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.     

网络游戏定制、角色依恋和忠诚度的关系研究

网络游戏具有巨大的经济前景和良好的发展态势,国内外很多企业都投入大量资金来开发网络游戏。面对激烈的市场竞争,如何吸引和留住游戏玩家,提高他们的忠诚度,是网络游戏开发商所面临的一个重要问题。本文采用问卷调查法,考察了网络游戏中的定制、角色依恋对网络游戏忠诚度的影响。结果表明：（1）网络游戏定制、角色依恋和忠诚度两两之间呈显著正相关。（2）网络游戏定制对网络游戏忠诚度没有直接影响,而是通过角色依恋的完全中介作用对网络游戏忠诚度产生影响。     

使用似然比D2统计量的题目属性定义方法

题目属性的定义是实施认知诊断评价的关键步骤, 通过有丰富经验的领域专家对题目的属性进行定义是当前的主要方法, 然而该方法受到许多主观经验因素的影响。寻找客观的题目属性定义或验证方法可以为主观定义过程提供策略支持或对结果进行改进, 因此已经引起研究者们的关注。本研究构建了一种简单高效的题目属性定义方法, 研究使用似然比D2统计量从作答数据中估计题目属性的方法, 实现属性掌握模式、题目参数和题目属性向量的联合估计。模拟研究结果表明, 使用似然比D2统计量可以有效地识别题目的属性向量, 该方法一方面可以实现新编制题目属性向量的在线估计, 另一方面可以验证已经定义的题目属性向量的准确性。     

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.     

One-to-one support for crisis intervention using online synchronous instant messaging: evaluating working alliance and client satisfaction

Young people are increasingly turning to online support, especially when traditional mental health services are not immediately available. Using a cross-sectional design, sociodemographic information and self-reported perceptions of the strength of the working alliance and client satisfaction were collected from a sample of participants (n = 78) who were users of a service providing free online support using synchronous instant messaging. The results reported a significant positive relationship between the strength of the working alliance and client satisfaction, suggesting that the strength of the working alliance remains a key component in counselling, even online. Participants, however, scored significantly lower on both the strength of the working alliance and client satisfaction, compared to participants in offline settings as reported in past studies.     

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.