Flawed Self-Assessment

Overcoming the Challenges of Direct Observation and Feedback Programs: A Qualitative Exploration of Resident and Faculty Experiences

Problem: Prior studies have reported significant negative attitudes amongst both faculty and residents toward direct observation and feedback. Numerous contributing factors have been identified, including insufficient time for direct observation and feedback, poorly understood purpose, inadequate training, disbelief in the formative intent, inauthentic resident-patient clinical interactions, undermining of resident autonomy, lack of trust between the faculty-resident dyad, and low-quality feedback information that lacks credibility. Strategies are urgently needed to overcome these challenges and more effectively engage faculty and residents in direct observation and feedback. Otherwise, the primary goals of supporting both formative and summative assessment will not be realized and the viability of competency-based medical education will be threatened. Intervention: Toward this end, recent studies have recommended numerous strategies to overcome these barriers: protected time for direct observation and feedback; ongoing faculty and resident training on goals and bidirectional, co-constructed feedback; repeated direct observations and feedback within a longitudinal resident-supervisor relationship; utilization of assessment tools with evidence for validity; and monitoring for engagement. Given the complexity of the problem, it is likely that bundling multiple strategies together will be necessary to overcome the challenges. The Direct Observation Structured Feedback Program (DOSFP) incorporated many of the recommended features, including protected time for direct observation and feedback within longitudinal faculty-resident relationships. Using a qualitative thematic approach the authors conducted semi-structured interviews, during February and March, 2019, with 10 supervisors and ten residents. Participants were asked to reflect on their experiences. Interview guide questions explored key themes from the literature on direct observation and feedback. Transcripts were anonymized. Two authors independently and iteratively coded the transcripts. Coding was theory-driven and differences were discussed until consensus was reached. The authors then explored the relationships between the codes and used a semantic approach to construct themes. Context: The DOSFP was implemented in a psychiatry continuity clinic for second and third year residents. Impact: Faculty and residents were aligned around the goals. They both perceived the DOSFP as focused on growth rather than judgment even though residents understood that the feedback had both formative and summative purposes. The DOSFP facilitated educational alliances characterized by trust and respect. With repeated practice within a longitudinal relationship, trainees dropped the performance orientation and described their interactions with patients as authentic. Residents generally perceived the feedback as credible, described feedback quality as high, and valued the two-way conversation. However, when receiving feedback with which they did not agree, residents demurred or, at most, would ask a clarifying question, but then internally discounted the feedback. Lessons Learned: Direct observation and structured feedback programs that bundle recent recommendations may overcome many of the challenges identified by previous research. Yet, residents discounted disagreeable feedback, illustrating a significant limitation and the need for other strategies that help residents reconcile conflict between external data and one's self-appraisal.

Speaking up behavior and cognitive bias in hand hygiene: Competences of German-speaking medical students

Introduction

Infection prevention and speaking up on errors are core qualities of health care providers. Heuristic effects (e.g. overconfidence) may impair behavior in daily routine, while speaking up can be inhibited by hierarchical barriers and medical team factors. Aim of this investigation was to determine, how medical students experience these difficulties for hand hygiene in daily routine.

Methods

On the base of prior investigations we developed a questionnaire with 5-point Likert ordinal scaled items and free text entries. This was tested for validity and reliability (Cronbach’s Alpha 0.89). Accredited German, Swiss and Austrian universities were contacted and medical students asked to participated in the anonymous online survey. Quantitative statistics used parametric and non-parametric tests and effect size calculations according to Lakens. Qualitative data was coded according to Janesick.

Results

1042 undergraduates of 12 universities participated. All rated their capabilities in hand hygiene and feedback reception higher than those of fellow students, nurses and physicians (p<0.001). Half of the participants rating themselves to be best educated, realized that faulty hand hygiene can be of lethal effect. Findings were independent from age, sex, academic course and university. Speaking-up in case of omitted hand hygiene was rated to be done seldomly and most rare on persons of higher hierarchic levels. Qualitative results of 164 entries showed four main themes: 1) Education methods in hand hygiene are insufficient, 2) Hierarchy barriers impair constructive work place culture 3) Hygiene and feedback are linked to medical ethics and 4) There is no consequence for breaking hygiene rules.

Discussion

Although partially limited by the selection bias, this study confirms the overconfidence-effects demonstrated in post-graduates in other settings and different professions. The independence from study progress suggests, that the effect occurs before start of the academic course with need for educational intervention at the very beginning. Qualitative data showed that used methods are insufficient and contradictory work place behavior in hospitals are frustrating. Even 20 years after “To err is human”, work place culture still is far away from the desirable.

Replication and Extension of Alicke (1985) Better-Than-Average Effect for Desirable and Controllable Traits

People tend to regard themselves as better than average. We conducted a replication and extension of Alicke’s classic study on trait dimensions in evaluations of self versus others with U.S. American Mechanical Turk workers in two waves (total N = 1,573; 149 total traits). We successfully replicated the trait desirability effect, such that participants rated more desirable traits as being more descriptive of themselves than of others (original: [Formula: see text] = .78, 95% confidence interval [CI] [.73, .81]; replication: sr 2 = .54, 95% CI [.43, .65]). The effect of desirability was stronger for more controllable traits (effect of Desirability × Controllability interaction on self–other-ratings difference; original: [Formula: see text] = .21, 95% CI [.12, .28]; replication: sr 2 = .07, 95% CI [.02, .12]). In an extension, we found that desirable traits were rated as more common for others, but not for the self. Thirty-five years later, the better-than-average effect appears to remain robust. All materials, data, and code are available at https://osf.io/2y6wj/ .

Physiotherapy students' self-assessment of performance-Are there gender differences in self-assessment accuracy?

BACKGROUND AND PURPOSE

The ability to critically appraise one's performance is paramount in physiotherapy and, although there is a paucity of research in this area, factors such as gender have been suggested to moderate the self-assessment accuracy of healthcare students. The purpose of this study was to determine a posteriori self-assessment accuracy of first-year physiotherapy students following a multiple-choice anatomy examination and to determine the specific influence of gender as a potential moderator of self-assessment accuracy.

