Expertise for cars and birds recruits brain areas involved in face recognition

Expertise with unfamiliar objects ('greebles') recruits face-selective areas in the fusiform gyrus (FFA) and occipital lobe (OFA). Here we extend this finding to other homogeneous categories. Bird and car experts were tested with functional magnetic resonance imaging during tasks with faces, familiar objects, cars and birds. Homogeneous categories activated the FFA more than familiar objects. Moreover, the right FFA and OFA showed significant expertise effects. An independent behavioral test of expertise predicted relative activation in the right FFA for birds versus cars within each group. The results suggest that level of categorization and expertise, rather than superficial properties of objects, determine the specialization of the FFA.

The devil is in the third year: a longitudinal study of erosion of empathy in medical school

PURPOSE

This longitudinal study was designed to examine changes in medical students' empathy during medical school and to determine when the most significant changes occur.

METHOD

Four hundred fifty-six students who entered Jefferson Medical College in 2002 (n = 227) and 2004 (n = 229) completed the Jefferson Scale of Physician Empathy at five different times: at entry into medical school on orientation day and subsequently at the end of each academic year. Statistical analyses were performed for the entire cohort, as well as for the "matched" cohort (participants who identified themselves at all five test administrations) and the "unmatched" cohort (participants who did not identify themselves in all five test administrations).

RESULTS

Statistical analyses showed that empathy scores did not change significantly during the first two years of medical school. However, a significant decline in empathy scores was observed at the end of the third year which persisted until graduation. Findings were similar for the matched cohort (n = 121) and for the rest of the sample (unmatched cohort, n = 335). Patterns of decline in empathy scores were similar for men and women and across specialties.

CONCLUSIONS

It is concluded that a significant decline in empathy occurs during the third year of medical school. It is ironic that the erosion of empathy occurs during a time when the curriculum is shifting toward patient-care activities; this is when empathy is most essential. Implications for retaining and enhancing empathy are discussed.

The hidden curriculum, ethics teaching, and the structure of medical education

The authors raise questions regarding the wide-spread calls emanating from lay and medical audiences alike to intensify the formal teaching of ethics within the medical school curriculum. In particular, they challenge a prevailing belief within the culture of medicine that while it may be possible to teach information about ethics (e.g., skills in recognizing the presence of common ethical problems, skills in ethical reasoning, or improved understanding of the language and concepts of ethics), course material or even an entire curriculum can in no way decisively influence a student's personality or ensure ethical conduct. To this end, several issues are explored, including whether medical ethics is best framed as a body of knowledge and skills or as part of one's professional identity. The authors argue that most of the critical determinants of physician identity operate not within the formal curriculum but in a more subtle, less officially recognized "hidden curriculum." The overall process of medical education is presented as a form of moral training of which formal instruction in ethics constitutes only one small piece. Finally, the authors maintain that any attempt to develop a comprehensive ethics curriculum must acknowledge the broader cultural milieu within which that curriculum must function. In conclusion, they offer recommendations on how an ethics curriculum might be more fruitfully structured to become a seamless part of the training process.

Personality and leadership: a qualitative and quantitative review

This article provides a qualitative review of the trait perspective in leadership research, followed by a meta-analysis. The authors used the five-factor model as an organizing framework and meta-analyzed 222 correlations from 73 samples. Overall, the correlations with leadership were Neuroticism = -.24, Extraversion = .31, Openness to Experience = .24, Agreeableness = .08, and Conscientiousness = .28. Results indicated that the relations of Neuroticism, Extraversion, Openness to Experience, and Conscientiousness with leadership generalized in that more than 90% of the individual correlations were greater than 0. Extraversion was the most consistent correlate of leadership across study settings and leadership criteria (leader emergence and leadership effectiveness). Overall, the five-factor model had a multiple correlation of .48 with leadership, indicating strong support for the leader trait perspective when traits are organized according to the five-factor model.

