National survey of psychotherapy training in psychiatry, psychology, and social work

CONTEXT

Approximately 3% of the US population receives psychotherapy each year from psychiatrists, psychologists, or social workers. A modest number of psychotherapies are evidence-based therapy (EBT) in that they have been defined in manuals and found efficacious in at least 2 controlled clinical trials with random assignment that include a control condition of psychotherapy, placebo, pill, or other treatment and samples of sufficient power with well-characterized patients. Few practitioners use EBT.

OBJECTIVE

To determine the amount of EBT taught in accredited training programs in psychiatry, psychology (PhD and PsyD), and social work and to note whether the training was elective or required and presented as a didactic (coursework) or clinical supervision.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional survey of a probability sample of all accredited training programs in psychiatry, psychology, and social work in the United States. Responders included training directors (or their designates) from 221 programs (73 in psychiatry, 63 in PhD clinical psychology, 21 in PsyD psychology, and 64 in master's-level social work). The overall response rate was 73.7%. Main Outcome Measure Requiring both a didactic and clinical supervision in an EBT.

RESULTS

Although programs offered electives in EBT and non-EBT, few required both a didactic and clinical supervision in EBT, and most required training was non-EBT. Psychiatry required coursework and clinical supervision in the largest percentage of EBT (28.1%). Cognitive behavioral therapy was the EBT most frequently offered and required as a didactic in all 3 disciplines. More than 90% of the psychiatry training programs were complying with the new cognitive behavior therapy requirement. The 2 disciplines with the largest number of students and emphasis on clinical training-professional clinical psychology (PsyD) and social work-had the largest percentage of programs (67.3% and 61.7%, respectively) not requiring a didactic and clinical supervision in any EBT.

CONCLUSION

There is a considerable gap between research evidence for psychotherapy and clinical training. Until the training programs in the major disciplines providing psychotherapy increase training in EBT, the gap between research evidence and clinical practice will remain.

Mindfulness training for stress management: a randomised controlled study of medical and psychology students

BACKGROUND

Distress and burnout among medical and psychology professionals are commonly reported and have implications for the quality of patient care delivered. Already in the course of university studies, medicine and psychology students report mental distress and low life satisfaction. There is a need for interventions that promote better coping skills in students in order to prevent distress and future burnout. This study examines the effect of a seven-week Mindfulness-Based Stress Reduction (MBSR) programme on mental distress, study stress, burnout, subjective well-being, and mindfulness of medical and psychology students.

METHODS

A total of 288 students (mean age = 23 years, 76% female) from the University of Oslo and the University of Tromsø were randomly allocated to an intervention or control group. The control group continued with their standard university courses and received no intervention. Participants were evaluated using self-reported measures both before and after the intervention. These were: the 'General Health Questionnaire, Maslach Burnout Inventory Student version, Perceived Medical School Stress, Subjective Well-being, and Five Facet Mindfulness Questionnaire' and additional indices of compliance.

RESULTS

Following the intervention, a moderate effect on mental distress (Hedges'g 0.65, CI = .41, .88), and a small effect on both subjective well-being (Hedges'g 0.40, CI = .27, .63) and the mindfulness facet 'non-reacting' (Hedges'g 0.33, CI = .10, .56) were found in the intervention group compared with the control group. A higher level of programme attendance and reported mindfulness exercises predicted these changes. Significant effects were only found for female students who additionally reported reduced study stress and an increase in the mindfulness facet 'non-judging'. Gender specific effects of participation in the MBSR programme have not previously been reported, and gender differences in the present study are discussed.

CONCLUSION

Female medical and psychology students experienced significant positive improvements in mental distress, study stress, subjective well-being and mindfulness after participating in the MBSR programme.

TRIAL REGISTRATION

NCT00892138.

Evaluation of a Web-based introductory psychology course: I. Learning and satisfaction in on-line versus lecture courses

We offered introductory psychology on the World-Wide Web (WWW) and evaluated the on-line format relative to the traditional lecture-test format, using a pretest-posttest nonequivalent control group design. Multiple sections of the introductory course were offered each semester; on-line and lecture sections were taught by the same instructor, the same textbook was used, and the same in-class examinations were taken. For on-line sections, mastery quizzes, interactive individual exercises, and weekly laboratory meetings replaced lectures. Increased content knowledge was greater for the students in the Web sections, as was in-class examination performance. Use of the WWW and computers for academic purposes increased more in the on-line sections, and the on-line students showed a greater decrease in computer anxiety. The students in the on-line sections expressed appreciation for course components and the convenience of the course, but the lecture sections received higher ratings on course evaluations than did the on-line sections. Learning and course satisfaction were dissociated in the two course formats.

