医学教育中医师职业精神评估方法初探

医师职业精神是每个医师所必须达到并表现出来的一个基本胜任力,相应也是医学职业教育的重要内容。对医师职业精神的细化和评估是促进医师职业精神建设的基础,各种评估方法也是促进职业精神教育的基本工具。国外目前主要的医师职业精神评估方法为伦理知识和道德推理检测,定性、定量的观察评价。观察评估主体包括自评和不同来源的他评。结合医学教育的不同阶段选用合理的职业精神评估方法,可为国内医师职业精神的建设和教育提供参考和借鉴。     

Interviewing asylum seekers: A vignette study on the questions asked to assess credibility of claims about origin and persecution

The aim of the current vignette study is to map the style, type, and themes of questions that are asked when assessing the credibility of asylum seekers' claims. Sixty‐five officials from the Swedish Migration Agency (Migrationsverket ), were asked to respond to one out of four different vignettes that contained fictitious asylum narratives. Each vignette presented the types of problems often encountered by officials at the migration board. Two of the vignettes contained no evidence of the origin of the asylum seeker. The other two contained no evidence for the claim of persecution. The asylum officials were asked to formulate five questions that would help them to assess the veracity of the applicant's claim. Our analyses showed that they mainly formulated open questions in an information gathering style. A thematic analysis of the questions revealed that when a claim about origin was assessed, asylum officials mostly asked questions about life in the country of origin, identity documents, and the flight to Europe. When the claim about persecution was assessed, in contrast, asylum officials mostly formulated case‐specific questions (e.g., how the applicant was arrested). Hence, when the credibility of claims about origin is assessed, there seems to be a typical set of questions that asylum officials use. The asylum officials seem to assume that if the applicant is truly originating from a specific country or area, he or she should have ample knowledge about that area, its customs, and frequently encountered objects.     

Evaluation of an indirect assessment for identifying tasks for functional analysis

Although a demand analysis is helpful for identifying potential establishing operations for the functional analysis (FA) demand condition, it may not always be practical due to time constraints. A potential alternative is the Negative Reinforcement Rating Scale (NRRS), an indirect assessment tool that may serve as a time efficient alternative to a demand analysis. The experimenter assessed the reliability and validity of the NRRS for 5 individuals with autism spectrum disorder who exhibited problem behavior. Multiple types of interrater reliability were assessed across 2 informants, and NRRS outcomes were compared to a subsequent demand analysis and FA to assess its validity. Reliability was high (M = 84%) for NRRS numerical ratings of categories but low (M = 32.9%) for specific examples provided. NRRS-identified highly aversive tasks yielded better correspondence with demand analysis outcomes than did NRRS-identified less aversive tasks.     

The Tromsø Social Intelligence Scale, a self-report measure of social intelligence

Social intelligence is a construct that not only appeals to laymen as a relevant individual difference but also has shown promising practical applications. Nevertheless, the use of social intelligence in research and applied settings has been limited by definitional problems, difficulties in empirically differentiating social intelligence from related constructs, and the complexity of most existing measures of social intelligence. The goal of the present research was to address some of these obstacles by designing a multi‐faceted social intelligence measure that is short and easy to administer. Three studies were conducted to develop and validate the Tromsø Social Intelligence Scale (TSIS). Study 1 examined professional psychologists’ interpretations of social intelligence to derive a consensually agreed‐upon definition of the construct. In Study 2, a large pool of social intelligence items were tested, and a 3‐factor, 21‐item scale was identified. In Study 3, the stability of this measure was confirmed.     

Axis I anxiety and mental health disorders among stuttering adolescents

PurposeThe purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents.MethodParticipants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12–14 years; n = 20) and older adolescents (15–17 years; n = 17).ResultsThirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate–severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15–17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12–14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status.DiscussionThese results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment.     