Trust in leadership: meta-analytic findings and implications for research and practice

In this study, the authors examined the findings and implications of the research on trust in leadership that has been conducted during the past 4 decades. First, the study provides estimates of the primary relationships between trust in leadership and key outcomes, antecedents, and correlates (k = 106). Second, the study explores how specifying the construct with alternative leadership referents (direct leaders vs. organizational leadership) and definitions (types of trust) results in systematically different relationships between trust in leadership and outcomes and antecedents. Direct leaders (e.g., supervisors) appear to be a particularly important referent of trust. Last, a theoretical framework is offered to provide parsimony to the expansive literature and to clarify the different perspectives on the construct of trust in leadership and its operation.

Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?

Despite the profound and pervasive importance of trust in medical settings, there is no commonly shared understanding of what trust means, and little is known about what difference trust actually makes, what factors affect trust, and how trust relates to other similar attitudes and behaviors. To address this gap in understanding, the emerging theoretical, empirical, and public policy literature on trust in physicians and in medical institutions is reviewed and synthesized. Based on this review and additional research and analysis, a formal definition and conceptual model of trust is presented, with a review of the extent to which this model has been confirmed by empirical studies. This conceptual and empirical understanding has significance for ethics, law, and public policy.

Selection and use of content experts for instrument development

Content experts frequently are used in the judgment-quantification stage of content validation of instruments. However, errors in instrumentation may arise when important steps in selecting and using these experts are not carefully planned. The systematic process of choosing, orienting, and using content experts in the judgment-qualification stage of instrument development is addressed, with particular attention to the often neglected, important step of familiarizing these experts with the conceptual underpinnings and measurement model of the instrument. An example using experts to validate content for a measure of caregiver burden is used to illustrate this stage of instrument review.

Effects of psychotherapy with children and adolescents revisited: a meta-analysis of treatment outcome studies

A meta-analysis of child and adolescent psychotherapy outcome research tested previous findings using a new sample of 150 outcome studies and weighted least squares methods. The overall mean effect of therapy was positive and highly significant. Effects were more positive for behavioral than for nonbehavioral treatments, and samples of adolescent girls showed better outcomes than other Age x Gender groups. Paraprofessionals produced larger overall treatment effects than professional therapists or students, but professionals produced larger effects than paraprofessionals in treating overcontrolled problems (e.g., anxiety and depression). Results supported the specificity of treatment effects: Outcomes were stronger for the particular problems targeted in treatment than for problems not targeted. The findings shed new light on previous results and raise significant issues for future study.

Removing the Shadow of Suspicion: The Effects of Apology Versus Denial for Repairing Competence- Versus Integrity-Based Trust Violations

Two studies were conducted to examine the implications of an apology versus a denial for repairing trust after an alleged violation. Results reveal that trust was repaired more successfully when mistrusted parties (a) apologized for violations concerning matters of competence but denied culpability for violations concerning matters of integrity, and (b) had apologized for violations when there was subsequent evidence of guilt but had denied culpability for violations when there was subsequent evidence of innocence. Supplementary analyses also revealed that the interactive effects of violation type and violation response on participants' trusting intentions were mediated by their trusting beliefs. Combined, these findings provide needed insight and supporting evidence concerning how trust might be repaired in the aftermath of a violation.

Cultural competence: a systematic review of health care provider educational interventions

OBJECTIVE

We sought to synthesize the findings of studies evaluating interventions to improve the cultural competence of health professionals.

DESIGN

This was a systematic literature review and analysis.

METHODS

We performed electronic and hand searches from 1980 through June 2003 to identify studies that evaluated interventions designed to improve the cultural competence of health professionals. We abstracted and synthesized data from studies that had both a before- and an after-intervention evaluation or had a control group for comparison and graded the strength of the evidence as excellent, good, fair, or poor using predetermined criteria.

MAIN OUTCOME MEASURES

We sought evidence of the effectiveness and costs of cultural competence training of health professionals.

RESULTS

Thirty-four studies were included in our review. There is excellent evidence that cultural competence training improves the knowledge of health professionals (17 of 19 studies demonstrated a beneficial effect), and good evidence that cultural competence training improves the attitudes and skills of health professionals (21 of 25 studies evaluating attitudes demonstrated a beneficial effect and 14 of 14 studies evaluating skills demonstrated a beneficial effect). There is good evidence that cultural competence training impacts patient satisfaction (3 of 3 studies demonstrated a beneficial effect), poor evidence that cultural competence training impacts patient adherence (although the one study designed to do this demonstrated a beneficial effect), and no studies that have evaluated patient health status outcomes. There is poor evidence to determine the costs of cultural competence training (5 studies included incomplete estimates of costs).