METHOD

One-hundred-and-forty-two students (n = 72 female) enrolled in their second semester of a three-and-a-half-year physiotherapy programme participated in the study. A purpose-made self-assessment questionnaire was used to measure the students' self-assessment ability, estimating their performance on 11 different anatomical categories following the examination. This was then compared with a criterion measure matched with the questionnaire. The accuracy of the students' self-assessment was investigated by the relation between self-assessment and objective performance.

RESULTS

The study showed low-to-moderate self-assessment accuracy (rho ranging from 0.318 to 0.675) with the students underestimating their performance in six out of 11 categories (p < 0.019). Gender did not contribute significantly to differences in accuracy between students' self-assessment and the criterion measure (p = 0.474).

CONCLUSION

According to the results, the students demonstrated low-to-moderate self-assessment accuracy when compared to their performance. Notably, the results clearly showed that gender did not function as a moderator of self-assessment accuracy among first-year physiotherapy students.

Search Dog Handlers Show Positive Bias When Scoring Their Own Dog's Performance

Self-assessments of performance are commonly used in the human workplace, although compared to peer or supervisor ratings, they may be subject to positive biases or leniency. The use of subjective ratings scales in animal sciences is also common, although little consideration is usually given to possible rater bias. Dog handlers, work very closely and form strong relationships with their dogs and are also best placed to monitor dog performance since they often work in isolation. Previous work found ratings of search dog performance correlated well between experienced dog trainers, instructors, and scientists; but until now, there has been no investigation into ratings made by a dog's own handler. We compared handlers' subjective assessment of their own dog's search performance to scores given by other handlers and in a second study, to scores made by impartial raters. We found that handlers generally showed leniency; for example scoring their own dogs more favorably for Control (responsiveness to commands) and Strength of Indication. But the degree of bias varied with the trait being scored and between raters. Such differences may be attributable to greater desirability or importance of favorable scores for certain traits, or a lack of clarity of their precise meaning. Handlers may vary in susceptibility to bias due to differing levels of experience and the extent to which they view their dog's ability as dependent on their own. The exact causes require further investigation. We suggest working dog agencies provide rater-training to overcome leniency, improve reliability and validity, and to increase handler's motivation to provide accurate assessments. This study represents one of a series of steps to formulate robust, validated and evidence-based performance rating systems and has relevance to any situation where raters assess their own performance or others (particularly where they may have a vested interest in, or loyalty toward, the ratee).

Affective agnosia: a core affective processing deficit in the alexithymia spectrum

Affective agnosia, an impairment in knowing how one feels emotionally, has been described as an extreme deficit in the experience and expression of emotion that may confer heightened risk for adverse medical outcomes. Alexithymia, by contrast, has been proposed as an over-arching construct that includes a spectrum of deficits of varying severity, including affective agnosia at the more severe end. This perspective has been challenged by Taylor and colleagues, who argue that the concept of affective agnosia is unnecessary. We compare these two perspectives by highlighting areas of agreement, reasons for asserting the importance of the affective agnosia concept, errors in Taylor and colleagues’ critique, and measurement issues. The need for performance-based measures of the ability to mentally represent emotional states in addition to metacognitive measures is emphasized. We then draw on a previously proposed three-process model of emotional awareness that distinguishes affective response generation, conceptualization and cognitive control processes which interact to produce a variety of emotional awareness and alexithymia phenotypes - including affective agnosia. The tools for measuring these three processes, their neural substrates, the mechanisms of brain-body interactions that confer heightened risk for adverse medical outcomes, and the differential treatment implications for different kinds of deficits are described. By conceptualizing alexithymia as a spectrum of deficits, the opportunity to match specific deficit mechanisms with personalized treatment for patients will be enhanced.

Students’ Self-Efficacy, Causal Attribution Habits and Test Grades

Why do students vary in their performance on exams? It may be that their test preparation is insufficient because they overestimate their anticipated grade. Our study investigates four issues related to performance on a final examination. First, we analyze whether students’ ability to accurately predict their grade and their subjective confidence in this prediction may account for their grade. Second, we ask whether students at different levels of performance vary in their ability to accurately predict their grade, and if so, whether subjective confidence also differs. Third, we ask whether the accuracy and confidence of learners’ predictions are conditioned by self-efficacy beliefs and causal attribution habits, which serve as indices of motivation for test preparation. Fourth, we ask whether different causal attribution preferences contribute to self-efficacy. We use statistical analysis of data from a general education course at a large public university in the United States. Our results indicate that poor performers’ overestimates are likely to be wishful thinking as they are expressed with low subjective confidence. Self-efficacy is a significant contributor to the inaccuracy of students’ predicted grades and subjective confidence in such predictions. Professors’ understanding of learners’ forecasting mechanisms informs strategies devoted to academic success.

Careful conversations: an educational video to support parents in communicating about weight with their children

BACKGROUND

Parents may struggle to initiate healthy weight-related conversations with their children. Educational videos may be an effective tool for improving parents' knowledge and self-efficacy on this topic. The aim of this pilot study was to develop an educational video to assist parents in weight-related conversations with their child, and to assess changes in parents' self-efficacy on this topic.

METHODS

Video development was based on a scoping review and semi-structured interviews with parents. Respondent demographics and user satisfaction were assessed at pre- and post- video, and 4-6 months later. Self-efficacy scores were compared between parent groups based on weight concerns over time.

RESULTS

Fifty-seven parents participated in the video questionnaires, and 40 repeated measures 4-6 months later. Significant improvements in self-efficacy in "raising the issue of weight" and "answering questions or concerns" were found after watching the video (p ≤ 0.002) compared to baseline, and scores 4-6 months post baseline remained slightly elevated, but non-significant. Parents with concerns about their child being overweight had significantly lower perceived self-efficacy scores compared to parents with no concerns about their child's weight (p = 0.031). The video was found to be positively received and of relevance to parents across a number of different domains.

