The role of the emotive, moral, and cognitive components for the prediction of medical students' empathic behavior in an Objective Structured Clinical Examination (OSCE).

OBJECTIVES: Investigate whether medical students' emotive abilities, attitudes, and cognitive empathic professional abilities predict empathic behavior in an Objective Structured Clinical Examination (OSCE). METHODS: Linear and multiple regressions were used to test concurrent validity between Interpersonal Reactivity Index (IRI), Jefferson Scale of Physician Empathy (JSPE-S), Situational Judgement Test (SJT-expert-based score (SJT-ES), SJT-theory-based score (SJT-TS)) and empathic behavior in an OSCE measured by Berlin Global Rating (BGR) and Verona Coding Definitions for Emotion Sequences (VR-CoDES). RESULTS: Highest amounts of explained variance of empathic behavior measured by VR-CoDES were found for the SJT-ES (R2 = 0.125) and SJT-TS (R2 = 0.131). JSPE-S (R2 = 0.11) and SJT-ES (R2 = 0.10) explained the highest amount of variance in empathic behavior as measured by BGR. Stepwise multiple regression improved the model for BGR by including SJT-ES and JSPE-S, explaining 16.2% of variance. CONCLUSIONS: The instrument measuring the emotive component (IRI) did not significantly predict empathic behavior, whereas instruments measuring moral (JSPE-S) and cognitive components (SJT) significantly predicted empathic behavior. However, the explained variance was small. PRACTICE IMPLICATIONS: The instrument measuring the emotive component (IRI) did not significantly predict empathic behavior, whereas instruments measuring moral (JSPE-S) and cognitive components (SJT) significantly predicted empathic behavior. However, the explained variance was small. In a longitudinal assessment program, triangulation of different instruments assessing empathy offers a rich perspective of learner's empathic abilities. Empathy training should include the acquisition of knowledge, attitudes, and behavior to support learner's empathic behaviors.

Reduced Resting-State Connectivity in the Precuneus is correlated with Apathy in Patients with Schizophrenia.

A diagnosis of schizophrenia is associated with a heterogeneous psychopathology including positive and negative symptoms. The disconnection hypothesis, an early pathophysiological framework conceptualizes the diversity of symptoms as a result of disconnections in neural networks. In line with this hypothesis, previous neuroimaging studies of patients with schizophrenia reported alterations within the default mode network (DMN), the most prominent network at rest. The aim of the present study was to investigate the functional connectivity during rest in patients with schizophrenia and with healthy individuals and explore whether observed functional alterations are related to the psychopathology of patients. Therefore, functional magnetic resonance images at rest were recorded of 35 patients with schizophrenia and 41 healthy individuals. Independent component analysis (ICA) was used to extract resting state networks. Comparing ICA results between groups indicated alterations only within the network of the DMN. More explicitly, reduced connectivity in the precuneus was observed in patients with schizophrenia compared to healthy controls. Connectivity in this area was negatively correlated with the severity of negative symptoms, more specifically with the domain of apathy. Taken together, the current results provide further evidence for a role DMN alterations might play in schizophrenia and especially in negative symptoms such as apathy.

What works best in a general practice specific OSCE for medical students: Mini-CEX or content-related checklists?

Aim: To develop and pilot a General Practice (GPr) OSCE assessing medical students dealing with patient encounters, which are typical for GPr and to compare different measurement instruments (global ratings, content-specific checklists).Methods: A blueprint based on Entrusted Professional Activities was used to develop prototypical OSCE stations. Four stations were tested with voluntary medical students. Students were videotaped and assessed with self-developed content-specific checklists, a global rating for communication skills, and mini-CEX. Results were compared according to students' phases of studies.Results: All three measurements were able to discriminate between clinical and pre-clinical students. Clearest results were achieved by using mini-CEX. Content-specific checklists were not able to differentiate between those groups for the more difficult stations. Inter-station reliability for the global ratings was sufficient for high-stakes exams. Students enjoyed the OSCE-setting simulating GPr consultation hours. They would prefer feedback from GPs after the OSCE and from simulated patients after each encounter.Discussion and conclusion: Although the OSCE was short, results indicate advantages for using a global rating instead of checklists. Further research should include validating these results with a larger group of students and to find the threshold during the phases of education for switching from checklists to global ratings.

