The anthropological tradition in the philosophy of medicine

The tradition of anthropological medicine in philosophy of medicine is analyzed in relation to the earlier interest in epistemological issues in medicine around the turn of the century as well as to the current interest in medical ethics. It is argued that there is a continuity between epistemological, anthropological and ethical approaches in philosophy of medicine. Three basic ideas of anthropologically-oriented medicine are discussed: the rejection of Cartesian dualism, the notion of medicine as science of the human person, and the necessity of a comprehensive understanding of disease. Next, it is discussed why the anthropological movement has been superseded by the increasing interest in medical ethics. It is concluded that the present-day moral issues cannot be interpreted and resolved without clarification of the underlying anthropological images.     

AN EXPERIMENTAL COMPARISON OF A CONTINGENCY MANAGED COURSE WITH LARGE LECTURE METHOD1

Contingency management procedures resembling the Personalized System of Instruction (PSI) were compared with a conventional lecture method in teaching an introductory psychology course. The use of a within-subjects design in which half of the students experienced both teaching conditions made it possible to examine the reliability of test-score differences over time when subjects were balanced over conditions. In the contingency management course, material was broken down into 14 small units, each unit covering about 30 pages of text. Students were assigned to an undergraduate teaching assistant who was encouraged to develop a close working relationship with each of his/her 13 assigned students. Specifically, this meant that the assistant was to call each student by his/her first name, show an interest in the student's quiz performance, help the student understand difficult concepts, and discuss various topics of interest to the student. Each week, the teaching assistant administered up to four different 10-item multiple-choice quizzes over the week's chapter. A modified “Doomsday Contingency” required each student either to achieve a score of 80% on one of the four quizzes or drop the course. Most students passed the quiz during the first session of the week; those not passing were tutored on special areas of weakness. No student was actually forced to leave the course under the Doomsday Contingency. Although quizzes were administered on a group basis, they were scored individually while the student stood near by. In addition to the weekly quiz assignment, students under the contingency management procedures were asked to attend one lecture per week. The contingency management method departed from traditional PSI in that (1) self pacing was minimal, such that students were required to master one unit per week or drop the course, (2) teaching assistants met with students in small groups, and usually gave individual tutoring only to those students who did not pass the quiz on the first attempt, and (3) students were asked to attend one lecture per week. However, it was similar to PSI in that small units of subject matter were assigned and unit mastery was assessed through use of undergraduate assistants who delivered immediate feedback. Students in the conventional lecture group attended three 50-min lectures each week; two of these lectures followed textbook material closely, while the third, which was attended by all students, concerned material only indirectly related to the text. As a result, students in both conditions were exposed to essentially identical material. Students in the lecture condition could also obtain copies of the unit quizzes, although few did so. Course grades were determined by scores on two 45-item multiple-choice hourly exams, each covering half of the semester material (each worth 25%), and by a 90-item final exam over the entire course (worth 50%). These measures also served as the dependent variables. The experimental design employed a crossover technique in which one fourth of the students began with the contingency management method and then switched to lecture method at midsemester, while another fourth began with the lecture method and switched to contingency management. The other students stayed in the same condition throughout the semester, half under contingency management and half under the lecture method. On the last day of class, all students filled out an extensive questionnaire that assessed their opinions and attitudes about the teaching techniques. In addition to allowing for assessment of any progressive effects that the contingency management procedures might have had over time, the crossover design also permitted students to make meaningful comparisons of the two teaching methods, since half of the students experienced both methods in the same course. Although average test performance was only slightly higher under the contingency management condition, this difference occurred on each exam and was statistically reliable in each case. Further, the method did not interact with time, as it produced about a three-item advantage per half semester. On each of the three exams, teaching method accounted for between 5 and 8% of the total variance in test scores. Finally, attitude measures indicated that students experiencing half a semester of the contingency management procedures preferred them to the lecture technique, but that only those students with a full semester of contingency management rated the course significantly better than students in the full semester lecture course.     

Maximum likelihood additivity analysis

A maximum likelihood estimation procedure was developed to fit unweighted and weighted additive models to conjoint data obtained by the categorical rating, the pair comparison or the directional ranking method. The scoring algorithm used to fit the models was found to be both reliable and efficient, and the program MAXADD is capable of handling up to 300 parameters to be estimated. Practical uses of the procedure are reported to demonstrate various advantages of the procedure as a statistical method.The research reported here was supported by Grant A6394 to the author from the Natural Sciences and Engineering Research Council of Canada. Portions of this research were presented at the Psychometric Society meeting in Iowa City, Iowa, in May, 1980.Thanks are due to Jim Ramsay, Justine Sergent and anonymous reviewers for their helpful comments.Two MAXADD programs which perform the computations discussed in this paper may be obtained from the author.     