Competencies conference: future directions in education and credentialing in professional psychology

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was organized around eight competency-focused work groups, as well as work groups on specialties and the assessment of competence. A diverse group of psychologists participated in this multisponsored conference. After describing the background and structure of the conference, this article reviews the common themes that surfaced across work groups, with attention paid to the identification, training, and assessment of competencies and competence. Recommendations to advance competency-based education, training, and credentialing in professional psychology are discussed. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care

OBJECTIVE

To evaluate benefits for postnatal women of two psychologically informed interventions by health visitors.

DESIGN

Prospective cluster trial randomised by general practice, with 18 month follow-up.

SETTING

101 general practices in Trent, England.

PARTICIPANTS

2749 women allocated to intervention, 1335 to control.

INTERVENTION

Health visitors (n=89 63 clusters) were trained to identify depressive symptoms at six to eight weeks postnatally using the Edinburgh postnatal depression scale (EPDS) and clinical assessment and also trained in providing psychologically informed sessions based on cognitive behavioural or person centred principles for an hour a week for eight weeks. Health visitors in the control group (n=49 38 clusters) provided usual care.

MAIN OUTCOME MEASURES

Score >or=12 on the Edinburgh postnatal depression scale at six months. Secondary outcomes were mean Edinburgh postnatal depression scale, clinical outcomes in routine evaluation-outcome measure (CORE-OM), state-trait anxiety inventory (STAI), SF-12, and parenting stress index short form (PSI-SF) scores at six, 12, 18 months.

RESULTS

4084 eligible women consented and 595 women had a six week EPDS score >or=12. Of these, 418 had EPDS scores available at six weeks and six months. At six months, 34% women (93/271) in the intervention group and 46% (67/147) in the control group had an EPDS score >or=12. The odds ratio for score >or=12 at six months was 0.62 (95% confidence interval 0.40 to 0.97, P=0.036) for women in the intervention group compared with women in the control group. After adjustment for covariates, the odds ratio was 0.60 (0.38 to 0.95, P=0.028). At six months, 12.4% (234/1880) of all women in the intervention group and 16.7% (166/995) of all women in the control group had scores >or=12 (0.67, 0.51 to 0.87, P=0.003). Benefit for women in the intervention group with a six week EPDS score >or=12 and for all women was maintained at 12 months postnatally. There was no differential benefit for either psychological approach over the other.

CONCLUSION

Training health visitors to assess women, identify symptoms of postnatal depression, and deliver psychologically informed sessions was clinically effective at six and 12 months postnatally compared with usual care.

TRIAL REGISTRATION

ISRCTN92195776.

Applying a Family Resilience Framework in Training, Practice, and Research: Mastering the Art of the Possible

With growing interest in systemic views of human resilience, this article updates and clarifies our understanding of the concept of resilience as involving multilevel dynamic processes over time. Family resilience refers to the functioning of the family system in dealing with adversity: Assessment and intervention focus on the family impact of stressful life challenges and the family processes that foster positive adaptation for the family unit and all members. The application of a family resilience framework is discussed and illustrated in clinical and community-based training and practice. Use of the author's research-informed map of core processes in family resilience is briefly noted, highlighting the recursive and synergistic influences of transactional processes within families and with their social environment. Given the inherently contextual nature of the construct of resilience, varied process elements may be more or less useful, depending on different adverse situations over time, with a major crisis; disruptive transitions; or chronic multistress conditions. This perspective is attuned to the diversity of family cultures and structures, their resources and constraints, socio-cultural and developmental influences, and the viability of varied pathways in resilience.

Teaching from the clinical reasoning literature: combined reasoning strategies help novice diagnosticians overcome misleading information

OBJECTIVE

Previous research has revealed a pedagogical benefit of instructing novice diagnosticians to utilise a combined approach to clinical reasoning (familiarity-driven pattern recognition combined with a careful consideration of the presenting features) when diagnosing electrocardiograms (ECGs). This paper reports 2 studies demonstrating that the combined instructions are especially valuable in helping students overcome biasing influences.

