The Relationship Between System Justification and Perspective-Taking and Empathy.

Four studies tested the hypotheses that system-justifying beliefs will be negatively associated with perspective-taking (PT) and empathic concern (EC) and this negative relationship will be exacerbated when system-justifying people encounter information that challenges system-justifying stereotypes. System justification and PT and EC were negatively associated at the dispositional level (Study 1). Experimentally increased PT decreased system justification through increased EC (Study 2) whereas experimentally increased system justification decreased PT and EC (Study 3). Moderation analyses indicated that when exposed to status-quo-inconsistent information (e.g., a Black vs. White person and/or a woman vs. man of high socioeconomic status), system-endorsing people were less likely to engage in PT (Study 4). There was no effect of system justification on actual helping behavior.

The effect of cognitive load on decision making with graphically displayed uncertainty information.

An experiment examined the ability of five graphical displays to communicate uncertainty information when end users were under cognitive load (i.e., remembering an eight-digit number). The extent to which people could accurately derive information from the graphs and the adequacy of decisions about optimal behaviors based on the graphs were assessed across eight scenarios in which probabilistic outcomes were described. Results indicated that the load manipulation did not have an overall effect on derivation of information from the graphs (i.e., mean and probability estimation) but did suppress the ability to optimize behavioral choices based on the graph. Cognitive load affected people's use of some graphical displays (basic probability distribution function) more than others. Overall, the research suggests that interpreting basic characteristics of uncertainty data is unharmed under conditions of limited cognitive resources, whereas more deliberative processing is negatively affected.

Decision making for risk management: a comparison of graphical methods for presenting quantitative uncertainty.

Previous research has shown that people err when making decisions aided by probability information. Surprisingly, there has been little exploration into the accuracy of decisions made based on many commonly used probabilistic display methods. Two experiments examined the ability of a comprehensive set of such methods to effectively communicate critical information to a decision maker and influence confidence in decision making. The second experiment investigated the performance of these methods under time pressure, a situational factor known to exacerbate judgmental errors. Ten commonly used graphical display methods were randomly assigned to participants. Across eight scenarios in which a probabilistic outcome was described, participants were asked questions regarding graph interpretation (e.g., mean) and made behavioral choices (i.e., act; do not act) based on the provided information indicated that decision-maker accuracy differed by graphical method; error bars and boxplots led to greatest mean estimation and behavioral choice accuracy whereas complementary cumulative probability distribution functions were associated with the highest probability estimation accuracy. Under time pressure, participant performance decreased when making behavioral choices.

Brugada syndrome unmasked by fever.

Brugada syndrome (BS) is a cardiac rhythm disturbance that predisposes patients to sudden cardiac death. Brugada is classically described with specific electrocardiographic (EKG) findings of ST elevation and right bundle branch block in precordial leads and is an often unrecognized contributor to sudden cardiac death. We present a case of BS with cyclic EKG findings in a febrile 20-year-old active duty, Vietnamese male who presented following a witnessed syncopal event. His classic findings of Brugada pattern on EKG demonstrated reversibility with clinical defervescence. In patients with a suggestive history, a normal EKG cannot definitively rule out BS as the Brugada pattern can be unmasked by stress, which in this case was represented by a pneumonia-induced fever.

Patient satisfaction with family physician colonoscopists.

PURPOSE: assessing patient satisfaction after endoscopy with a standardized survey is recommended by gastrointestinal professional societies. The purpose of this study was to assess both patient satisfaction with colonoscopy performed by family physicians and physicians' technical competence in colonoscopy. METHODS: modified Group Health Association of America 9 surveys were sent to all 230 patients who received a colonoscopy by family physicians at Madigan Army Medical Center from June to December 2007. Responses were graded on a 5-point Likert scale (LS), with a score of ≥ 3 (good to excellent) defined as a favorable response. Procedure reports and medical records were reviewed for all patients, and selected quality indicators were compared with recommended colonoscopy standards. RESULTS: sixty-nine percent of patients responded: 85 men (54%; mean age ± SD, 54.9 ± 5.6 years) and 73 women (46%; mean age ± SD, 54.3 ± 4.3 years). The overall rating of the visit received a favorable response rate of 98% (average LS rating, 4.6). Nearly all patients said they would have the procedure repeated by the same physician (98%) and at the same facility (98%). The overall reach-the-cecum rate was 100%. Adenomas were detected in 22% of women and 36% of men. All polyps measuring <2 cm were removed, and 99% of the procedures had scope withdrawal times of at least 6 minutes. Hemostasis techniques were used for 2 patients after polypectomy. There were no perforations. CONCLUSION: family physicians can perform colonoscopy with a high level of accuracy, safety, and patient satisfaction.

Using a simulated surgical skills station to assess laceration management by surgical and nonsurgical residents.