CONCLUSION(S)

Preliminary findings suggest an educational video about initiating weight-related conversations may be an effective tool for increasing parents' perceived self-efficacy in the short term. Further work is needed to validate findings in a randomized controlled trial, and with diverse parent populations.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03664492 . Registered 10 September 2018 - Retrospectively registered.

The Psychology of Following Instructions and Its Implications

The ability to follow instructions is an important aspect of everyday life. Depending on the setting and context, following instructions results in outcomes that have various degrees of impact. In a clinical setting, following instructions may affect life or death. Within the context of the academic setting, following instructions or failure to do so can impede general learning and development of desired proficiencies. Intuitively, one might think that following instructions requires simply reading instructional text or paying close attention to verbal directions and performing the intended action afterward. This commentary provides a brief overview of the cognitive architecture required for following instructions and will explore social behaviors and mode of instruction as factors further impacting this ability.

Looking at Mental Effort Appraisals through a Metacognitive Lens: Are they Biased?

A central factor in research guided by the Cognitive Load Theory (CLT) is the mental effort people invest in performing a task. Mental effort is commonly assessed by asking people to report their effort throughout performing, learning, or problem-solving tasks. Although this measurement is considered reliable and valid in CLT research, metacognitive research provides robust evidence that self-appraisals of performance are often biased. In this review, we consider the possibility that mental effort appraisals may also be biased. In particular, we review signs for covariations and mismatches between subjective and objective measures of effort. Our review suggests that subjective and most objective effort measures appear reliable and valid when evaluated in isolation, because they discriminate among tasks of varying complexity. However, not much is known about their mutual correspondence—that is, whether subjective measures covariate with objective measures. Moreover, there is evidence that people utilize heuristic cues when appraising their effort, similar to utilization of heuristic cues underlying metacognitive appraisals of performance. These cues are identified by exposing biases—mismatch in effects of cue variations on appraisals and performance. The review concludes with a research agenda in which we suggest applying the well-established methodologies for studying biases in self-appraisals of performance in metacognitive research to investigating effort appraisals. One promising method could be to determine the covariation of effort appraisals and objective effort measures as an indicator of the resolution of effort appraisals.

Self-reports of Dutch dog owners on received professional advice, their opinions on castration and behavioural reasons for castrating male dogs

Male dogs are often castrated based on the thought that it facilitates well-behavedness. However, the causal evidence for this from prospective studies lacks and the existing associative studies present mixed results depending on the studied behaviours. We aimed to gain insight into possible factors driving an owner’s decision to castrate their male dog, through a quantitative survey based on a convenience sample. We determined the advice owners received from three types of dog professionals (veterinarian practitioners, behavioural trainers, behavioural therapists) and the owners’ assessments of castration’s behavioural effects. Data on 491 Dutch owners of castrated and intact male dogs were analysed with Chi-square tests. Results indicate that owners of both castrated and intact dogs received castration advice most often from veterinarian practitioners, with pro-castration at higher frequencies for owners of castrated dogs (Chi-square, P<0.001). Overall, most owners disagreed with or were neutral about statements on castration positively affecting male dog behaviour at a population level. Nevertheless, 58% (N = 145) of the owners of castrated dogs (N = 249) reported that correcting unwanted behaviour was a reason to castrate their own male dog. Unwanted behaviour involved aggression in 50% (N = 70) of the owner-dog dyads. Castrated dog’s aggression changes were reported on most as ‘no change’. The second most common answer indicated an aggression decrease in dogs castrated to correct unwanted behaviour and an increase in dogs castrated for other reasons (Chi-square, P<0.001). The increase in aggression in a subset of castrated dogs is concerning, as aggression can pose risks to the dog’s welfare. We acknowledge the limitations of our study which identifies associations rather than provides causal evidence. Still, we recommend professionals’ awareness of possible negative behavioural changes following castration, like increased aggression. Future research on behavioural consequences of castrating dogs needs to build a more solid knowledge base for balanced advice regarding castration.

Predicting Individual Preferences in Mindfulness Techniques Using Personality Traits

The growing popularity of mindfulness-based interventions (MBIs) has prompted exciting scientific research investigating their beneficial effects on well-being and health. Most mindfulness programs are provided as multi-faceted packages encompassing a set of different mindfulness techniques, each with distinct focus and mechanisms. However, this approach overlooks potential individual differences, which may arise in response to practicing various mindfulness techniques. The present study investigated preferences for four prototypical mindfulness techniques [focused attention (FA), open monitoring (OM), loving-kindness (LK), and body scan (BS)] and identified factors that may contribute to individual differences in these preferences. Participants without prior mindfulness experiences were exposed to each technique through audio-guided instructions and were asked to rank their preferences at the end of all practices. Results indicated that preferences for loving-kindness were predicted by empathy, and that females tended to prefer loving-kindness more than males. Conversely, preferences for open monitoring were predicted by nonreactivity and nonjudgment of present moment experiences. Additionally, higher state mindfulness was detected for individuals’ preferred technique relative to other alternatives. These findings suggest that individuals tend to prefer techniques compatible with their personalities, as the predictor variables encompass trait capacities specifically relevant to practicing these techniques. Together, our results suggest the possibility that assessing individual difference and then tailoring MBIs to individual needs could be a useful way to improve intervention effectiveness and subsequent outcomes.

Grade-Level Differences in Teacher Feedback and Students' Self-Regulated Learning

This study investigated grade-level differences in teacher feedback, students' self-regulated learning (SRL), and their relationship. Secondary students participated in the study (N = 1,260; 430 10th-, 460 11th-, and 370 12th-graders). Latent factor mean difference analyses suggested that teacher feedback and students' SRL level varied across grades. Comparatively, 10th-grade teachers were perceived to provide verification feedback, scaffolding feedback, and praise most frequently; 12th-grade teachers were perceived to provide directive feedback and criticism most frequently; and 11th-grade teachers were perceived to provide all types of feedback least frequently. Students' SRL generally declined as they aged. Results from three-group structural equation modeling indicated that praise generally exhibited the strongest correlations with SRL regardless of grade level; directive feedback was negatively correlated with 10th graders' SRL but positively correlated with the SRL of 11th and 12th graders; scaffolding and verification feedback were positively correlated with 11th graders' SRL; and criticism had small correlations with SRL, regardless of grade level.