Response Selection Contributes to the Preparation Cost for Bimanual Asymmetric Movements

Movement preparation of bimanual asymmetric movements takes more time than bimanual symmetric movements in choice reaction-time conditions. This bimanual asymmetric cost may be caused by increased processing demands on any stage of movement preparation. The authors tested the contributions of each stage of movement preparation to the asymmetric cost by using the additive factors method. This involved altering the stimulus contrast, response compatibility, and response complexity. These manipulations changed the processing demands on stimulus identification, response selection, and response programming, respectively. Any manipulation with a larger reaction time cost than control suggests that stage contributes to the bimanual asymmetric cost. The bimanual asymmetric cost was larger for incompatible stimuli, which supports that response selection contributes to the bimanual asymmetric cost.     

自适应分组认知诊断测验设计及其选题策略

应用OMST在线装配模式,提出自适应分组认知诊断测验（CD-AMGT）。由于知识状态的先决关系是偏序关系,而且构成格（lattice),利用知识状态当前估计值在格中的上下确界对被试真实知识状态的可能范围进行界定,由此装配下一分组,分组中结合PWKL策略或SHE策略进行选题以兼顾诊断精度、效率和安全性。模拟实验表明,CD-AMGT与PWKL、SHE对比,当题目类型丰富时,以分类准确率略微降低为代价,其题库使用均匀性和计算用时均表现出较大优势。     

三类多层中介效应分析方法比较

比较了贝叶斯法、Monte Carlo法和参数Bootstrap法在2-1-1多层中介分析中的表现。结果发现：1)有先验信息的贝叶斯法的中介效应点估计和区间估计都最准确;2)无先验信息的贝叶斯法、Monte Carlo法、偏差校正和未校正的参数Bootstrap法的中介效应点估计和区间估计表现相当,但Monte Carlo法在第Ⅰ类错误率和区间宽度指标上表现略优于其他三种方法,偏差校正的Bootstrap法在统计检验力上表现略优于其他三种方法,但在第Ⅰ类错误率上表现最差;结果表明,当有先验信息时,推荐使用贝叶斯法;当先验信息不可得时,推荐使用Monte Carlo法。     

加强住院医师临床思维能力培养的探讨

良好的临床思维能力,是住院医师能否成为合格和高水平医生的关键。对住院医师临床思维能力的培养必须明确临床思维的哲学本质和组成的关键要素,并结合住院医师的特点去培养。要注重基本知识、基本理论和基本技能训练,把握正确的恩维程序,运用哲学思想,并以学科综合为中心。     

《周易》境遇学SWOT分析法论纲

"境遇学"是如何应对境遇的"学问",其着眼点在于提升个体生命的"境界".<周易>是集中体现中国古代"境遇学"的一部代表性著作.<周易·大象传>所预设的境遇是方方面面的,其应对之方也是随宜变化的,其中体现着非凡的道德智慧.但它属于"不占之易",可操作性不强.当代西方的SWOT分析法(又称"态势分析法")从优势、劣势、机会威胁四个方面作企业战略研究与个人生涯规划分析,与<周易>境遇学有很强的互补性.本文尝试将中国古老的"<周易>境遇学"与当代西方"SWOT分析法"相结合,提出<周易>境遇学SWOT分析法".     

基于认知设计系统的几何类比推理测验的编制及认知模型分析

认知诊断是一种新的测量范式。本研究首先根据Mulholland,Pellegrino＆Glaser和Whitely＆Schneider关于类比推理的研究结果,采用认知设计系统编制了几何类比推理测试题,并对所编制的测试题的质量进行验证,然后采用口语报告法分析解决几何类比推理所涉及的认知模型,结果表明：1）编制的几何类比推理测试题的质量比较好;2）学生解决类比推理所涉及的认知属性主要为置换、翻转、旋转、数量、大小、颜色与条纹和形状。     

拓广分部评分模型下计算机自适应测验变加权选题策略

摘要: 在计算机自适应测验中, 对0-1评分模型按a-分层选题是高效安全的策略,但多级评分模型的项目难度/步骤参数有多个而无法直接应用这种选题策略。信息函数能够很好地综合项目所有参数及能力参数,但最大信息量选题策略会影响考试安全。本文提出一种变加权选题策略,它通过调用一个与信息量相关联的函数,该函数与信息量成正比,与区分度的某个幂函数成反比,从而达到既能综合项目所有参数又按a分层的效果。在GPCM模型下用蒙特卡罗实验进行比较研究,结果显示新的选题策略总体效果比已有相关结果好。