双系统模型临床推理与医学教育

双系统模型认为在临床推理中存在分析性和非分析性两种不同的加工方式,着重介绍了基于双系统模型的临床推理的有效性,尤其是非分析加工的作用。分析性和非分析性两种思维模式在临床推理中是互补的,在诊断误差发生时只是单纯的批判直觉系统或分析系统是不明智的。提出了该模型对医学教育的启示,如增加医学课程中临床推理的教学,呈现多样化的临床案例,鼓励学生寻求反馈和直觉探索等。因此,在医学教育中培养学生双系统临床思维具有重要意义。     

A Comprehensive Literature Review of the Rank Reversal Phenomenon in the Analytic Hierarchy Process

During the last few decades, several multi‐criteria decision analysis methods have been proposed to help in selecting the best compromise alternatives. Among them, analytic hierarchy process (AHP) and its applications have attracted much attention from academics and practitioners. However, since the early 1980s, critics have raised questions regarding its proper use. One of them concerns the unacceptable changes in the ranks of the alternatives, called rank reversal, upon changing the structure of the decision. Several modifications were suggested to preserve ranks. In this paper, a classification scheme and a comprehensive literature review are presented in order to uncover, classify and interpret the current research on AHP methodologies and rank reversals. On the basis of the scheme, 61 scholarly papers from 18 journals are categorized into specific areas. The specific areas include the papers on the topics of adding/deleting alternatives and the papers published in adding/deleting criteria. The scholarly papers are also classified by (1) year of publication, (2) journal of publication, (3) authors' geographic location and (4) using the AHP in association with other methods. It is hoped that the paper can meet the needs of researchers and practitioners for convenient references of AHP methodologies and rank reversals and hence promote the future of rank reversal research. Copyright © 2012 John Wiley & Sons, Ltd.     

The first interview: Anxieties and research on initiating psychoanalysis

A qualitative clinical study of preliminary interviews by the Working Party on Initiating Psychoanalysis (WPIP) of the European Psychoanalytic Federation suggests that the unconscious dynamics in first interviews are extraordinarily powerful and that they give rise to deep unconscious anxieties in both patient and analyst, with the corresponding defences against them. Furthermore, the group dynamics observed in the clinical workshops and in the research team doing the study suggest that both the anxieties and the defences are conveyed to these groups in the form of unelaborated ‘session residues’ provoking renewed anxieties and defences in them. These findings contribute to our understanding of what goes on in first interviews, but also raise interesting questions about the psychoanalytic research process in psychoanalysis and how confrontation with the unknown is dealt with in that context. Rather than as a means to avoid anxiety, method in clinical research can be seen as a way to help the research group to contain its reactions and to tolerate them until the group finds its way to further elaboration. These points are illustrated with a clinical case drawn from the study.     

I Don’t See Color,All People Are the Same: Whiteness and Color-Blindness as Training and Supervisory Issues

This article describes cultural responsiveness training, with a particular emphasis to working with white students. Training methods, which have been effective in examining issues of power and privilege, will be described. Excerpts from previous trainees’ correspondences will be shared to demonstrate how they may have been influenced by such exercises. I will share how reflections of this work have helped to shape who I am. Recommendations for others who wish to pursue cultural sensitivity training will be offered.     

“THESE ANXIETIES ARE NOT MINE”: ADOLESCENCE,THE OEDIPAL CONFIGURATION,AND TRANSGENERATIONAL FACTORS

Part 1 of this paper draws on the film Back to the Future (1985) to highlight various aspects of adolescence, the oedipal situation, and transgenerational factors. The authors then discuss the Oedipus myth and its themes of adolescence, narcissism, identity, acting out, repetition, aggression, and the parent–child relationship, among others. Comments drawn from Winnicott's writing on oedipal issues are discussed as well. As an illustration of some of these issues, in Part 2, the authors present the clinical case of Osvaldo, age sixteen. Transference‐countertransference issues in this treatment are explored in depth.