OBJECTIVE: To assess laceration management performance among surgical and nonsurgical postgraduate year-1 (PGY-1) residents objectively and to test for interval improvement. METHODS: From 2006 to 2008, 106 PGY-1 residents from 10 medical specialties were evaluated with a simulated surgical skills station using pigs' feet before and after internship. Subjects were given 11 minutes to choose the proper suture, prepare and close the wound, and answer laceration management questions. Trainees were classified as surgical (emergency medicine, general surgery, obstetrics and gynecology, orthopedics, and otolaryngology) and nonsurgical (family medicine, internal medicine, neurology, pediatrics, and transitional year). An objective checklist was used to assess performance. RESULTS: A total of 106 PGY-1 residents (age range, 25-44 years; mean, 28.7 years) participated, consisting of 41 surgical (39%) and 65 nonsurgical residents (61%). Surgical group scores improved from 78.4% to 87.7% (P < .001). Nonsurgical scores improved from 67.2% to 73.1% (P < .001). There was similar improvement between groups (surgical, 9.4%; nonsurgical, 5.9%; P  =  .21). Surgical residents outscored nonsurgical residents before (P < .001) and after (P < .001) internship. CONCLUSION: Surgical residents outperformed nonsurgical residents before and after the PGY-1 year with similar score improvements. A simulated surgical skills station can be used to evaluate procedure performance objectively and to test for interval improvement. A simulated surgical skills station may serve as a useful adjunct to apprenticeship in assessing procedure competence.

Assessing intern core competencies with an objective structured clinical examination.

BACKGROUND: Residents are evaluated using Accreditation Council for Graduate Medical Education (ACGME) core competencies. An Objective Structured Clinical Examination (OSCE) is a potential evaluation tool to measure these competencies and provide outcome data. OBJECTIVE: Create an OSCE to evaluate and demonstrate improvement in intern core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice before and after internship. METHODS: From 2006 to 2008, 106 interns from 10 medical specialties were evaluated with a preinternship and postinternship OSCE at Madigan Army Medical Center. The OSCE included eight 12-minute stations that collectively evaluated the 6 ACGME core competencies using human patient simulators, standardized patients, and clinical scenarios. Interns were scored using objective and subjective criteria, with a maximum score of 100 for each competency. Stations included death notification, abdominal pain, transfusion consent, suture skills, wellness history, chest pain, altered mental status, and computer literature search. These stations were chosen by specialty program directors, created with input from board-certified specialists, and were peer reviewed. RESULTS: All OSCE testing on the 106 interns (ages 25 to 44 [average, 28.6]; 70 [66%] men; 65 [58%] allopathic medical school graduates) resulted in statistically significant improvement in all ACGME core competencies: patient care (71.9% to 80.0%, P < .001), medical knowledge (59.6% to 78.6%, P < .001), practice-based learning and improvement (45.2% to 63.0%, P < .001), interpersonal and communication skills (77.5% to 83.1%, P < .001), professionalism (74.8% to 85.1%, P < .001), and systems-based practice (56.6% to 76.5%, P < .001). CONCLUSION: An OSCE during internship can evaluate incoming baseline ACGME core competencies and test for interval improvement. The OSCE is a valuable assessment tool to provide outcome measures on resident competency performance and evaluate program effectiveness.

Maintenance of skills for today's family physician: the SAGE approach to physician learning.

Physicians need practical ways to maintain and augment clinical skills after residency training. The problem is amplified when a physician encounters a new practice environment that requires retraining in particular skills. With their broad scope of practice, family physicians are especially prone to deterioration of infrequently used skills. The SAGE model for lifelong learning provides a simple solution for today's military family physicians. Scan, assess, gather, and experience are four key steps physicians should take when maintaining or upgrading clinical skills. This approach allows physicians to identify available resources and to develop action plans to improve skills. Supervisors must encourage physicians to be honest in self-assessment of patient care skills and should support the acquisition of improved skills. System-based solutions, in keeping with suggestions from the Institute of Medicine, are introduced.

Resolution of conflicts between internal and external information sources on a time reproduction task: the role of perceived information reliability and attributional style.

Erroneous knowledge of results (KR) that conflicts with other internal or external information sources is preferentially used and misguides performance on motor and mental timing tasks. Buekers et al. [J. Motor Behavior 26 (1994) 27] hypothesized that KR is used preferentially because participants deem it to be the most reliable information source. We tested this hypothesis in two experiments. We manipulated subjective reliability of information and information content and demonstrated that both reliability and content are assessed and used. In a third experiment we examined whether attributional style affected the use of internal and external information. While KR was present, attributional style was unrelated to performance. However, when erroneous KR was withdrawn, participants who scored high in internal attributional style or high in controllability showed more accurate performance. Whereas evaluation of information quality is explicit, information provided by the KR, whether accurate or not, may influence both implicit and explicit aspects of the tasks.

Factors important to success in the volunteer long-term care ombudsman role.

This study found that the satisfaction of one state's largely older volunteers' altruistic, affiliation, and self-improvement motives corresponded to increased organizational loyalty and better performance across several dimensions. Younger volunteers served for shorter periods and were more highly motivated by the "self-improvement" need. Altruism and organizational loyalty emerged as particularly important motivations.

The MBTI and social information processing: an incremental validity study.

The ability of the Myers-Briggs Type Indicator (MBTI; Myers & McCaulley, 1985) to predict performance on social cognitive tasks tapping information processing effort was assessed. Judgment and intuition interacted to predict amount of attributional adjustment on a dispositional attribution task. The MBTI scales predicted processing above and beyond measures of the five factors, rational-experiential preferences, and causal uncertainty. The relevance of these results for interpretation of the MBTI indexes is discussed.