案例教学与医学伦理学教育

案例教学已经成为普遍的方法在我国各医学院校的医学伦理学教学中广泛使用,案例教学作为一种方法,如何客观地看待它,需结合医学伦理学教育的目的和内容。案例教学具有增加互动、加深理解和提高分析能力等优点,但如果驾驭不好,也会暴露一些弱点,而起到反作用。试图还案例教学法于医学伦理学教育的本来位置。     

案例教学的医学伦理学再造

我国医学伦理学采用案例教学法已经有二十余年的历史了。在此期间,案例教学得到了一定的发展,却也受到了诸多因素的限制。当前,中国医学伦理学的案例教学朝哪里去、怎么去等一系列新的问题摆在我们面前,这些问题必须依赖于加强我国医学伦理学软件环境的建设并对案例教学进行医学伦理学的再造方能加以解决。     

Single case research results as clinical outcomes

The movement toward evidence-based treatments, interventions, or practices pressures single case research (SCR) to use statistical summaries which have broad credibility. These summaries also need to be easily understood and useful in schools and clinics. To date the effect size families, “proportion of variance” (R², Eta²) and “standardized mean difference” (Cohen's d, Hedges' g) have little popularity in SCR. This paper demonstrates a set of alternative Clinical Outcome indices widely used in the field of medicine: Risk Difference, Relative Risk, Relative Risk Improvement, and Odds Ratio, which compare patients in treatment versus control conditions. Translated to SCR designs, the baseline phase becomes the control condition, the intervention phase becomes the treatment condition, and improvement is defined as non-overlapping data between phases. The positive attributes of Clinical Outcomes are demonstrated: (a) easily interpretable results, (b) close relationship with concept of non-overlapping data, (c) minimal data assumptions, (d) minimal statistical expertise required, (e) multiple contrasts possible for diagnostic understanding, (f) exact confidence intervals for results, and (g) close relationship to Pearson R effect size family.     

运动员退役过程的心理定性分析：成功与失败的个案研究

研究采用定性分析的方法,旨在探索我国运动员退役过程中为什么有的运动员能够顺利退役,重新开创新事业,而有的运动员却不能。研究以Torregrosa等的理论模式为设计思路,采用综合个案研究设计,选取4个成功和4个失败个案,通过访谈、文献和语言分析技术,对8个运动员退役过程中的意识和行为进行剖析。结果发现运动员在退役过程中,主要在心理状态、退役意识、退役计划、自我调节、社会支持和生活满意度6个方面,反映出成功退役的运动员与失败退役的运动员之间的不同特征。成功退役的运动员通常有一个良好的退役意识。主动计划选择退役后的事业发展;退役失败的运动员则表现为对退役问题消极回避的应对行为。文章就这些发现进行了讨论,并建议了进一步定量研究的方向     

From marine ecology to crime analysis: Improving the detection of serial sexual offences using a taxonomic similarity measure

Jaccard has been the choice similarity metric in ecology and forensic psychology for comparison of sites or offences, by species or behaviour. This paper applies a more powerful hierarchical measure—taxonomic similarity (Δ_s), recently developed in marine ecology—to the task of behaviourally linking serial crime. Forensic case linkage attempts to identify behaviourally similar offences committed by the same unknown perpetrator (called linked offences). Δ_s considers progressively higher‐level taxa, such that two sites show some similarity even without shared species. We apply this index by analysing 55 specific offence behaviours classified hierarchically. The behaviours are taken from 16 sexual offences by seven juveniles where each offender committed two or more offences. We demonstrate that both Jaccard and Δ_s show linked offences to be significantly more similar than unlinked offences. With up to 20% of the specific behaviours removed in simulations, Δ_s is equally or more effective at distinguishing linked offences than where Jaccard uses a full data set. Moreover, Δ_s retains significant difference between linked and unlinked pairs, with up to 50% of the specific behaviours removed. As police decision‐making often depends upon incomplete data, Δ_s has clear advantages and its application may extend to other crime types. Copyright © 2007 John Wiley & Sons, Ltd.     

Words, hemispheres, and processing mechanisms: A response to Marsolek and Deason (2007)

Ellis, Ansorge and Lavidor (2007) [Ellis, A.W., Ansorge, L., & Lavidor, M. (2007). Words, hemispheres, and dissociable subsystems: The effects of exposure duration, case alternation, priming and continuity of form on word recognition in the left and right visual fields. Brain and Language, 103, 292–303.] presented three experiments investigating the effects of exposure duration and format (normal vs mixed or alternating case) on the recognition of words presented in the left and right visual fields. The experiments were conducted within the framework of ‘dissociable neural subsystems theory’ developed by Marsolek and colleagues. Marsolek and Deason (2007) [Marsolek, C.J. & Deason, R.G. (2007). Hemispheric asymmetries in visual word-form processing: Progress, conflict, and evaluating theories. Brain and Language, 103, 304–307.] offer some reflections on our paper, including alternative interpretations of some of our findings. We respond to those reflections in this reply.     

Cognitive–Behavioral-Interpersonal Scenarios: Interformulator Reliability and Convergent Validity

Although a clinical case formulation can help focus treatment, little is known about the reliability and convergent validity of independently generated, cognitive–behavioral or cognitive–interpersonal formulations. Using videotapes of a semi-structured interview, pairs of clinicians independently formulated 2–3 cognitive–behavioral–interpersonal scenarios (CBISs) on each of 4 women with mood or comorbid mood and anxiety disorders. Ten licensed psychologists then rated each CBIS on 15 dimensions involving cognition, affect, symptoms, and interpersonal functioning. Reliability of the mean ratings (aggregated over the 10 raters) was >.83 for all dimensions. The set of CBISs formulated by a clinician for a patient generally demonstrated good convergent (same patient/different formulator) and discriminant (different patient/same or different formulator) validity on three factor-analytically derived general dimensions of depression, anxiety, and interpersonal functioning. Within each of three patients, pairs of formulators generally agreed on the situational components of the CBISs and demonstrated adequate to very good convergent validity of corresponding CBIS content. These results contribute to accumulating evidence for the reliability and validity of clinical scenarios as an idiographic, situation-level case formulation. Such formulations can help identify multiple cognitive, behavioral, or interpersonal intervention points in the causal chain leading to distress or dysfunction.     

Vincent van Gogh's early years as an artist

Vincent van Gogh (1853–1890) was an artist for 10 years, from 1880 to 1890. As a mature artist, he was capable of executing works in a rapid fashion, sometimes up to three a day and requiring less than an hour for each. But it took him 9 years of deliberate repetition to evolve the competencies with which to execute his works rapidly. This paper examines the first 2 years of his artistic development, a period when he consciously set about to establish the foundations for his later production, including having an overall plan, establishing a skill for drawing before proceeding to painting, experimenting judiciously in a controlled manner, and amplifying novelty by varied repetition. All these factors are considered as work objectivity, which is the notion that regardless of how far-ranging his motivations might have been, he was objective and planful in an approach to the creative enterprise.