulatory Issues in Nanomedicine

The paper is intended to focus on peculiarities of nanomedicine and the importance of social concerns implicated, in order to understand if existing regulations are appropriate to maintain its safety or if a new ad hoc regulatory framework is needed. Consideration of social challenges will underline the crucial role of medical ethics in regulatory discussion.

The Impact of Couple Therapy on Service Utilization among Military Veterans: The Moderating Roles of Pretreatment Service Utilization and Premature Termination

Couple therapy reduces relational and individual distress and may affect utilization of other health services, particularly among higher service utilizers. Although average decreases in service utilization are predicted among recipients of couple therapy, low utilizers of services may appropriately increase use. The relationship between couple therapy and service utilization was examined among a sample of 179 U.S. military veterans who received treatment in Veterans Affairs (VA) specialty couple therapy clinics. Consistent with hypotheses, overall mental and physical health visits decreased from the 12 months preceding couple therapy to the 12 months following treatment. Moderator analyses showed that decreases were greatest among individuals who were rated by their therapist as having completed a full course of couple therapy, suggesting that change was attributable to intervention. Pretreatment service utilization also moderated observed change—higher utilizers’ use of services decreased substantially, whereas lower utilizers’ slightly increased. Cost analyses revealed that the estimated per person mean cost in our sample decreased by $930.33 in the year following compared to the year prior to couple therapy, as per 2008 VA cost data. As service utilization data were only available for one partner and only for 1 year posttherapy, the true magnitude of this effect may be underestimated. Our findings are relevant to policy makers as they demonstrate that couple therapy reduces average service utilization and associated costs and addresses calls for analyses of cost effectiveness of systemic interventions.     

Enhancing quality of life in medical populations: a vision for body image assessment and rehabilitation as standards of care

This article presents a vision and framework for establishing body image assessment and rehabilitation as a standard of care for patients with medical disorders. Making this vision a reality depends upon: (1) a thorough understanding of the body image construct; (2) application of many new forms of body image assessment; (3) refined understanding of body image disorder and dysfunction in the context of medical conditions; and (4) a clear plan to implement and evaluate prevention, rehabilitation, and treatment programs. Applying the many important developments that have occurred in body image theory, assessment, and intervention over the past decade holds promise for enhancing the quality of life of many individuals with medical conditions.     

Psychosocial Correlates of Medical Mistrust Among African American Men

The current study proposed and tested a conceptual model of medical mistrust in a sample of African American men (N = 216) recruited primarily from barbershops in the Midwest and Southeast regions of the United States. Potential psychosocial correlates were grouped into background factors, masculine role identity/socialization factors, recent healthcare experiences, recent socioenvironmental experiences (e.g., discrimination), and healthcare system outcome expectations (e.g., perceived racism in healthcare). Direct and mediated relationships were assessed. Results from the hierarchical regression analyses suggest that perceived racism in healthcare was the most powerful correlate of medical mistrust even after controlling for other factors. Direct effects were found for age, masculine role identity, recent patient–physician interaction quality, and discrimination experiences. Also, perceived racism in healthcare mediated the relationship between discrimination experiences and medical mistrust. These findings suggest that African American men’s mistrust of healthcare organizations is related to personal characteristics, previous negative social/healthcare experiences, and expectations of disparate treatment on the basis of race. These findings also imply that aspects of masculine role identity shape the tone of patient–physician interactions in ways that impede trust building processes.