Exploring The Impact of Acceptance and Commitment Based Cultural Humility Training on Standardized Patient Interactions: Revisiting the Measurement Process.

Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

An Acceptance and Commitment Training (ACT) Framework for Teaching Cultural Humility: A Guide for Translating ACT from a Therapeutic Context into a Medical Education Curriculum.

The objective of this project was to train future physicians to work effectively and thoughtfully with diverse populations by teaching them to employ Acceptance and Commitment Training (ACT) skills to increase cultural humility, with the goal of improving attitudes, knowledge, and beliefs about working with diverse patients. We developed ACT for cultural humility online interactive modules as part of an elective course to teach Medical Spanish to 4th-year medical students. Pre- and post-pilot data pertaining to the cultural humility training modules on the Work-Related Acceptance and Action questionnaire, Multidimensional Cultural Humility Scale, knowledge, attitudes, and beliefs were analyzed using paired samples t-tests and Wilcoxon signed-rank tests. We also included descriptive data pertaining to overall satisfaction with the cultural humility modules and intent to apply the material learned to patient care. Our data showed a significant increase in the cultural humility of our participants as well as an increase in psychological flexibility, a higher favorability rating toward various ethnicities, improvements in attitude, and positive changes in beliefs and knowledge following completion of the modules. The modules were well received by the medical students, with high social validity ratings. The ACT for cultural humility curriculum has great potential to enhance medical education in diversity, equity, and inclusion by increasing both the understanding and the cultural humility of medical students and future professionals to work with diverse populations. The current paper provides a framework that can be used by other programs to shape the education of the future medical workforce to help promote culturally humble care.

Diversifying academic medicine: One search committee at a time.

Despite increasing attention to lack of diversity among medical education faculty, those traditionally underrepresented in medicine remain so. In 2017, the University of Nevada, Reno School of Medicine approved a new policy to increase diversity in the faculty search process, which includes a mandatory 2-h workshop on best practices in search processes and implicit bias training. Workshop participants were 179 search committee members making up 55 committees from February 2017 to March 2020. Participants completed two separate social validity surveys, one immediately following the workshop and another following the close of their search, and rated various aspects of the workshop. Each search committee completed a Diversity Checklist (DCL) of various mandatory and best practices to be implemented during each search. Historical data on diversity of job applicants, interviewees, and hires over the 5-year period immediately preceding workshop implementation were compared with corresponding diversity data from the participant search committees for a 3-year period following implementation of the workshop. Social validity surveys indicated high ratings pertaining to the benefits of the workshop (means 3.82-4.39 out of 5). Implementation of practices outlined in the DCL were high (94% of mandatory and 87% of best practices). Chi-square analyses of diversity data before and after implementation revealed significant increases in overall diversity (both race and gender) of applicants (p < 0.001), interviewees (p = 0.002), and those offered a position (p = 0.002), in the time period following implementation. Follow-up comparisons found greater increases for gender relative to race/ethnicity.

Assessment of medical student burnout: toward an implicit measure to address current issues.

The feasibility of implicitly assessing medical student burnout was explored, using the Implicit Relational Assessment Procedure (IRAP), to measure longitudinal student burnout over the first two years of medical school and directly comparing it with an existing explicit measure of burnout (Maslach Burnout Inventory; MBI). Three successive cohorts of medical students completed both implicit and explicit measures of burnout at several time points during their first two years of medical school. Both assessments were conducted via the internet within a one-week period during the first week of medical school, the end of the first year of medical school, and the end of the second year, though not all cohorts were able to complete the assessments at all time points. Mixed linear models were used to compare the two measures directly, as well as to evaluate changes over time in each measure separately. Minimal correspondence was observed between the implicit and explicit measures of burnout on a within-subject basis. However, when analyzed separately, all subscales of both measures detected significant change over time in the direction of greater levels of burnout, particularly during the first year of medical school. These results provide preliminary evidence the IRAP is able to assess implicit attitudes related to burnout among medical students, though additional research is needed. The IRAP detected consistent improvements in positive implicit attitudes toward medical training during students' second year of medical school, which was not detected by the MBI. Possible implications of these findings are discussed.

Restructuring Law Enforcement Agencies to Support Prosocial Values: A Behavior-Scientific Model for Addressing Police Brutality.

