Do medical decision analyses' largest gains grow from the smallest trees?

Some decision analysts recommend reserving their models for careful, complete study of complex problems. Others believe simple problem analyses provide the greatest gains. To clarify these issues, I tested: (1) whether simple published analyses compared to complex ones, produced results as non-intuitive; and (2) whether non-intuitiveness represented analytic gain (or equivalently, intuitive loss). Very limited data also examined (3) the gain from adding model intricacy for a given problem vs. selecting more complex problems for analysis. To assess two non-intuitiveness measures, 75 subjects (33 physicians and 42) non-physicians stated their intuitive preferences in 40 (22 published and 18 unpublished) medical dilemmas. For both physicians and non-physicians, simpler models (those with lees than 30 terminal branches in the decision tree) had about one third the non-intuitiveness of more complex ones. Three tests also supported the premise that analyses outperform intuition, therefore that on average the formers' non-intuitiveness reflects less analytic gain. In addition, for different models of the same problem, tree complexity did not correlate with gain. Thus, simpler trees may not generally gain less because they inadequately describe problems. Instead, simpler analyses may represent simpler problems, with more similar intuitive and formal solutions. If so, these findings may help us avoid some costly but unnecessary simple analyses.     

The life and times of PSI

This paper describes the essential features of the personalized system of instruction (PSI). Results from outcome research examining the effectiveness of PSI-based courses relative to traditional methods provide unequivocal support for the superiority of PSI. Parametric studies, or component analyses, show that the mastery requirement, immediate performance feedback, and review units are the key features underlying high quality student performances in PSI courses. The use of student proctors as peer-tutors, optional lectures, and selfpacing do not, in and of themselves, appear to be vital to student success in PSI courses. Despite its superiority, PSI has not supplanted traditional methods as the dominant pedagogical system in higher education. Difficulties inherent in overcoming the inertia of the lecture within our established instructional system, the implications of PSI for that system, and the Zeitgeist that permeates educational reform are the major obstacles to widespread adoption of PSI.     

Human performance on conjunctive fixed-interval fixed-ratio schedules

Eighteen young adults performed a lever-pulling task for money. Subjects were initially exposed to a fixed-interval 80-second schedule and subsequently to one of three conjunctive schedules in which the added fixed-ratio requirement was set at either 10, 80, or 120 responses. Three fixed-interval response patterns emerged: high constant rate, intermediate rate, or low rate, with most subjects displaying the last. Conjunctive performance was related to the subjects' prior fixed-interval patterns and the conjunctive ratio requirements. Low-rate subjects tended to optimize reinforcement (maximum reinforcers for minimum responses) on conjunctive schedules. Response rate was directly related to ratio requirements. Subjects' performance closely corresponded to their verbal statements of the contingencies.     

Standardized classroom management program: Social validation and replication studies in Utah and Oregon

A comprehensive validation study was conducted of the Program for Academic Survival Skills (PASS), a consultant-based, teacher-mediated program for student classroom behavior. The study addressed questions related to: (a) brief consultant training, (b) subsequent teacher training by consultants using PASS manuals, (c) contrasts between PASS experimental teachers and students and equivalent controls on measures of teacher management skills, student classroom behavior, teacher ratings of student problem behaviors, and academic achievement, (d) reported satisfaction of participants, and (e) replication of effects across two separate school sites. Results indicated that in both sites significant effects were noted in favor of the PASS experimental group for (a) teacher approval, (b) student appropriate classroom behavior, and (c) four categories of student inappropriate behavior. Program satisfaction ratings of students, teachers, and consultants were uniformly positive, and continued use of the program was reported a year later. Discussion focused upon issues of cost-effectiveness, differential site effects, and the relationship between appropriate classroom behavior and academic achievement.     

Issues in multivariate assessment of a large-scale behavioral program

Several social and research issues directly affected the development and implementation of multivariate assessment in a large community-based applied research program. Examples are drawn from experiences of the Preparation through Responsive Educational Programs Project for disruptive and skill deficient adolescents in suburban, rural, and urban junior high school settings, focusing on the assessment of academic and social skill development and long-term skill maintenance. The social context altered both project treatment and follow-up plans, requiring assessment of potentially unintended effects and decreasing consistency across sites. Future community acceptance of such programs may depend on the investigators' adaptation to diverse community pressures for program conduct and assessment and the measurement of phenomena that are not always directly observable.     

Concurrent schedules: undermatching and control by previous experimental conditions.

Five pigeons were trained on concurrent variable-interval schedules. A series of conditions in which the ratio of reinforcement rates on two keys was progressively increased and then decreased was arranged twice. The birds were then exposed to an irregular sequence of conditions. Each condition in which reinforcement was available on both keys lasted six sessions. Performance in the first, third, and sixth sessions after a condition change was analyzed. Following a condition change, preference was biased toward the preference in the last condition, but this effect largely disappeared before the sixth session of training. The birds' preferences also appeared less sensitive to reinforcement rates in early sessions after a transition. Preference in a session was a function of both the reinforcements in that session and the reinforcements obtained in as many as four or five previous sessions. The effects of reinforcements in previous sessions could be summarized by the performance in the immediately preceding session, giving a relatively simple relation between present performance and a combination of present reinforcement and prior session performance. While such hysteresis could cause undermatching when only a small number of sessions are arranged in a condition, undermatching in a stable-state performance probably arises elsewhere.     