METHODS

Undergraduate psychology students were trained to diagnose 10 cardiac conditions via ECG presentation. Half of all participants were instructed to reason in a combined manner and half were given no explicit instruction regarding the diagnostic task. In Study 1 (n = 60), half of each group was biased towards an incorrect diagnosis through presentation of counter-indicative features. In Study 2 (n = 48), a third of the test ECGs were presented with a correct diagnostic suggestion, a third with an incorrect suggestion, and a third without a suggestion.

RESULTS

Overall, the instruction to utilise a combined reasoning approach resulted in greater diagnostic accuracy relative to leaving students to their own intuitions regarding how best to approach new cases. The effect was particularly pronounced when cases were made challenging by biasing participants towards an incorrect diagnosis, either through mention of a specific feature or by making an inaccurate diagnostic suggestion.

DISCUSSION

These studies advance a growing body of evidence suggesting that various diagnostic strategies identified in the literature on clinical reasoning are not mutually exclusive and that trainees can benefit from explicit guidance regarding the value of both analytic and non-analytic reasoning tendencies.

Does the Graduate Record Examination predict meaningful success in the graduate training of psychologists? A case study

The authors consider the empirical validity of the Graduate Record Examination (GRE) as a predictor of various kinds of performance in a graduate psychology program, including 1st- and 2nd-year grades; professors' ratings of students' dissertations; and professors' ratings of students' analytical, creative, practical, research, and teaching abilities. On the basis of the triarchic theory of intelligence, the GRE was predicted to be of some use in predicting graduate grades but of limited or no use in predicting other aspects of performance. In fact, the test was found to be useful in predicting 1st-year grades but not other kinds of performance, with one exception--performance on the GRE Analytical test was predictive, but only for men. The authors conclude that there is a need to develop better theory-based tests.

Emotion skills training for medical students: a systematic review

OBJECTIVE

To identify emotion skills training methods and outcomes using a systematic review of medical student curricula studies.

METHODS

We searched the English language literature listed in the PubMed, Educational Resources Information Center (ERIC), PsycINFO and Web of Science databases, from 1980 to the present, using a comprehensive list of emotion skills keywords and subsequent hand searches. A total of 828 articles were initially identified. A manual search yielded 161 articles on broadly defined emotion skills educational programmes for medical students. A more stringent review and hand search of reference lists yielded a final 26 articles that included 'other-directed' emotion skills (i.e. cognitive and behavioural skills intended to manage the emotions of others), a description of the training programme, and assessment data.

RESULTS

Emotion skills courses varied by total number of contact hours (2-64 hours), session frequency (from 1 session per day to 1 session every 6 months), duration (2 weeks to 2 years), pedagogy, patients targeted and educational outcomes. Student evaluation data were positive. Fifteen of 26 studies used objective emotion skills measures. Only 6/26 studies included a control or comparison condition and 5/26 used a randomised, controlled trial (RCT) design. All 5 RCTs showed positive outcomes with modest improvements in emotion communication skills, empathy, use of emotion words, supportive behaviours and enriched patient understanding.

CONCLUSIONS

The heterogeneity of emotion skills curricular studies makes direct comparisons difficult. However, all controlled trials showed positive outcomes, suggesting the importance and effectiveness of 'other-directed' emotion skills training. No specific recommendations about curricular amount and frequency, timing and pedagogy can be made.

Cultural malpractice. The growing obsolescence of psychology with the changing U.S. population

With the changing demographics occurring in the United States, psychology must make substantive revisions in its curriculum, training, research, and practice. Without these revisions, psychology will risk professional, ethical, and economic problems because psychology will no longer be a viable professional resource to the majority of the U.S. population. In particular, this article discusses the need for psychology to address issues of ethnicity/culture, gender, and sexual orientation.

Virtual reality and brain anatomy: a randomised trial of e-learning instructional designs

CONTEXT

Computer-aided instruction is used increasingly in medical education and anatomy instruction with limited research evidence to guide its design and deployment.

OBJECTIVES

To determine the effects of (a) learner control over the e-learning environment and (b) key views of the brain versus multiple views in the learning of brain surface anatomy.