Ready, willing and able: a model to explain successful use of feedback

Educators have long noticed differences in how students receive and use feedback. Despite the development of best practice guidelines, some learners in the health professions still struggle to incorporate corrective feedback. To date, little research has been done to examine learner characteristics and how those traits might explain differences in feedback-related behavior. A qualitative study using a constructivist, grounded theory approach was conducted to examine the behaviors and learner characteristics that contribute to successful use of feedback. Medical and physician assistant students in their clinical years at one academic health center were interviewed to determine how they used feedback to learn. An overarching theory was developed to explain the process used by students who successfully used feedback. Participants needed to be ready, willing, and able to learn from feedback. Readiness required the learner to hear the corrective feedback without negative emotion and understand how to use the criticism. Willingness required a valuing process that resulted in meaning making. It also required motivation and a growth mindset. Able learners needed to utilize strategic learning behaviors to incorporate feedback into practice change. Barriers to feedback use included emotional interference, inability to create a positive narrative around the feedback encounter and understand it as part of a larger context, and the inability to utilize adaptive learning strategies. The paper considers important education theories, such as Self-regulated Learning and Achievement Goal Theory-theories that should be incorporated into future research.

The Nomological Net of the HEXACO Model of Personality: A Large-Scale Meta-Analytic Investigation

Based on lexical studies, the HEXACO (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness to experience) model of personality has been proposed as a model of basic personality structure that summarizes individual differences in six broad trait dimensions. Although research across various fields relies on the HEXACO model increasingly, a comprehensive investigation of the nomological net of the HEXACO dimensions is missing entirely. Thus, it remains unclear whether each HEXACO dimension accounts for individual variation across theoretically relevant outcome criteria. We close this gap through a large-scale meta-analytic investigation, testing whether each HEXACO dimension is uniquely linked to one broad and theoretically relevant outcome domain. Results from 426 individual meta-analyses, 436 independent samples, and 3,893 effect-size estimates corroborate this unique mapping. Specifically, honesty-humility maps onto the outcome domain of exploitation, emotionality onto insecurity, extraversion onto sociality, agreeableness versus anger onto obstruction, conscientiousness onto duty, and openness to experience onto exploration. Overall, the current investigation provides a comprehensive empirical test of the (breadth of) content captured by the HEXACO dimensions and allows for a broad specification of the nomological net of the HEXACO model overall.

Cognitive bias in professional hand hygiene and feedback: A national online-survey on overconfidence in Germany

To evaluate learning motivation barriers in infection control and feedback competences, we conducted a national online survey in Germany. Among 767 healthcare workers, overconfidence effects could be detected independent from age, gender, profession, education, and hospital-size. The identified effects may impair learning motivation relevant for supervisors and educators in infection control.

Discrepancy between perceived diet quality and actual diet quality among US adult cancer survivors

OBJECTIVES

Little is known about cancer survivors' self-perception of their dietary quality compared with their measured diet quality and how those perceptions may influence their actual diet. This study aimed to fill this gap using national large datasets.

METHODS

National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2014 were used. The healthy eating index (HEI) based on 24-h dietary recall was used to measure diet quality. Logistic regression models were fit to examine the influence of the misperception of eating healthiness on diet quality.

RESULTS

The agreement between self-perceived and actual diet quality was low (Kappa = 0.06, 95% CI: 0.02, 0.09) among cancer survivors. Over-rating diet quality was associated with a 5.39 lower total HEI score (P < 0.0001), 1.00 lower HEI score for empty calorie intake (P = 0.0028), 0.15 lower score for vegetable intake (P = 0.108), and 0.29 lower score for fruit intake; under-rating one's diet quality was associated with a 7.12 higher total HEI score (P < 0.0001), 2.57 higher HEI score for empty calorie intake (P < 0.0001), 0.02 higher score for vegetable intake (P = 0.904), and 0.84 higher score for fruit intake (P = 0.001). Our multinomial regression estimates suggested that each 10-year increase in age was associated with an increase in the odds of being an over-rater vs. a correct-rater (OR: 11.4, 95% CI: 10.01, 10.2). Hispanics were more likely than non-Hispanic whites to over-rate their diet quality (OR: 1.792, 95% CI: 1.062, 3.024).

CONCLUSIONS

Tailored nutrition interventions and guidance aimed at reducing the divergence between self-assessed and actual diet quality have the potential to improve cancer survivorship and narrow racial/ethnic and socioeconomic disparities.

Development and initial validation of the Perceived Scarcity Scale

Though socio-economic status (SES) partially explains the experience of stress and health outcomes, most research to date has relied on a small number of traditional indicators that fail to capture the full domain of socioeconomic factors. The recent reconceptualization of perceived scarcity is proposed as a subjective indicator of SES when attempting to predict both stress and health outcomes. Although a conceptualization of perceived scarcity has been advanced, a psychometrically sound scale is needed to assess the utility and scientific import of this concept. No such scale exists. Therefore, the current paper describes the development, psychometric properties, and initial validation of the Perceived Scarcity Scale (PScS). Four studies using traditional scale development processes were employed to develop (Studies 1 and 2) and provide an initial validation (Studies 3 and 4) for the PScS. Results support the existing model of perceived scarcity and indicate that the measure is valid. Moreover, the scale predicted concurrent perceived stress, as well as longitudinal ratings of perceived stress, global health, quality of life, and symptoms of depression and anxiety. The development of the new scale provides clinicians and researchers with a brief, validated measure that can assess the level of perceived scarcity individuals currently experience.

Erkenne dich selbst!