New Graph-Theoretical-Multimodal Approach Using Temporal and Structural Correlations Reveals Disruption in the Thalamo-Cortical Network in Patients with Schizophrenia.

Schizophrenia has been understood as a network disease with altered functional and structural connectivity in multiple brain networks compatible to the extremely broad spectrum of psychopathological, cognitive, and behavioral symptoms in this disorder. When building brain networks, functional and structural networks are typically modeled independently: Functional network models are based on temporal correlations among brain regions, whereas structural network models are based on anatomical characteristics. Combining both features may give rise to more realistic and reliable models of brain networks. In this study, we applied a new flexible graph-theoretical-multimodal model called FD (F, the functional connectivity matrix, and D, the structural matrix) to construct brain networks combining functional, structural, and topological information of magnetic resonance imaging (MRI) measurements (structural and resting-state imaging) to patients with schizophrenia (n = 35) and matched healthy individuals (n = 41). As a reference condition, the traditional pure functional connectivity (pFC) analysis was carried out. By using the FD model, we found disrupted connectivity in the thalamo-cortical network in schizophrenic patients, whereas the pFC model failed to extract group differences after multiple comparison correction. We interpret this observation as evidence that the FD model is superior to conventional connectivity analysis, by stressing relevant features of the whole-brain connectivity, including functional, structural, and topological signatures. The FD model can be used in future research to model subtle alterations of functional and structural connectivity, resulting in pronounced clinical syndromes and major psychiatric disorders. Lastly, FD is not limited to the analysis of resting-state functional MRI, and it can be applied to electro-encephalography, magneto-encephalography, etc.

The Metacognition Assessment Scale (MAS-A): Results of a pilot study applying a German translation to individuals with schizophrenia spectrum disorders.

OBJECTIVES: Metacognition, the capacity 'to think about thinking' and thus to reflect and to master interpersonal problems on a mentalistic basis, is often impaired among patients with schizophrenia spectrum disorders and has been suggested as a potential treatment target. However, little is known about the reliability of its measurement and links with related phenomena. The aim of this study was to validate a German translation of the Metacognition Assessment Scale (MAS-A) as a measure to assess metacognition from free narratives of patients' personally relevant episodes and relationships. DESIGN AND METHODS: MAS-A was applied to narratives of 22 individuals with schizophrenia spectrum disorders together with self-ratings and behavioural tests of metacognitive and related functions such as mentalizing and emotional awareness. Multi-level modelling allowed to calculate inter-rater reliability (IRR) and inter-rater agreement (IRA) and to include test results as level-2 predictors of the aggregated scorings on the MAS-A subscales in order to explore convergent validity. After considering neurocognition and symptom scores as further predictors, aggregated scorings were correlated with psychosocial functioning. RESULTS: There were high IRRs and IRAs all over the ratings. None of the related measures accounted for variance in MAS-A scorings, indicating the existence of separable, non-overlapping constructs. Verbal memory and positive symptoms were significant predictors for MAS-A subscales. MAS-A, but no other measure, displayed significant associations with psychosocial functioning. CONCLUSIONS: MAS-A is a reliable expert rating to assess metacognition from patients' free narratives. Considering the link to psychosocial functioning, MAS-A appears to be a promising tool for the evaluation of metacognition. PRACTITIONER POINTS: MAS-A is a reliable tool to evaluate metacognitive function from narratives about emotionally relevant topics and meaningful relationships. Metacognition appears separate from neighbouring constructs such as mentalizing, ToM, or emotional awareness. MAS-A scales are significantly predicted by verbal memory and positive symptoms. Only MAS-A scales display significant associations with psychosocial functioning, and it thus is a promising tool to evaluate metacognition in psychotherapy research.