If We Build It … Will They Come? – Establishing a Cancer Genetics Services Clinic for an Underserved Predominantly Latina Cohort

Background: Cancer genetic counseling and testing is a standard of care option for appropriate families and can identify individuals at increased risk prior to diagnosis, when prevention or detection strategies are most effective. Despite documented efficacy of cancer risk reduction in high-risk individuals, underserved and minority individuals have a disproportionate cancer burden and limited access to genetic counseling. Methods: A needs assessment survey documented gaps in knowledge and interest in prevention. Satellite clinics were established at two indigent healthcare systems. Cancer genetics CME lectures were conducted and referral guidelines disseminated to clinicians who referred patients for counseling. Results: An increase in clinician knowledge was demonstrated post-CME and reflected by quality referrals. Eighty-eight percent of patients kept their appointments. In the predominantly Latina⁶ (n=77) clinic population, 71.4% were affected with cancer, and 17 mutation positive families were identified. Preliminary data shows a positive impact on patients' motivation and behavior. The majority has expressed satisfaction and reduction in anxiety. Conclusions: This study demonstrates feasibility and acceptability of cancer genetics services in this population, suggesting the potential to reduce cancer morbidity in underserved, high-risk families.“Latino” is the most common census term for individuals of Spanish, Mexican, Central and South American, Cuban, or Puerto Rican descent, referring to ethnicity, and is generally considered a more ethnically/culturally based term for individuals of the aforementioned groups. As this cohort is female the feminine noun “Latina” is used     

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

Understanding and Improving the Validity of Self-Report of Parenting

Although researchers using parental self-report data have questioned its validity (Holden, 2001) and called for more work in this area (Krevans & Gibbs, 1996; Locke & Prinz, 2002), methodological concerns regarding self-report about parenting practices have not been addressed adequately. The susceptibility of parental report to systematic distortions suggests a need for research on ways to improve self-report. This paper attempts to synthesize research findings from other fields (e.g., survey methodology) about ways to improve the validity of self-report, and to discuss the implications for self-report of parenting behaviors. Methods for improving self-report are presented for each of the 5 major tasks in responding to a question: (1) understanding the question, (2) recalling relevant behavior, (3) inference and estimation, (4) mapping the answer onto the response format, and (5) “editing” the answer for reasons of social desirability. Self-administered interviewing, audio-computer-assisted interviewing, pretesting, conversational interviewing, and the decompositional item may be among the best candidates for use in parental self-report. Recommendations are offered with respect to strategies that might prove useful in improving parental assessment of parenting, and to research efforts to evaluate the utility and potential costs of these strategies.     

Psychometric properties of the Situational Inventory of Body-Image Dysphoria-Short form in a Spanish sample

The primary objective of this study was to translate and validate Situational Inventory of Body-Image Dysphoria-Short form (SIBID-S) in a Spanish population. The scale consists of 20 items to assess the frequency of dysphoric body-image emotions in certain situational contexts, using a five-point rating scale. The questionnaire was administered to 214 women between the ages of 14 and 29 years, from primary and secondary schools and a university. Principal components analysis indicated a one-factor structure for the entire sample and both younger (<18) and older (≥18) participants. Internal consistency was high (0.94), and the test–retest reliability over 1 month ranged between 0.89 and 0.93. The SIBID-S showed good convergent validity in relation to other pertinent measures of body image, eating pathology, and self-esteem. Moreover, the SIBID-S was differentiated low-risk, subclinical eating disturbed, and clinical eating disordered patients. Results support the potential utility of the SIBID-S in the Spanish female population, including a younger group than previously studied, as well as its usefulness in the assessment of body image among females varying in degrees of eating pathology.     

Functional analysis and treatment of aggression maintained by preferred conversational topics

After an initial functional analysis of a participant's aggression showed unclear outcomes, we conducted preference and reinforcer assessments to identify preferred forms of attention that may maintain problem behavior. Next, we conducted an extended functional analysis that included a modified attention condition. Results showed that the participant's aggression was maintained by access to preferred conversational topics. A function-based intervention decreased aggression and increased an appropriate communicative response.