DESIGN

Randomised trial with 2 phases of study. Participants Volunteer sample of 1st-year psychology students (phase 1, n = 120; phase 2, n = 120). Interventions Phase 1: computer-based instruction in brain surface anatomy with 4 conditions: (1) learner control/multiple views (LMV); (2) learner control/key views (LKV); (3) programme control/multiple views (PMV); (4) programme control/key views (PKV). Phase 2: 2 conditions: low learner control/key views (PKV) versus no learner control/key views (SKV). All participants performed a pre-test, post-test and test of visuospatial ability.

MAIN OUTCOME MEASURES

A 30-item post-test of brain surface anatomy structure identification.

RESULTS

The PKV group attained the best post-test score (57.7%) and the PMV group received the worst (42.2%), with the 2 high learner control groups performing in between. For students with low spatial ability, estimated scores are 20% lower for those who saw multiple views during learning. In phase 2, students with the most static condition and no learner control (SKV) performed similarly to those students in the PKV group.

CONCLUSIONS

Multiple views may impede learning, particularly for those with relatively poor spatial ability. High degrees of learner control may reduce effectiveness of learning.

More practice, less preach? the role of supervision processes and therapist characteristics in EBP implementation

Identifying predictors of evidence-based practice (EBP) use, such as supervision processes and therapist characteristics, may support dissemination. Therapists (N = 57) received training and supervision in EBPs to treat community-based youth (N = 136). Supervision involving modeling and role-play predicted higher overall practice use than supervision involving discussion, and modeling predicted practice use in the next therapy session. No therapist characteristics predicted practice use, but therapist sex and age moderated the supervision and practice use relation. Supervision involving discussion predicted practice use for male therapists only, and modeling and role-play in supervision predicted practice use for older, not younger, therapists.

Determinants and outcomes of motivation in health professions education: a systematic review based on self-determination theory

PURPOSE

This study aimed at conducting a systematic review in health professions education of determinants, mediators and outcomes of students' motivation to engage in academic activities based on the self-determination theory's perspective.

METHODS

A search was conducted across databases (MEDLINE, CINHAL, EMBASE, PsycINFO, and ERIC databases), hand-search of relevant journals, grey literature, and published research profile of key authors. Quantitative and qualitative studies were included if they reported research in health professions education focused on determinants, mediators, and/or outcomes of motivation from the self-determination and if meeting the quality criteria.

RESULTS

A total of 17 studies met the inclusion and quality criteria. Articles retrieved came from diverse locations and mainly from medical education and to a lesser extent from psychology and dental education. Intrapersonal (gender and personality traits) and interpersonal determinants (academic conditions and lifestyle, qualitative method of selection, feedback, and an autonomy supportive learning climate) have been reported to have a positive influence on students' motivation to engage in academic activities. No studies were found that tested mediation effects between determinants and students' motivation. In turn, students' self-determined motivation has been found to be positively associated with different cognitive, affective, and behavioural outcomes.

CONCLUSION

This study has found that generally, motivation could be enhanced by changes in the educational environment and by an early detection of students' characteristics. Doing so may support future health practitioners' self-determined motivation and positively influence how they process information and their emotions and how they approach their learning activities.

Prevalence, type, disclosure, and severity of adverse life events in college students

OBJECTIVE

Some information on the prevalence of adverse life experiences is available for the general population and college students, but the extent, nature, and severity of these events is unclear.

PARTICIPANTS

The authors recruited undergraduate college students (N = 6,053) from diverse academic settings (public and private schools) and geographic locations.

METHODS

They examined the prevalence, nature, severity, and disclosure of adverse events, in addition to reports of posttraumatic stress disorder (PTSD) symptomatology within the sample.

RESULTS

Across multiple studies, prevalence rates of adverse events ranged from 55.8% to 84.5%, replicating previous findings in larger samples. In a subset of undergraduate students (n = 97) who the authors interviewed in greater depth, 9% reported symptoms of clinical PTSD and an additional 11% reported subclinical symptoms.

CONCLUSIONS

Research using college samples for the study of stressful life events is a useful and reasonable strategy. The authors discuss implications for research, as well as screening and referral services at universities.