Zusammenfassung. Die eigenständige Suche sowie das adäquate Verständnis von Gesundheitsinformationen bilden eine wichtige Grundlage für die fundierte Entscheidungsfindung bei gesundheitlichen Problemen. Die hierfür zentralen Fähigkeiten sind die Gesundheitsinformationskompetenz (Health Information Literacy, HIL) und die allgemeine kognitive Fähigkeit (IQ). Die Konsequenzen einer adäquaten oder weniger adäquaten Einschätzung der eigenen Fähigkeiten für alltägliche Entscheidungen können erheblich sein, wurden jedoch im Kontext der Suche nach Gesundheitsinformationen noch nicht untersucht. In dieser Studie wurde zunächst überprüft, inwiefern HIL und IQ einen differenzierbaren Vorhersagebeitrag hinsichtlich der Präferenz bestimmter Eigenschaften von Gesundheitsinformationsquellen (Expertise, Interaktion, Zugänglichkeit) aufweisen. In einer explorativen Analyse wurden anschließend Unterschiede im Vorhersagebeitrag von Selbsteinschätzungs- und Leistungsmaßen von HIL und IQ untersucht. Dabei wurden Auswirkungen einer Über- oder Unterschätzung der eigenen Fähigkeiten im Hinblick auf die Präferenz bestimmter Quelleneigenschaften betrachtet. N = 286 Personen nahmen an der Untersuchung teil. Mit Hilfe von Response Surface Analysen wurde ein differenzierbarer Einfluss von HIL und IQ ermittelt. Spezifische Effekte der selbst eingeschätzten und objektiv gemessenen Fähigkeiten sowie der Interaktion dieser Maße wurden in Form einer Über- oder Unterschätzung identifiziert. Neben der tatsächlichen Fähigkeit spielen somit auch die eigene Einschätzung dieser Fähigkeit sowie eine daraus resultierende Unter- oder Überschätzung eine wichtige Rolle. In Forschung und Praxis Tätige sollten dies bei der Entwicklung und Durchführung von Maßnahmen zur Förderung der fundierten Entscheidungsfindung bei Patientinnen und Patienten berücksichtigen. Eine englische Übersetzung als Rohfassung dieses Artikels finden Sie als Elektronisches Supplement 1.

Transcranial Direct Current Stimulation of the Medial Prefrontal Cortex Has No Specific Effect on Self-referential Processes

The processing of self-referential information can be influenced by transcranial magnetic stimulation (TMS). The present randomized controlled study investigated whether similar effects can be elicited through the application of transcranial direct current stimulation (tDCS) regarding the "self-serving bias" (SSB) and the "mnemic neglect effect" (MNE). Seventy-five healthy males (M age = 25; SD = 4.3) were investigated in a between-groups design with random assignment by applying anodal, cathodal, or sham tDCS to the medial prefrontal cortex (mPFC). After stimulation, the participants judged if 80 personality traits (40 positive, 40 negative) were self-descriptive or not. Finally, the participants had to recall the previously presented adjectives. All three stimulation groups showed the expected SSB and MNE. Still, and contrary to our hypotheses, tDCS revealed neither a significant interaction effect between groups and valence concerning the number of chosen self-referential traits (F (2,72) = 1.36, p = 0.26,η G 2 = 0.02) nor an interaction effect between groups, valence, and self-reference concerning the percentage of recalled words (F (2,71) = 0.69, p = 0.50,η G 2 = 0.01). However, a post hoc inspection of effect sizes revealed that less negative traits were indicated as self-referential in the anodal compared to the cathodal group (ES: -0.59; CI: -1.16 to -0.03). Moreover, the participants showed-regardless of self-reference and type of stimulation-a better recall with tDCS in comparison to sham stimulation. Our results indicate that tDCS of the mPFC in healthy young men has no influence on the SSB and the MNE. However, tDCS seems to improve memory performance.

Self-Assessment of Driving Style and the Willingness to Share Personal Information

The availability of better behavioral information about their customer portfolios holds the promise for different and more accurate pricing models for insurers. Changes in pricing, however, are always fraught with danger for insurers, as they enter long-term commitments with incomplete historical information. On the other hand, sharing personal information is still viewed with skepticism by consumers. Which type of personal information are consumers willing to share with insurers, and for what purpose? How would they like to be rewarded for this openness? For insurers, how will the transition shift their risk portfolios? This paper addresses these questions for auto insurance, particularly how the self-assessment of one’s driving style impacts this dynamic. In a survey of approximately 900 Swiss residents, we found that offering a compensation, especially premium discounts, but also services, significantly improves willingness to share information. Higher trust in insurance increases sharing. Women and younger people are more willing to share information. On the other hand, customers are less willing to disclose, to insurers, information not traditionally associated with insurance. The self-assessment of driving style also plays a significant role. More risk-averse driving styles are correlated with higher sharing. Conversely, riskier driving styles are correlated with lower sharing. This result is significant for insurers, as new data-driven pricing and services models should tend to attract less risky customer portfolios.

Confidence, performance, and accuracy of self-assessment of social cognition: A comparison of schizophrenia patients and healthy controls

Impairments in self-assessment in schizophrenia have been shown to have functional and clinical implications. Prior studies have suggested that overconfidence can be associated with poorer cognitive performance in people with schizophrenia, and that reduced awareness of performance may be associated with disability. However, overconfidence is common in healthy individuals as well. This study examines the correlations between performance on a social cognitive test, confidence in performance, effort allocated to the task, and correlates of confidence in patients with schizophrenia and healthy controls (HC). Measures included self-reports of depression, social cognitive ability, and social functioning. A performance-based emotion recognition test assessed social cognitive performance and provided the basis for confidence judgments. Although schizophrenia patients had reduced levels of overall confidence, there was a substantial subset of schizophrenic patients who manifested extreme overconfidence and these people had the poorest performance and reported the least depression. Further, a substantial number of HC over-estimated their performance as well. Patients with schizophrenia, in contrast to HC, did not adjust their effort to match task difficulty. Confidence was minimally related to task performance in patients but was associated with more rapid decisions in HC, across both correct and incorrect responses. Performance on social cognitive measures was minimally related to self-reports of social functioning in both samples. These data suggest global self-assessments are based on multiple factors, with confidence affecting self-assessments in the absence of feedback about performance.

