Evaluation of a workshop to teach clinical bioethics in the clinical setting.

That the teaching of medical ethics must extend into the clinical years in order for medical students to effectively acquire the knowledge and skills required for dealing with clinical bioethical issues has been widely recognized. A limiting factor has been the lack of physicians able to teach bioethics in the clinical setting. This paper describes the structure and evaluation of a workshop for teaching clinicians how to teach bioethics in the clinical setting. 80 physicians participated in 4 workshops in which they were provided with the ethical principles needed to deal with clinical bioethical issues and appropriate teaching methods. Methods such as paper cases, videotaped standardized patient interactions and live standardized patients were presented. The workshops have been highly evaluated. Post workshop evaluation showed that a significant number of physicians taught ethical issues during rounds and seminars. The frequency of teaching ranged from once per month to one or more times per week.

Experimental evidence for offspring learning in parent-offspring communication.

The offspring of birds and mammals solicit food from their parents by a combination of movements and vocalizations that have come to be known collectively as 'begging'. Recently, begging has most often been viewed as an honest signal of offspring need. Yet, if offspring learn to adjust their begging efforts to the level that rewards them most, begging intensities may also reflect offsprings' past experience rather than their precise current needs. Here we show that bird nestlings with equal levels of need can learn to beg at remarkably different levels. These experiments with hand-raised house sparrows (Passer domesticus) indicated that chicks learn to modify begging levels within a few hours. Moreover, we found that the begging postures of hungry chicks in natural nests are correlated with the average postures that had previously yielded them parental feedings. Such learning challenges parental ability to assess offspring needs and may require that, in response, parents somehow filter out learned differences in offspring signals.

Hippocampal plasticity involves extensive gene induction and multiple cellular mechanisms.

Long-term plasticity of the central nervous system (CNS) involves induction of a set of genes whose identity is incompletely characterized. To identify candidate plasticity-related genes (CPGs), we conducted an exhaustive screen for genes that undergo induction or downregulation in the hippocampus dentate gyrus (DG) following animal treatment with the potent glutamate analog, kainate. The screen yielded 362 upregulated CPGs and 41 downregulated transcripts (dCPGs). Of these, 66 CPGs and 5 dCPGs are known genes that encode for a variety of signal transduction proteins, transcription factors, and structural proteins. Seven novel CPGs predict the following putative functions: cpg2--a dystrophin-like cytoskeletal protein; cpg4--a heat-shock protein: cpg16--a protein kinase; cpg20--a transcription factor; cpg21--a dual-specificity MAP-kinase phosphatase; and cpg30 and cpg38--two new seven-transmembrane domain receptors. Experiments performed in vitro and with cultured hippocampal cells confirmed the ability of the cpg-21 product to inactivate the MAP-kinase. To test relevance to neural plasticity, 66 CPGs were tested for induction by stimuli producing long-term potentiation (LTP). Approximately one-fourth of the genes examined were upregulated by LTP. These results indicate that an extensive genetic response is induced in mammalian brain after glutamate receptor activation, and imply that a significant proportion of this activity is coinduced by LTP. Based on the identified CPGs, it is conceivable that multiple cellular mechanisms underlie long-term plasticity of the nervous system.

Selecting candidates for a medical school: an evaluation of a selection model based on cognitive and personality predictors.

Two studies were conducted to attempt to evaluate the selection procedures used in Hadassah Medical School. The predictors assessed were the Israeli high school matriculation examinations, a general aptitude test, an interview and a semi-projective test designed to assess personality pathology. In the first study 145 students of the 1975 and 1976 cohorts were assessed, the criteria being a combination of peer evaluations, evaluation of supervisors and academic record. Results showed the matriculation average score to be the only effective predictor for all criteria. In the second study 155 students of the 1979, 1980 and 1981 cohorts were assessed, the criteria being evaluation of supervising doctors, BSc grades and grades during the clinical period. Results again indicated that the matriculation test is the most effective predictor. In this study, however, the other variables added to the prediction of criteria based on clinical evaluations. The results were discussed, raising several possible explanations for the relatively high validity of the matriculation scores. It was suggested the matriculation scores capture personality dimensions, such as motivation and adjustment to the learning environment, which are important factors for success in medical training.

How do supervising doctors construe the medical student in clinical training?

Basing the prediction of student performance in medical school on intellective-cognitive abilities alone has proved to be more pertinent to academic achievement than to clinical practice. A major obstacle to the development of adequate measures has been the elusive nature of requirements for successful clinical performance. The present study aimed at defining the relevant variables through an analysis of the concept of the medical student held by supervising doctors. With the aid of a methodology derived from cognitive-social psychology, the components of how training doctors of a large medical school evaluate their students were first explicated in structured interviews. In a second phase of the research, 18 supervisors in five major clinical departments rated their student-supervisees on 15 obtained traits. Findings of trait correlations with an overall evaluation, as well as Guttman's 'Smallest Space Analysis' (1968), indicated a clear priority of cognitive-motivational traits in supervisors' judgements and reduced relevance of personal and interpersonal variables. Certain inconsistencies between avowed ideology of medical training and actual supervising practice could be detected.

Phenomenological structuring of the adult lifespan as a function of age and sex.

The hypothesis that increasing differentiation in the phenomenological structure of the lifespan can be expected to occur during adolescence and early adulthood, stabilization during adulthood and a process of de-differentiation in the later part of life, was tested on eighty Israeli participants, age sixteen to seventy-eight. They were asked to divide the course of life into periods, starting at age eleven, and to mark the range of each period. As hypothesized the younger people perceived the lifespan as more differentiated (divided into more periods) whereas older people perceived it in a less differentiated way. There was consensus among the different age groups in their perception of the different stages of development. The earlier stages were viewed as more differentiated whereas the later periods were viewed in a more global way. In addition, women tended to perceive the lifespan as somewhat more differentiated than men; they also tended to perceive the pace of life as more rapid.