Policing in the United States is irrefutably a component of systemic racism. The history of police brutality against the Black community can be found in our amendments, laws, and cultural practices-it is an infrastructure of oppression. Though police brutality is not a new development, it has reached a fever pitch with the deaths of George Floyd and Breonna Taylor. Recent calls to defund the police put law enforcement agencies squarely, and rightly, in the spotlight of social justice movements and reform. Current issues operating within law enforcement agencies ensure the perpetuation of a system that reinforces the status quo and gives nothing back to the communities that have been victims of brutality. A philosophical restructuring of how law enforcement agencies interact with the communities they serve is paramount. The purpose of this article is to propose a behavior-scientific model aimed at both the individual and organizational levels of law enforcement agencies using elements of acceptance and commitment training and Elinor Ostrom's core design principles, called Prosocial. The Prosocial model promotes the clarification of values within organizations and the communities they serve and reinforces values-consistent action. The model therefore has the potential to be a useful tool to combat systemic racism and police brutality within law enforcement agencies. The proposed model will be discussed in the context of who created it (White academicians), who will be implementing it (law enforcement), and ultimately who should benefit from it above and beyond the cessation of police brutality and without psychological or financial cost (Black communities).

Creating Inclusive and Equitable Cultural Practices by Linking Leadership to Systemic Change.

From a global pandemic to the killings of George Floyd, Breonna Taylor, Ahmaud Arbery, Rayshard Brooks, and others in the Black community, the year 2020 has cast light on long-standing social injustices. With this has come a critical social movement and a call for change-specifically, a call for transformative solutions that address not only new challenges but also centuries of systemic issues, such as systemic oppression and systemic racism. Leadership across the globe has scrambled to answer the call, some issuing statements committed to change, others engaging in necessary action. What is critical, however, is that leadership understands the cultural factors that have given rise to centuries of oppressive practices, and that leaders are held accountable for the commitments they have expressed. Leadership must promote, create, and maintain prosocial, inclusive, and healthy work environments. This requires new cultural practices and a focused organizational model. Equally important is the need to resolve ambiguity and communicate effectively, with strategic consideration of constituent perspectives and needs. Therefore, the purpose of this article is to discuss the contribution of behavior analysis to addressing systemic oppression, as well as the pivotal role leadership communication plays in occasioning social change. It is our hope that this conceptual work will inspire behavior scientists to advance the field of behavior analysis and social movements in the direction of equitable, prosocial change that dismantles systemic oppression.

The Will to Fight: Aversion-Induced Aggression and the Role of Motivation in Intergroup Conflicts.

Aggressive behavior is a source of many significant human problems, most notably the catastrophic loss of life and resources that can result from violent conflicts between groups. Aggressive behavior is particularly likely to arise from aversive conditions that function as motivating operations (MOs) that establish the stimulation produced by aggressive acts as reinforcing. We describe the behavior that arises from these circumstances as aversion-induced aggression (AIA) and argue that the MOs associated with AIA are important factors in initiating and sustaining violent conflicts between groups. In support of this, we survey the basic nonhuman research that has demonstrated the aggression-motivating functions of aversive stimuli. We extend our analysis of AIA to humans and describe how the special properties of verbal stimuli serve as the basis for notable differences between AIA in humans and nonhumans. We describe how aversive conditions may be exploited by leaders to establish support for aggression against another group in the pursuit of their objectives. We suggest that conflicts between groups cannot be resolved in the long term unless the motivational conditions from which conflicts arise are alleviated. Aggression is rarely effective in this regard because it exacerbates these conditions. For this reason, we advocate against the use of aggression as a tool for resolving conflicts between groups and consider how behavior science may contribute to the development and evaluation of alternative nonviolent practices.

A deeper look at implicit weight bias in medical students.

The Implicit Relational Assessment Procedure (IRAP, Barnes-Holmes et al. in Psychol Rec 60:527-542, 2010) was utilized as a relatively new tool to measure implicit weight bias in first- and third-year medical students. To date, only two studies (Miller et al. in Acad Med 88:978-982, 2013; Phelan et al. in Med Educ 49:983-992, 2015) have investigated implicit weight bias with medical students and both have found pro-thin/anti-fat implicit attitudes, on average, using the Implicit Association Test (IAT, Greenwald and Banaji in Psychol Rev 102:4-27, 1995) as the assessment tool. The IRAP, however, allows for a deeper analysis of implicit attitudes with respect to both thin and fat in isolation, and it was found that medical students are, on average, actually both pro-thin and pro-fat, and on average are more pro-thin than pro-fat, as opposed to anti-fat. Additionally, it was found that medical students' implicit weight bias against fat/obese individuals improved over the first 2 years of medical training, and this improvement was specifically driven by improved implicit attitudes toward overweight and obese, while implicit attitudes toward thin remained constant over that time. The implications of more sensitive implicit bias assessment and specific changes in bias over time are discussed within the context of medical education curriculum development.