CONCLUSIONS

Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.

Reframing medical education to support professional identity formation

Teaching medical professionalism is a fundamental component of medical education. The objective is to ensure that students understand the nature of professionalism and its obligations and internalize the value system of the medical profession. The recent emergence of interest in the medical literature on professional identity formation gives reason to reexamine this objective. The unstated aim of teaching professionalism has been to ensure the development of practitioners who possess a professional identity. The teaching of medical professionalism therefore represents a means to an end.The principles of identity formation that have been articulated in educational psychology and other fields have recently been used to examine the process through which physicians acquire their professional identities. Socialization-with its complex networks of social interaction, role models and mentors, experiential learning, and explicit and tacit knowledge acquisition-influences each learner, causing them to gradually "think, act, and feel like a physician."The authors propose that a principal goal of medical education be the development of a professional identity and that educational strategies be developed to support this new objective. The explicit teaching of professionalism and emphasis on professional behaviors will remain important. However, expanding knowledge of identity formation in medicine and of socialization in the medical environment should lend greater logic and clarity to the educational activities devoted to ensuring that the medical practitioners of the future will possess and demonstrate the qualities of the "good physician."

Non-technical skills for surgeons in the operating room: A review of the literature

BACKGROUND

This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills.

METHODS

A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect.

RESULTS

A number of "core" categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons.

CONCLUSIONS

Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.

The relationship of emotional exhaustion to work attitudes, job performance, and organizational citizenship behaviors

The authors investigated the negative consequences of emotional exhaustion for individual employees and their employers. On the basis of social exchange theory, the authors proposed that emotional exhaustion would predict job performance, 2 classes of organizational citizenship behavior, and turnover intentions. In addition, the authors posited that the relationship between emotional exhaustion and effective work behaviors would be mediated by organizational commitment. With only a few exceptions, the results of 2 field studies supported the authors' expectations. In addition, emotional exhaustion exerted an independent effect on these criterion variables beyond the impact of age, gender, and ethnicity.

Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort

OBJECTIVE

To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort.

PARTICIPANTS AND METHODS

Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction.

RESULTS

Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months.

CONCLUSION

Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months.

Debriefing as formative assessment: closing performance gaps in medical education

The authors present a four-step model of debriefing as formative assessment that blends evidence and theory from education research, the social and cognitive sciences, experience drawn from conducting over 3,000 debriefings, and teaching debriefing to approximately 1,000 clinicians worldwide. The steps are to: 1) note salient performance gaps related to predetermined objectives, 2) provide feedback describing the gap, 3) investigate the basis for the gap by exploring the frames and emotions contributing to the current performance level, and 4) help close the performance gap through discussion or targeted instruction about principles and skills relevant to performance. The authors propose that the model, designed for postsimulation debriefings, can also be applied to bedside teaching in the emergency department (ED) and other clinical settings.

Misplaced endotracheal tubes by paramedics in an urban emergency medical services system

STUDY OBJECTIVE

To determine the incidence of unrecognized, misplaced endotracheal tubes inserted by paramedics in a large urban, decentralized emergency medical services (EMS) system.

METHODS

We conducted a prospective, observational study of patients intubated in the field by paramedics before emergency department arrival. During an 8-month period, emergency physicians assessed tube position at ED arrival using a combination of auscultation, end-tidal carbon dioxide (ETCO(2)) monitoring, and direct laryngoscopy.