Development of the Greifswald questionnaire for the measurement of interprofessional attitudes

Introduction: The implementation of interprofessional education (IPE) could be a potential approach to dealing with increasing complexity in health care. And thus, encouraging interprofessional collaborations to minimize errors in patient care. However, empirical evidence regarding the effectiveness of IPE is inconclusive. One reason for this is a lack of valid and reliable evaluation instruments. This study aims to illustrate the first steps of the development and validation of a German evaluation instrument for the measurement of interprofessional attitudes. Methods: To achieve high psychometric quality, we first selected relevant attitude dimensions and specified criteria for the wording of the items. The a priori developed factor structure was evaluated via factor analysis and the internal consistencies of the scales were analysed in a sample of medical students and nursing trainees, both participants of an IPE course (n=338). Stability was evaluated in an additional sample of nursing trainees (n=14). Results: The Factor analysis revealed three dimensions. Whereby, the two factors "Relevance of learning interprofessional communicational techniques" (German: Wichtigkeit Techniken interprofessioneller Kommunikation zu lernen) (α=.85) and "Doubts, dismissal and perceived barriers" (German: Zweifel, Ablehnung und wahrgenommene Barrieren) (α=.73) revealed good to acceptable internal consistency. Third-factor "Attitude towards another profession" (German: Einstellung zur anderen Berufsgruppe) (α=.62) remained below a desired internal consistency of α>.70. Factors "Doubts, dismissal and perceived barriers", as well as "Attitude towards another profession" showed sufficient stability for pre-/post-measurements. Discussion: The Greifswald Questionnaire for the Measurement of Interprofessional Attitudes is the first version of a three-dimensional tool to evaluate IPE in German-speaking countries. Results showed insufficient item difficulty in the tested sample, which resulted in an insufficient internal consistency, and retest reliability for some factors. Further studies are required to investigate item difficulty, internal consistency and retest reliability in a postgraduate sample.

The Perceived Ability of Gastroenterologists, Hepatologists and Surgeons Can Bias Medical Decision Making

Medical errors are a troubling issue and physicians should be careful to scrutinize their own decisions, remaining open to the possibility that they may be wrong. Even so, doctors may still be overconfident. A survey was here conducted to test how medical experience and self-confidence can affect physicians working in the specific clinical area. Potential participants were contacted through personalized emails and invited to contribute to the survey. The “risk-intelligence” test consists of 50 statements about general knowledge in which participants were asked to indicate how likely they thought that each statement was true or false. The risk-intelligence quotient (RQ), a measure of self-confidence, varies between 0 and 100. The higher the RQ score, the better the confidence in personal knowledge. To allow for a representation of 1000 physicians, the sample size was calculated as 278 respondents. A total of 1334 individual emails were sent to reach 278 respondents. A control group of 198 medical students were also invited, of them, 54 responded to the survey. The mean RQ (SD)of physicians was 61.1 (11.4) and that of students was 52.6 (9.9). Assuming age as indicator of knowledge, it was observed that physicians ≤34 years had a mean RQ of 59.1 (10.1); those of 35–42 years had 61.0 (11.0); in those of 43–51 years increased to 62.9 (12.2); reached a plateau of 63.0 (11.5) between 52–59 years and decreased to 59.6 (12.1) in respondents ≥60 years (r²:0.992). Doctors overestimate smaller probabilities and under-estimate higher probabilities. Specialists in gastroenterology and hepato-biliary diseases suffer from some degree of self-confidence bias, potentially leading to medical errors. Approaches aimed at ameliorating the self-judgment should be promoted more widely in medical education.

Functional MRI reveals evidence of a self-positivity bias in the medial prefrontal cortex during the comprehension of social vignettes

A large literature in social neuroscience has associated the medial prefrontal cortex (mPFC) with the processing of self-related information. However, only recently have social neuroscience studies begun to consider the large behavioral literature showing a strong self-positivity bias, and these studies have mostly focused on its correlates during self-related judgments and decision-making. We carried out a functional MRI (fMRI) study to ask whether the mPFC would show effects of the self-positivity bias in a paradigm that probed participants’ self-concept without any requirement of explicit self-judgment. We presented social vignettes that were either self-relevant or non-self-relevant with a neutral, positive or negative outcome described in the second sentence. In previous work using event-related potentials, this paradigm has shown evidence of a self-positivity bias that influences early stages of semantically processing incoming stimuli. In the present fMRI study, we found evidence for this bias within the mPFC: an interaction between self-relevance and valence, with only positive scenarios showing a self vs other effect within the mPFC. We suggest that the mPFC may play a role in maintaining a positively biased self-concept and discuss the implications of these findings for the social neuroscience of the self and the role of the mPFC.

Erwartungen und Kenntnisse von Ausbildungskandidaten in Verhaltenstherapie zu Psychotherapienebenwirkungen

<b><i>Hintergrund:</i></b> Die Aufklärung, Erkennung, Vorbeugung und Bearbeitung von Psychotherapienebenwirkungen stellt hohe Anforderungen an Therapeuten. Grundsätzlich gilt zudem, dass es psychologische Barrieren gibt, negative therapeutische Entwicklungen wahrzunehmen und dem eigenen therapeutischen Handeln zuzuordnen. Dazu trägt bei, dass dieses Thema bislang in der Ausbildung eher wenig Beachtung findet und kaum systematisch abgehandelt wird. Um den eventuellen Handlungsbedarf abschätzen zu können, sind Daten von Interesse zu den einschlägigen Einstellungen und Kenntnissen von Therapeuten in Ausbildung. <b><i>Methode:</i></b> In einem halbstrukturierten Interview wurden 100 Psychotherapeuten in Ausbildung mit dem Schwerpunkt Verhaltenstherapie zu Nebenwirkungen ihrer Arbeit befragt. Die Therapeuten machten Angaben zur Qualität, Häufigkeit und den möglichen Ursachen von Psychotherapienebenwirkungen. <b><i>Ergebnisse:</i></b> Therapeuten in Ausbildung rechnen in etwa jedem 2. Fall mit dem Auftreten von Nebenwirkungen. Sie erwarten vor allem Symptomverschlechte­rung und negative Entwicklungen im sozialen Netz. Es zeigt sich eine Tendenz, das eigene Verfahren und die eigenen Behandlungen für weniger riskant zu halten als die der Kollegen. Ursachen von Nebenwirkungen sehen die Therapeuten vor allem in der therapeutischen Beziehung sowie The­rapeutenvariablen und weniger in Patientencharakteristika. <b><i>Schlussfolgerung:</i></b> Psychotherapeuten in Ausbildung sind sich dem Problem der Nebenwirkungen durchaus bewusst, was ein guter Ansatzpunkt für die Vermittlung entspre­chender Ausbildungsinhalte ist. An den Aus- und Weiterbildungsinstituten sollten Seminare zum Problem der Psychotherapienebenwirkungen zum Standard gehören.