The diversification of psychology: a multicultural revolution

The National Multicultural Conference and Summit was held in January 1999 in Newport Beach, California. Hosted by Divisions 17 (Counseling Psychology), 35 (Society for the Psychology of Women), and 45 (Society for the Psychological Study of Ethnic Minority Issues), the event drew support from many American Psychological Association (APA) divisions and other major organizations and sponsors. Approximately 550 psychologists and graduate students attended the conference, which was intended to (a) examine state-of-the-art issues in ethnic minority psychology, (b) identify barriers to becoming a multicultural profession, and (c) forge alliances for political action and advocacy. The summit participants unanimously endorsed resolutions aimed at implementing cultural competence in all psychological endeavors. Multicultural themes arising from the summit included the diversification of the United States; the facilitation of difficult dialogues on race, gender, and sexual orientation; spirituality as a basic dimension of the human condition; the invisibility of monoculturalism and Whiteness; and the teaching of multiculturalism and diversity. APA was strongly encouraged to take the lead in seeing that multicultural competence becomes a defining feature of psychological practice, education and training, and research.

The impact of CBT and ACT models using psychology trainee therapists: a preliminary controlled effectiveness trial

The present study compares the impact of individualized treatment provided by trainee therapists based on a traditional cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT) model. Fourteen therapists were given initial training in CBT and ACT. Outpatients (N = 28) were randomized to either approach, with each therapist treating one client within each model, linked to a functional analysis. Clients treated within an ACT model showed better symptom improvement than the CBT clients, despite the fact that students felt initially less knowledgeable about ACT and were more fearful throughout when it was used. CBT improved client self-confidence more rapidly than ACT, and ACT improved acceptance more than CBT. Both processes predicted better outcomes; acceptance remained predictive when controlling for self-confidence but not vice versa. Overall, therapists with limited training in both models got better results with ACT and the processes of change fit with the ACT model.

Changes in memory awareness during learning: the acquisition of knowledge by psychology undergraduates

First-year psychology students took multiple-choice examinations following each of 4 lecture courses and 3 laboratory research methods courses. One lecture course was later retested. Students indicated state of memory awareness accompanying each answer: recollective experience (remember), "just know" (know), feeling of familiarity (familiarity), or guess. On the lecture courses, higher performing students differed from other students because they had more remember responses. On research methods, higher performing students differed because they knew more, and in the delayed retest, higher performing students differed because they now knew rather than remembered more. These findings demonstrate a shift from remembering to knowing, dependent upon level attained, type of course, and retention interval, and suggest an underlying shift in knowledge representation from episodic to semantic memory. The authors discuss theoretical and educational implications of the findings.

Implicit anti-fat bias in physical educators: physical attributes, ideology and socialization

OBJECTIVE

To investigate the implicit and explicit prejudice of physical education (PE) students before, and following extensive professional training, and to examine the relationship of anti-fat prejudice to relevant psychosocial predictors.

DESIGN

Implicit and explicit anti-fat prejudice of year one and three PE students (cross-sectional sample) were assessed and compared to a similarly matched (age, body mass index (BMI), education) sample of psychology students.

SUBJECTS

Three hundred and forty-four university students, 180 PE students, 164 psychology students (67% female, mean age 20 years, BMI: mean 23.18 kg/m(2)).

MEASUREMENTS

Measures of implicit and explicit anti-fat prejudice were administered to PE and psychology students in either their second week, or near completion of their third year, of university study. Physical identity, body esteem and social dominance orientation (SDO) were assessed in order to establish their relationship with anti-fat bias.

RESULTS

PE students displayed higher levels of implicit anti-fat bias than psychology students, and other health professionals. Additionally, year three PE students displayed higher levels of implicit anti-fat attitudes than year one PE students. The higher implicit anti-fat biases exhibited by year three PE students were associated with SDO, and lower body esteem.

CONCLUSION

Physical educators, and particularly those more socialized in the PE environment, display strong negative prejudice toward obese individuals that is greater than that displayed by other groups. These prejudices appear to be supported by an over-investment in physical attributes, and ideological beliefs.

Further studies on interviewer training and inter-rater reliability of the Present State Examination (PSE)

The Present State Examination (PSE) is discussed with regard to its use in surveys of subjects who are not psychiatric patients. Although the PSE was originally developed for use by psychiatrists with patients with obvious mental illness, the interview also contains sections dealing in considerable detail with the commoner and less severe complaints and symptoms that are found in a significant proportion of 'normal subjects'. A shortened version of the PSE (8th edition) is described, limited to these sections, which has been used in population surveys, by interviewers who are not psychiatrists, The training of such interviewers is described, and information on a reliability and repeatability study is presented. This shows that with proper training, non-psychiatric interviewers can achieve standards of inter-rater reliability that are comparable to those previously reported between psychiatrists.

