Health Care Reform: What History Doesn’t Teach

The paper begins by tracing the historical development of American medicine as practice, profession, and industry from the eighteenth century to the present. This historical outline emphasizes shifting conceptions of physicians and physician ethics. It lays the basis for showing, in the second section, how contemporary controversies about the physician’s role in managed care take root in medicine’s past. In the final two sections, I revisit both the historical analysis and its application to contemporary debates. I argue that historical narratives can function as “master narratives” that suppress or leave out historical facts. I bring to the surface what is covered up by the master narrative approach, and show its relevance to contemporary ethical debates. I conclude by proposing that preserving the integrity of medicine will require modifying the master narratives we tell about physicians. The integrity of medicine also offers new perspectives for thinking about managed care and the broader topic of health care reform.     

A pragmatic trial evaluating the effectiveness of web versus live training in functional behavior assessment and interventions among special educators

This study adopted a pragmatic trial with randomization to investigate the relative effectiveness of web versus live training on special educators' competence and perceived skills in functional behavior assessments (FBA) and behavior interventions. Pragmatic trials seek to determine the effectiveness of an intervention in a real-world setting to ensure better application and generalizability in routine practice conditions. The live training group received an in-person workshop delivered in a lecture format via powerpoint slides. The web training group received asynchronous online instruction via a secure website. The same training content was delivered to both groups. Participants were randomly assigned across both instructional modalities and completed two pre- and post-test measures. Results indicated that participants (N = 104) in both groups showed a significant increase in theoretical competence of FBA and behavior interventions post training. Only participants in the live workshop group reported a significant increase in perceived skill scores. When comparing outcomes across groups, the live training group gained significantly more theoretical competence in FBA and behavior interventions than that in the web training group. These results shed light on the practical implications of online platforms for professional development among in-service teachers in behavior management for schools with children having disabilities and challenging behavior.     

Psychologists' representations of gender identity between Spain and Greece: A qualitative cross-cultural study

Trans people's relationship with mental health providers carries historical tensions. Counseling services have been tied to standardized procedures or diagnostic certification of dysphoria and gender evaluations, while other psychosocial demands have been largely disregarded. Moreover, protocols and approaches focus disproportionately on Anglo-American frameworks, in terms of epistemic resources established to describe gender-diverse experiences. These issues affect both representations of gender identity and attitudes toward counseling. The present study aimed to address psychologists' accounts cross-culturally, by using qualitative data acquired through interviews with active practitioners from Spain and Greece. Eighteen qualitative semi-structured interviews were conducted in both countries in order to delve into the narratives related to trans mental health care provision. Thematic analysis using Atlas.ti was used to systematize the data. The accounts centered on gender identity representations and attributions, attitudes toward counseling, relationship with diagnoses, psychological approaches, and competent training. Findings point to the need for all-encompassing, obligatory training of psychologists on trans mental health, followed by situated considerations of the contextual factors that may contribute to experiencing gender diversity differently. More cross-cultural qualitative accounts are thus encouraged, to enrich and update the upcoming trans literature on the matter.     

Professional standards: Can they shape practice in an international context?

A summary of the career of a Russian engineer who practiced a century ago in western Europe, as well as in Russia, provides an example of how ethical standards can influence practice across national boundaries. An examination of his career and his conception of engineering, of the evolution of engineering standards and codes, and of the process of formulating codes in particular instances explains how international standards can shape practice in an international context. An earlier version of this paper was presented at the Engineering Foundation Conference on “Ethics for Science and Engineering Based International Industries”, Durham, NC, USA, 14–17 September 1997.     

Unique ethical problems in information technology

A distinction is made between moral indoctrination and instruction in ethics. It is argued that the legitimate and important field of computer ethics should not be permitted to become mere moral indoctrination. Computer ethics is an academic field in its own right with unique ethical issues that would not have existed if computer technology had not been invented. Several example issues are presented to illustrate this point. The failure to find satisfactory non-computer analogies testifies to the uniqueness of computer ethics. Lack of an effective analogy forces us to discover new moral values, formulate new moral principles, develop new policies, and find new ways to think about the issues presented to us. For all of these reasons, the kind of issues presented deserve to be addressed separately from others that might at first appear similar. At the very least, they have been so transformed by computing technology that their altered form demands special attention.     