New assessment systems for residential treatment,management, research,and evaluation: A symposium

An introduction and overview are presented to new observational assessment systems for ongoing assessment and monitoring of both staff and resident (client or patient) functioning in residential treatment programs for emotionally disturbed and mentally retarded adults.Preparation of articles and the research and development on which the articles are based was supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from the Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.A symposium presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979.     

Systems use to objectify program evaluation,clinical, and management decisions

The utility of the observational assessment systems at different levels — from local clinical to systemwide management — is outlined. An overview is provided of TSBC information applied to individualized problem identification and programming/monitoring, discharge and competency determinations, and both absolute and comparative program evaluation. The utility of SRIC information for prgoramming/monitoring and for staff training and evaluation is outlined in addition to the applied uses of the information of the assessment systems in combination. Once implemented, the continuous data from the systems allow for empirically based self-corrective improvements in the quality of mental health services while automatically providing a basis for legal documentation and accurate cost/effectiveness comparisons of mental health programs.Preparation of this article and the research and development on which the article is based were supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health, and by grants from The Joyce Foundation and the Illinois Department of Mental Health and Developmental Disabilities.Presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979, as part of a symposium on New assessment systems for residential treatment, management, research, and evaluation.     

COMPARING TREATMENT TACTICS WITH A HYPERACTIVE PRESCHOOL CHILD: STIMULANT MEDICATION AND PROGRAMMED TEACHER INTERVENTION1

Two treatment tactics, food and praise contingent on appropriate play and varying doses of methylphenidate (Ritalin), were evaluated for their effects on a preschool child's activity changes. In addition, other social, verbal, and academic behaviors were monitored to examine possible side effects of the two treatment tactics. Fewer free-play activity changes occurred during contingent reinforcement phases while medication had variable effects: increasing attention to tasks but, at higher doses, decreasing intelligibility of speech and responsiveness to mands. The study outlines a replicable model for comparing medication with alternative behavioral strategies to control hyperactivity and enhance skill development.     

SHORT- AND LONG-TERM EFFECTS OF CONTINGENCY MANAGED INSTRUCTION ON LOW,MEDIUM, AND HIGH GPA STUDENTS1

Undergraduate students had been assigned to a contingency managed course or a conventional lecture course (Du Nann and Fernald, Journal of Applied Behavior Analysis, 1976, 9 , 373–374). Two years later, some 35% (N = 86) of the original classes responded to a letter offering them $2.00 to participate in a study of their educational experiences. These students completed a multiple-choice test on material from the course, and answered questions about activities and attitudes that might have been affected by the experience in Introductory Psychology. In the contingency management course 2 yr past, students were tested each week on a chapter of textbook material with 10-item multiple-choice quizzes. The course employed a modified “Doomsday Contingency”, requiring each student to achieve 80% mastery on one of the four weekly quizzes or drop the course. Quizzes were given in small groups and scored individually, while the student stood near, by an undergraduate proctor assigned to that group. The proctor was asked to show interest in the students' quiz performances, help clear up difficult areas, and develop a friendly working relationship with each student. While many students passed the quiz on the first attempt, others were given individual tutoring, so that no one was in fact forced to drop the course. In addition to the weekly quiz assignment, students in the contingency managed group were asked to attend one lecture each week. While the contingency management course procedures had much in common with PSI (Keller, Journal of Applied Behavior Analysis, 1968, 1 , 79–89), several departures made them unique. First, self-pacing was curtailed because students were required to master one unit per week or drop the course. Second, proctors met with students in small groups, usually giving individual tutoring only to those students who did not pass the quiz on the first attempt. Finally, students were asked to attend one lecture per week. Students in the conventional lecture group were not asked to pass weekly quizzes, but instead attended three 50-min lectures each week. Two of these lectures followed the textbook material closely, while the third, which was also attended by students from the contingency management course, covered material only indirectly related to the text. This partition of lecture content allowed material to be similar across the two instructional groups. Although students in the lecture condition were told they could obtain copies of the quizzes, few of them did so. Course grades were determined by scores on two 45-item multiple-choice hourly exams, each covering half the semester material (each worth 25%), and by a 90-item final exam, which served as a measure of short-term retention. Before analyzing the follow-up data, several characteristics of the returning students were compared to determine the comparability of the sample from the two original classes. Most important, both attrition and the current mean GPAs of students from the two classes were very similar. These considerations, and others, suggested there was no systematic sampling bias to confound comparisons of student performance. A 2 (contingency management versus traditional lecture) by 3 (high, medium, and low GPA) analysis of variance was computed on the course final-exam scores and the follow-up measures. Instructional procedure and GPA interacted on the final exam such that low and medium GPA students performed significantly better under contingency management, but there was no significant effect of instructional procedure with high GPA students. On the 2-yr retention measures, students from the contingency management course performed significantly (p < 0.01) better on items drawn from quizzes used in their original course, and marginally better (p < 0.10) on items drawn from the final exams, but no interactions with GPA appeared. Furthermore, instructional method produced no significant main effects or interaction with how many students became majors or minors in psychology, how many psychology courses were later taken, how many books in psychology were reported to have been read, or on students' evaluation of the interest and importance of psychology.