Toward Practice-Based Continuing Education Protocols: Using Testing to Help Physicians Update Their Knowledge

INTRODUCTION

Using assessment to facilitate learning is a well-established priority in education but has been associated with variable effectiveness for continuing professional development. What factors modulate the impact of testing in practitioners are unclear. We aimed to improve capacity to support maintenance of competence by exploring variables that influence the value of web-based pretesting.

METHODS

Family physicians belonging to a practice-based learning program studied two educational modules independently or in small groups. Before learning sessions they completed a needs assessment and were assigned to either sit a pretest intervention or read a relevant review article. After the learning session, they completed an outcome test, indicated plans to change practice, and subsequently documented changes made.

RESULTS

One hundred twelve physicians completed the study, 92 in small groups. The average lag between tests was 6.3 weeks. Relative to those given a review article, physicians given a pretest intervention: (1) reported spending less time completing the assigned task (16.7 versus 25.7 minutes); (2) performed better on outcome test questions that were repeated from the pretest (65.9% versus 58.7%); and (3) when the learning module was completed independently, reported making a greater proportion of practice changes to which they committed (80.0% versus 45.0%). Knowledge gain was unrelated to physicians' stated needs.

DISCUSSION

Low-stakes formative quizzes, delivered with feedback, can influence the amount of material practicing physicians remember from an educational intervention independent of perceptions regarding the need to engage in continuing professional development on the particular topic.

Comparisons as Predictors of People’s Beliefs About the Importance of Changing Their Health Behaviors

Abstract. The current study tested relative strengths of different comparison beliefs for predicting people’s self-assessments of whether they should increase their health-relevant behaviors (exercise, sleep, and fruit and vegetable consumption). Comparison beliefs relevant to three standards (perceived global, local, expert standards) were evaluated. Data were combined from three similar studies (total N = 744) that had a cross-sectional, within-subject design. Participants completed importance-of-change scales regarding the three health behaviors and reported comparison beliefs and absolute behavior frequencies/amounts. Results were consistent across the three behaviors. Comparison beliefs predicted ratings of importance of changing one’s behavior, even beyond what is predicted by reports of absolute behavior frequency. Expert comparisons were consistently most predictive above and beyond the absolute estimates and the other comparison standards. There was no evidence of a local dominance effect when examining local versus global comparisons. Comparison beliefs have unique utility for predicting people’s perceived importance of changing their heath behavior. The fact that expert comparisons were consistently most predictive (and local comparisons the least) may have implications for interventions designed for encouraging behavior change.

Schizophrenia spectrum and other psychotic disorders

Since its earliest conceptualization, schizophrenia has been considered a disorder of "young men." Contemporary research suggests that there are sex differences in schizophrenia that are both transdiagnostic and representative of general sex/gender differences across the psychopathology spectrum. This chapter selectively summarizes representative sex/gender differences in clinical expression, epidemiology, risk factors, treatment, as well as course and outcome in schizophrenia. The consistent sex differences found, such as onset age, generic brain anomalies, and hormonal involvement, are not specific to schizophrenia or necessarily to psychopathology. It is suggested that in working with those diagnosed as meeting the current criteria for schizophrenia, clinicians adopt a transdiagnostic framework informed by sex and gender role processes.

Assessments of Research Competencies for Clinical Investigators: A Systematic Review

Although there is extensive research literature on clinical skill competencies and the use of competency-based frameworks for clinical research, the appropriate methods to assess these competencies are not as well understood. Our goal in this systematic literature review is to identify, compare, and critique assessments of clinical research competencies. Articles were included in this review if they examined clinical investigators or clinical investigators in training, focused on research-based skills, and included some form of assessment of research-based competencies. A total of 76 articles were identified as part of the initial search; 16 met the criteria for inclusion. Two types of assessments of clinical research competence were identified: subjective self-assessments (n = 13) and objective tests (n = 6). These assessments covered a wide range of competencies, but there were no competency domains common to all. Most assessments had limited validation. Training was consistently associated with self-assessed competence but had little relationship to objective measures of competence. In contrast, experience was consistently associated with objectively assessed competence but not with self-assessed competence. These findings have important implications for those interested in assessing medical education programs. We describe a recommended standard for validity for assessments used for the purposes of summative program assessment.

The effect of replacing 1 week of content teaching with an intensive simulation-based learning activity on physiotherapy student clinical placement performance

BACKGROUND

Simulation-based learning (SBL) activities are increasingly used to replace or supplement clinical placements for physiotherapy students. There is limited literature evaluating SBL activities that replace on-campus teaching, and to our knowledge, no studies evaluate the role of SBL in counteracting the negative impact of delay between content teaching and clinical placements. The aims of this study were to (i) determine the effect on clinical placement performance of replacing 1 week of content teaching with a SBL activity and (ii) determine if a delay between content teaching and clinical placement impacted clinical placement performance.