A rose by any other name: Maintaining the name and highlighting the uniqueness of psychology as a health care profession

In this article, we reply to the comments made by Holden and Levant (preceding articles). While we agree with their goals of expanding the scope of practice of psychology, standardizing training, and educating the public and other health care professionals about the field of clinical psychology, we do not agree that changing the discipline's name to psychological physician is a necessary or sufficient means to these ends. We outline the bases for our disagreement with the name change proposal and provide other proposals for reaching the goals set forth by Holden and Levant.     

The engineer’s moral right to reputational fairness

This essay explores the issue of the moral rights of engineers. An historical case study is presented in which an accomplished, loyal, senior engineer was apparently wronged as a result of actions taken by his employer in pursuit of legitimate business interests. Belief that the engineer was wronged is justified by showing that what happened to him violated what can validly be termed one of his moral rights as an engineer: the right to reputational fairness. It is then argued that, this right notwithstanding, under certain circumstances it is morally permissible for employers to override it. The paper concludes by identifying two complementary facets of this right, discussing its scope, and indicating what is required of employers obliged to respect it in two types of action contexts. An earlier version of this paper was presented at the Annual Meeting of the Society for the History of Technology in Washington, D.C. on October 16, 1993. I am indebted to Stephanie J. Bird, Taft Broome, Deborah Johnson, Carl Mitcham, Walter Vincenti, Vivian Weil, and Caroline Whitbeck for helpful critical comments. Professor of Industrial Engineering and Engineering Management and, by courtesy, of Civil Engineering, and in the Program in Science, Technology, and Society, School of Engineering, Stanford University, Stanford, CA, USA, 94305-2120.     

Professional Training in Applied Psychology: Towards a Signature Pedagogy for Forensic Psychology Training

Forensic Psychology is a recognised and important sub‐specialty of the Psychology discipline. However, after an expansion in the number of training places that were offered when programmes were first developed, recent years have seen these diminish in response to changes in university policies, resulting from reformulated Federal government funding models. In this article, we argue that it is important for the future of specialist areas of professional psychology to not only articulate the core skills and competencies that are associated with specialist practice but also to develop unique and distinctive approaches to teaching and learning signature pedagogies. Based on the premise that forensic psychological practice is, indeed, a distinctive activity that requires different skills and, importantly, different ways of thinking about the work from other areas of professional psychology, it is suggested that professional training in this area should aim to develop a signature pedagogy which combines methods of teaching and learning that have been developed in legal training programmes with principles of problem‐based learning.     

免费师范生教师职业认同量表的编制

鉴于免费师范生的特殊性,有必要对其教师职业认同进行科学研究。本研究在前期调研与访谈的基础上,对北京某高校284名免费师范生进行问卷测试,编制了《免费师范生教师职业认同量表》,并重新选取168名免费师范生施测,采用验证性因素分析技术对量表进行结构检验。研究结果表明：（1）免费师范生的教师职业认同感包括内在价值认同、外在价值认同、意志行为认同三个维度;（2）免费师范生教师职业认同量表具有良好的信、效度。     

Examining School Counseling Students' Multicultural and Sexual Orientation Competencies Through a Cross‐Specialization Comparison

Professional school counselors have an opportunity to directly address the educational, emotional, and social problems facing lesbian, gay, bisexual, transgender, and questioning youth. The purpose of this study was to examine the multicultural and sexual orientation counselor competencies of school counseling students through a cross‐specialization comparison with community agency students. Results indicate that school counseling students had significantly lower self‐reported multicultural and sexual orientation counselor competency scores. The findings and their implications are discussed.