RESULTS

A total of 108 intubated patients were studied. On arrival in the ED, 25% (27/108) of patients were found to have improperly placed endotracheal tubes. Of the misplaced tubes, 67% (18/27) were found to be in the esophagus, whereas in 33% (9/27), the tip of the tube was found to be in the hypopharynx, above the vocal cords. Of the patients with misplaced tubes noted in the hypopharynx, 33% (3/9) died while in the ED. For the patients found to have tubes in the hypopharynx, 56% (5/9) had evidence of ETCO(2) on ED arrival. For the patients found to have esophageal tube placement on ED arrival, 56% (10/18) died in the ED. Esophageal intubation was associated with an absence of expired CO(2) (17/18, 94%) on ED arrival. The single patient in this subset with a recordable ETCO(2) had been nasotracheally intubated with the tip of the endotracheal tube noted in the esophagus while spontaneous respirations were present. On patient arrival to the ED, 63% (68/108) of the patients had direct laryngoscopy in addition to ETCO(2) determination. All patients had ETCO(2) evaluation performed on arrival. All patients in whom an absence of ETCO(2) was demonstrated on patient arrival underwent direct laryngoscopy. In cases in which direct laryngoscopy was not performed, the attending physician documented the ETCO(2) in conjunction with the presence of bilateral breath sounds.

CONCLUSION

The incidence of out-of-hospital, unrecognized, misplaced endotracheal tubes in our community is excessively high and may be reflective of the incidence occurring in other communities. Data from other communities are needed to clarify the scope of this alarming issue.

Fundamental dimensions of social judgment: Understanding the relations between judgments of competence and warmth

In seems there are two dimensions that underlie most judgments of traits, people, groups, and cultures. Although the definitions vary, the first makes reference to attributes such as competence, agency, and individualism, and the second to warmth, communality, and collectivism. But the relationship between the two dimensions seems unclear. In trait and person judgment, they are often positively related; in group and cultural stereotypes, they are often negatively related. The authors report 4 studies that examine the dynamic relationship between these two dimensions, experimentally manipulating the location of a target of judgment on one and examining the consequences for the other. In general, the authors' data suggest a negative dynamic relationship between the two, moderated by factors the impact of which they explore.

Action-video-game experience alters the spatial resolution of vision

Playing action video games enhances several different aspects of visual processing; however, the mechanisms underlying this improvement remain unclear. Here we show that playing action video games can alter fundamental characteristics of the visual system, such as the spatial resolution of visual processing across the visual field. To determine the spatial resolution of visual processing, we measured the smallest distance a distractor could be from a target without compromising target identification. This approach exploits the fact that visual processing is hindered as distractors are brought close to the target, a phenomenon known as crowding. Compared with nonplayers, action-video-game players could tolerate smaller target-distractor distances. Thus, the spatial resolution of visual processing is enhanced in this population. Critically, similar effects were observed in non-video-game players who were trained on an action video game; this result verifies a causative relationship between video-game play and augmented spatial resolution.

Trait-based perspectives of leadership

The trait-based perspective of leadership has a long but checkered history. Trait approaches dominated the initial decades of scientific leadership research. Later, they were disdained for their inability to offer clear distinctions between leaders and nonleaders and for their failure to account for situational variance in leadership behavior. Recently, driven by greater conceptual, methodological, and statistical sophistication, such approaches have again risen to prominence. However, their contributions are likely to remain limited unless leadership researchers who adopt this perspective address several fundamental issues. The author argues that combinations of traits and attributes, integrated in conceptually meaningful ways, are more likely to predict leadership than additive or independent contributions of several single traits. Furthermore, a defining core of these dominant leader trait patterns reflects a stable tendency to lead in different ways across disparate organizational domains. Finally, the author summarizes a multistage model that specifies some leader traits as having more distal influences on leadership processes and performance, whereas others have more proximal effects that are integrated with, and influenced by, situational parameters.

Communication Interventions Make A Difference in Conversations Between Physicians and Patients

OBJECTIVE

We sought to synthesize the findings of studies examining interventions to enhance the communication behaviors of physicians and patients during outpatient encounters.

METHODS

We conducted searches of 6 databases between 1966 and 2005 to identify studies for a systematic review and synthesis of the literature. Eligible studies tested a communication intervention; were randomized controlled trials (RCTs); objectively assessed verbal communication behaviors as the primary outcome; and were published in English. Interventions were characterized by type (eg, information, modeling, feedback, practice), delivery strategy, and overall intensity. We abstracted information on the effects of the interventions on communication outcomes (eg, interpersonal and information exchanging behaviors). We examined the effectiveness of the interventions in improving the communication behaviors of physicians and patients.