METHODS

This study is a retrospective cohort study. Participants included students in the first two clinical placements of a graduate-entry, masters-level program. Six hundred twenty-nine student placements were analysed-285 clinical placements where students undertook a 20-h SBL activity immediately prior to clinical placement were compared with 344 placements where students received traditional content. Of the placements where students received the SBL, 147 occurred immediately following content teaching and 138 had a delay of at least 5 weeks. Performance on clinical placement was assessed using the Assessment of Physiotherapy Practice (APP).

RESULTS

There was a significant main effect of SBL with higher APP marks for the experimental group (3.12/4, SD = 0.25 vs 3.01/4, SD = 0.22), and post hoc analysis indicated marks were significantly higher for all seven areas of assessment. Students whose placements immediately followed content teaching performed better on mid-placement APP marks in two areas of assessment (analysis and planning, and intervention) compared to students for whom there was a delay. There were no statistically significant differences in relation to delay for end of placement APP marks.

CONCLUSION

Replacing 1 week of classroom teaching with a targeted, SBL activity immediately before placement significantly improved student performance on that clinical placement. A negative impact of delay was found on mid-placement, but not the end of placement APPs. Findings of improved performance when replacing a week of content teaching with a targeted SBL activity, and poorer performance on mid-placement marks with a delay between content teaching and clinical placement, may have implications for curriculum design.

The Illusion of Knowing in College: A Field Study of Students with a Teacher-Centered Educational Past

In the present study, the tendency to overestimate performance (illusion of knowing) was examined in college students whose educational past experiences had emphasized verbatim learning. Female students enrolled in core curriculum classes were sampled. Classes taught by the same instructor were randomly assigned to a self-assessment practice condition, where students predicted their test and class performance and were asked to reflect on discrepancies between predictions and actual performance, or to a control condition. At the end of the semester, irrespective of condition, as performance declined on the final test, predictions of final test grades became more inflated, but less confident, indicating that students were aware of their own deficiencies. Overall, students in the practice condition displayed not only greater prediction accuracy, but also greater final test performance than students in the control condition. Practice, however, benefited the most self-assessment accuracy of students whose final test grades were just above the passing grade. Although the responses to self-assessment practice of students with a teacher-centered educational past were largely similar to the responses of students from Western countries reported in the extant literature, differences in impact and meaning could be inferred.

Knowing What Others Know: Younger and Older Adults' Perspective-Taking and Memory for Medication Information

Health-related information can be important to communicate and remember, but we may not understand our own or others' memory abilities. In this study, younger and older adults estimated their performance before and after a cued-recall memory task in which they studied medication : side effect pairs. Participants also estimated the performance of a peer their own age, a medical student, and a person in the other age group (i.e., younger adults estimated older adults' performance and vice versa). In Experiment 1, participants completed four study-test cycles, each with new pairs. In Experiment 2, the same pairs were presented throughout. Overall, participants initially overestimated their memory performance, but after the task, several judgments were closer to participants' actual performance and that of their peers. Thus, people may not initially have accurate representations of how they and others remember health-related information, but these misconceptions may be ameliorated by testing and task experience.

Realizing One's Own Subjectivity: Assessors' Perceptions of the Influence of Training on Their Conduct of Workplace-Based Assessments

PURPOSE

Assessor training is essential for defensible assessments of physician performance, yet research on the effectiveness of training programs for promoting assessor consistency has produced mixed results. This study explored assessors' perceptions of the influence of training and assessment tools on their conduct of workplace-based assessments of physicians.

METHOD

In 2017, the authors used a constructivist grounded theory approach to interview 13 physician assessors about their perceptions of the effects of training and tool development on their conduct of assessments.

RESULTS

Participants reported that training led them to realize that there is a potential for variability in assessors' judgments, prompting them to change their scoring and feedback behaviors to enhance consistency. However, many participants noted they had not substantially changed their numerical scoring. Nonetheless, most thought training would lead to increased standardization and consistency among assessors, highlighting a "standardization paradox" in which participants perceived a programmatic shift toward standardization but minimal changes in their own ratings. An "engagement effect" was also found in which participants involved in both tool development and training cited more substantial learnings than participants involved only in training.

CONCLUSIONS

Findings suggest that training may help assessors recognize their own subjectivity when judging performance, which may prompt behaviors that support rigorous and consistent scoring but may not lead to perceptible changes in assessors' numeric ratings. Results also suggest that participating in tool development may help assessors align their judgments with the scoring criteria. Overall, results support the continued study of assessor training programs as a means of enhancing assessor consistency.

High-status lobbyists are most likely to overrate their success

Overconfidence helps individuals reach higher status within social groups by making them seem more competent regardless of objective ability, so this bias may be especially prevalent among status-oriented members of elite communities. Based on this premise, we explore whether lobbyists in the USA misperceive their success. Using models that (1) control for legislative outcome when predicting self-assessed policy success and (2) compare self-assessed policy success on specific proposals against the average success reported by all lobbyists working on the same side of an issue, we identify systematic tendencies to overrate achievements. Lobbyists with higher incomes, who reside in Washington, DC, USA, have congressional experience and who engage in a broader range of activities are more likely to overrate their success. Public interest group lobbyists tend to underestimate success. We conclude that political elites are subject to the same biases as others when evaluating their performance, and these biases may be largely status-driven.

Social Discounting in the Elderly: Senior Citizens are Good Samaritans to Strangers

Objectives

People tend to become more generous as they grow older, which may reflect an increase in their ego-transcending motives (i.e., concern more for the benefit of recipients than of the benefactors). The current study aimed to examine evidence for an enhanced ego-transcending motive among older adults.

Methods

We adapted the social-discounting framework to quantify generosity toward people of different social distances, ranging from socially close others (e.g., family and close friends) to socially distant others (e.g., total strangers), in both young and older adults. We hypothesized that the normative decrease in generosity as a function of social distance (e.g., less generous towards strangers compared to close friends) will be mitigated in older adults.

Results

Our results supported that older adults were more generous toward socially distant others (i.e., less social discounting) compared to younger adults.

Discussion

Thus, consistent with the idea that the elderly are more oriented to ego-transcending goals, older adults are generous even when their generosity is unlikely to be reciprocated.