The affirmation of the scientist-practitioner. A look back at Boulder

In the aftermath of World War II, several influences were paramount in forcing academic psychology to recognize, albeit reluctantly, the coming professionalization of psychology. The federal government, wishing to avoid a repeat of blunders following World War I that led to significant dissatisfaction among veterans, took proactive steps to ensure that mental health needs of the new veterans would be met. The USPHS and the VA were mandated to expand significantly the pool of mental health practitioners, a direction that led not only to the funding of the Boulder conference but also to the development of APA's accreditation program, funded practical and internship arrangements with the VA, and the USPHS grants to academic departments for clinical training. The GI Bill, amended to include payment for graduate education, created tremendous interest in graduate programs in psychology. As a result, psychology programs were inundated with funded applicants, most of whom were interested in the application of psychology to clinical and other applied fields. Graduate psychology departments were mixed in their views of this "blessing." The reality of a separate curriculum for professional training in psychology was a bitter pill for some academic psychologists to swallow. Graduate departments feared that control of their programs would be taken over by external forces and that they would lose their right to determine their own curriculum. Further, they feared the domination of clinical training within their own departments and the effects of such educational emphasis on their traditional experimental programs. The Boulder conference brought together these disparate needs and concerns, although one can argue about how well some points of view were represented with respect to others. It was a time of high anticipation and fear. The conference could easily have ended in failure, with such diverse interests being unable to reach any consensus. There are many letters in the correspondence of committee members that suggest disagreements serious enough to prevent the development of any single model of training. Instead, by most yardsticks that one could apply, the conference succeeded, perhaps beyond the dreams of many of those in attendance who were most invested in a model for professional training. In evaluating the legacy of Boulder, several points are apparent. First, the conference succeeded because 73 individuals were able to agree to some 70 resolutions in 15 days, creating the scientist-practitioner model of professional training. Such consensus was arguably a remarkable achievement. The endorsement of the model by academic units followed with little evident resistance, although it is clear that some Boulder-model programs were developed that bore little resemblance to the model's insistence on significant training in both research and practice. Second, as a response to social and political needs, the conference was clearly a success. The cooperation of the APA, the USPHS, and the VA benefited all three entities. Clinical psychology was given the financial support and backing to advance it as a profession, and the federal government was able to begin the process of securing the personnel needed to address the mental health needs of the nation. The architects of Boulder were clear that their vision of training for professional psychology should be viewed as dynamic and experimental rather than fixed and prescribed. Certainly there are several variants of professional training extant today, yet the overwhelming majority of currently accredited programs in psychology label themselves as "Boulder-model" programs or "scientist-practitioner" programs. Still, new national conferences on professional training in psychology occur with some regularity as participants seek to resolve many of the same concerns debated by those at Boulder. The grand experiment goes on.

The benefits of flexibility: the pedagogical value of instructions to adopt multifaceted diagnostic reasoning strategies

OBJECTIVES

Building on the advice of previous research to avoid parsing diagnostic strategies too finely, recent studies have shown that teaching novices to utilise analytic and non-analytic reasoning strategies yields higher diagnostic accuracy than teaching either in isolation. This study assesses the extent to which students spontaneously adopt a combined approach and compares its benefits with those experienced with a contrastive learning strategy known to enhance analogical transfer.

METHODS

A sample of 48 naïve students were trained to identify features on electrocardiograms (ECGs) and assign diagnoses. Half the participants learned in a standard manner, encountering diagnoses (and their associated features) in sequence. The remaining participants were explicitly instructed to draw comparisons between the diagnostic category being learned and another confusable diagnostic category (contrastive learning). Half the participants in both groups were further instructed to carefully identify all features while trusting guidance provided by feelings of familiarity (a combined reasoning strategy). The remaining participants were given no instructions on how to approach the diagnostic task.

RESULTS

Greater diagnostic accuracy was achieved following both contrastive learning and instructions to use a combined reasoning strategy relative to the control conditions. These variables did not interact with each other, nor did they interact with novelty of the test case. The effects were observed immediately after learning and following a 1-week delay.

DISCUSSION

The results emphasise the importance of explicitly empowering students to utilise multiple diagnostic strategies, including non-analytic approaches. In addition, this study reveals the benefit that can be gained from contrastive learning in a medical domain.