RESULTS

Thirty-six studies were reviewed: 18 involved physicians; 15 patients; and 3 both. Of the physician interventions, 76% included 3 or 4 types, often in the form of practice and feedback sessions. Among the patient interventions, 33% involved 1 type, and nearly all were delivered in the waiting room. Intervention physicians were more likely than controls to receive higher ratings of their overall communication style and to exhibit specific patient-centered communication behaviors. Intervention patients obtained more information from physicians and exhibited greater involvement during the visit than controls.

CONCLUSIONS

The interventions were associated with improved physician and patient communication behaviors. The challenge for future research is to design effective patient and physician interventions that can be integrated into practice.

A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40

BACKGROUND

This review, which focused on faculty development initiatives designed to improve teaching effectiveness, synthesized findings related to intervention types, study characteristics, individual and organizational outcomes, key features, and community building.

METHODS

This review included 111 studies (between 2002 and 2012) that met the review criteria.

FINDINGS

Overall satisfaction with faculty development programs was high. Participants reported increased confidence, enthusiasm, and awareness of effective educational practices. Gains in knowledge and skills, and self-reported changes in teaching behaviors, were frequently noted. Observed behavior changes included enhanced teaching practices, new educational initiatives, new leadership positions, and increased academic output. Organizational changes were infrequently explored. Key features included evidence-informed educational design, relevant content, experiential learning, feedback and reflection, educational projects, intentional community building, longitudinal program design, and institutional support.

CONCLUSION

This review holds implications for practice and research. Moving forward, we should build on current success, broaden the focus beyond individual teaching effectiveness, develop programs that extend over time, promote workplace learning, foster community development, and secure institutional support. We should also embed studies in a theoretical framework, conduct more qualitative and mixed methods studies, assess behavioral and organizational change, evaluate transfer to practice, analyse key features, and explore the role of faculty development within the larger organizational context.

Longitudinal field investigation of the moderating and mediating effects of self-efficacy on the relationship between training and newcomer adjustment

A longitudinal field study examined the moderating and mediating effects of self-efficacy on the relationship between training and the adjustment of newcomers during their 1st year of employment. The results provided some support for the hypothesis that initial self-efficacy moderates the relationship between training and adjustment. Training was more strongly related to posttraining self-efficacy, ability to cope, job performance, and intention to quit the profession for newcomers with low levels of initial self-efficacy mediates the relationship between training and adjustment; however, evidence of complete mediation was found only for ability to cope. Posttraining self-efficacy partially mediated the relationships between training and job satisfaction, organizational and professional commitment, and intention to quit the organization and the profession. Research and practical implications of these findings for the training and the socialization of newcomers are discussed.

Intelligence and leadership: a quantitative review and test of theoretical propositions

Meta-analysis was used to aggregate results from studies examining the relationship between intelligence and leadership. One hundred fifty-one independent samples in 96 sources met the criteria for inclusion in the meta-analysis. Results indicated that the corrected correlation between intelligence and leadership is.21 (uncorrected for range restriction) and.27 (corrected for range restriction). Perceptual measures of intelligence showed stronger correlations with leadership than did paper-and-pencil measures of intelligence. Intelligence correlated equally well with objective and perceptual measures of leadership. Additionally, the leader's stress level and the leader's directiveness moderated the intelligence-leadership relationship. Overall, results suggest that the relationship between intelligence and leadership is considerably lower than previously thought. The results also provide meta-analytic support for both implicit leadership theory and cognitive resource theory.

A general system for evaluating therapist adherence and competence in psychotherapy research in the addictions

The Yale Adherence and Competence Scale (YACS) is a general system for rating therapist adherence and competence in delivering behavioral treatments for substance use disorders. The system includes three scales measuring 'general' aspects of drug abuse treatment (assessment, general support, goals of treatment), as well as three scales measuring critical elements of three treatments that are frequently implemented as control or comparison treatments in clinical research in the addictions (clinical management (CM), twelve step facilitation (TSF), and cognitive behavioral therapy (CBT)). Validation of the YACS using data from a randomized clinical trial indicated that the scales have excellent reliability, factor structure, concurrent and discriminant validity. Correlations between adherence and competence scores within scales were in the moderate range, indicating independence (and thus nonredundancy) of these dimensions. Strategies for using the YACS in both psychotherapy and pharmacotherapy research in the addictions are described.