The effects of self‐explaining when learning with text or diagrams

Self‐explaining is an effective metacognitive strategy that can help learners develop deeper understanding of the material they study. This experiment explored if the format of material (i.e., text or diagrams) influences the self‐explanation effect. Twenty subjects were presented with information about the human circulatory system and prompted to self‐explain; 10 received this information in text and 10 in diagrams. Results showed that students given diagrams performed significantly better on post‐tests than students given text. Diagrams students also generated significantly more self‐explanations that text students. Furthermore, the benefits of self‐explaining were much greater in the diagrams condition. To discover why diagrams can promote the self‐explanation effect, results are interpreted with reference to the multiple differences in the semantic, cognitive and affective properties of the texts and diagrams studied.     

The design and use of the Bioethics Consultation Form

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.     

Making peace in gestational conflicts

Mary Anne Warren's claim that there is room for only one person with full and equal rights inside a single human skin ([1], p. 63) calls attention to the vast range of moral conflict engendered by assigning full basic moral rights to fetuses. Thereby, it serves as a goad to thinking about conflicts between pregnant women and their fetuses in a way that emphasizes relationships rather than rights. I sketch out what a care orientation might suggest about resolving gestational conflicts. I also argue that the care orientation, with its commitment to the significance of the partial and the particular, cannot be absorbed within standard, impartialist moral theory.     

Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

Medical hermeneutics: Where is the “text” we are interpreting?

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty.     

Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

On the processing of arguments

This paper is concerned with the processing of informal arguments, that is, arguments involving probable truth. A model of informal argument processing is presented that is based upon Hample's (1977) expansion of Toulmin's (1958) model of argument structure. The model postulates that a claim activates an attitude, the two components forming a complex that in turn activates reasons. Furthermore, the model holds occurrence of the reason, or possibly the claim and the reason, activates values. Three experiments are described that provide support for the model.This research was supported by the Mellon Foundation and by the Office of Educational Research and Improvement of the Department of Education via an award for the Center for the Study of Learning to the Learning Research and Development Center. The contents of the paper are not necessarily the position of any of these organizations.     

Culture wars: American moral divisions across the adult lifespan

Sociologists have argued that the public moral debate in contemporary America is characterized by a “culture war,” pitting “orthodox” and “progressivist” groups against one another (Hunter, 1991). This study addressed whether the culture war is evident in the moral thinking of ordinary Americans, and whether age-related patterns exist. Sixty fundamentalist Baptists (orthodox) and 60 mainline Baptists (progressivist) evaluated and reasoned about moral issues such as divorce and abortion. Each group was divided evenly into three age groups copsisting of young, midlife, and older adults. Moral reasoning was analyzed in terms of Shweder's (1990) ethics of autonomy, community, and divinity. Within all three age groups, progressivists used the ethic of, autonomy more than orthodox participants. Orthodox participants used the ethic of divinity more than progressivists. Orthodox and progressivist groups did not differ much in their use of the ethic, of community. Very few age group differences were found within the orthodox and progressivist groups. It is concluded that morality is conceived of in markedly different wasy by orthodox and progressivist groups, and that these conceptions are consistent across age groups.     

Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.