The Origin and Evolution of the Behavior Analysis Program at the University of Nevada, Reno.

The origins of the Behavior Analysis program at the University of Nevada, Reno by way of a self-capitalized model through its transition to a more typical graduate program is described. Details of the original proposal to establish the program and the funding model are described. Some of the unusual features of the program executed in this way are discussed, along with problems engendered by the model. Also included is the diversification of faculty interests over time. The status of the program, now, after 25 years of operation, is presented.

Prediction of junior faculty success in biomedical research: comparison of metrics and effects of mentoring programs.

Measuring and predicting the success of junior faculty is of considerable interest to faculty, academic institutions, funding agencies and faculty development and mentoring programs. Various metrics have been proposed to evaluate and predict research success and impact, such as the h-index, and modifications of this index, but they have not been evaluated and validated side-by-side in a rigorous empirical study. Our study provides a retrospective analysis of how well bibliographic metrics and formulas (numbers of total, first- and co-authored papers in the PubMed database, numbers of papers in high-impact journals) would have predicted the success of biomedical investigators (n = 40) affiliated with the University of Nevada, Reno, prior to, and after completion of significant mentoring and research support (through funded Centers of Biomedical Research Excellence, COBREs), or lack thereof (unfunded COBREs), in 2000-2014. The h-index and similar indices had little prognostic value. Publishing as mid- or even first author in only one high-impact journal was poorly correlated with future success. Remarkably, junior investigators with >6 first-author papers within 10 years were significantly (p < 0.0001) more likely (93%) to succeed than those with ≤6 first-author papers (4%), regardless of the journal's impact factor. The benefit of COBRE-support increased the success rate of junior faculty approximately 3-fold, from 15% to 47%. Our work defines a previously neglected set of metrics that predicted the success of junior faculty with high fidelity-thus defining the pool of faculty that will benefit the most from faculty development programs such as COBREs.

An Interdisciplinary Account of Martyrdom as a Religious Practice / Una visión interdisciplinaria del martirio como práctica religiosa

Los temas de este trabajo son el papel de las prácticas religiosas en la evolución cultural y las interrelaciones entre las prácticas religiosas y otras prácticas culturales. En ese sentido, las prácticas religiosas y no religiosas interactúan en diversas formas que pueden o no ser importantes o necesarias para su mantenimiento. La preservación de prácticas particulares por la manipulación deliberada de estas interrelaciones es frecuente. Se presume que la motivación de las autoridades con el poder de manipular las prácticas se centra en el valor de los resultados producidos. Ese valor, explícita o implícitamente, es la supervivencia del grupo o la supervivencia cultural. Este trabajo proporciona un análisis descriptivo de las condiciones socioeconómicas e históricas que generan las prácticas religiosas asociadas con el martirio. Nuestro análisis toma el contacto interdisciplinario entre el análisis de la conducta y ciencias sociales tales como la sociología y la antropología utilizando los conceptos de metacontingencia y macrocontingencia. Abordamos la importancia de esta interacción para las prácticas religiosas como el martirio en la supervivencia grupal o cultural, y concluimos con una discusión de los retos que los analistas del comportamiento enfrentan como ingenieros culturales.

The role of religious practices in cultural evolution and the interrelations of religious and other cultural practices are the topics of this paper. In that regard, religious and non-religious practices interact in a variety of ways and may be important or necessary for the maintenance of each. The preservation of particular practices by the deliberate manipulation of these interrelations is commonplace. Presumably, the motivation of authorities with the power to manipulate practices is centered on the value of outcomes produced. That value, explicitly or implicitly, is group survival or cultural survival. This paper provides a descriptive analysis of the socio-economic and historical conditions that generate religious practices associated with martyrdom. Our analysis draws upon interdisciplinary contact between behavior analysis and social sciences such as sociology and anthropology by utilizing concepts of metacontingency and macrocontingency. We address the significance of this interaction to the role of religious practices such as martyrdom in group survival or cultural survival and conclude with a discussion of the challenges facing behavior analysts as cultural engineers.

Role of contextual control in second language performance.

Transfer of training from an instructional environment to a natural environment may bring about ineffective language performance by bilingual individuals. In that regard, this study was designed to demonstrate the effect of such a transition on individuals' language performance. A series of Japanese and English words were used as sample and comparisons in a matching procedure. Differential conditioning was implemented in the presence two types of contextual stimuli. After three sets of relations were established, the physical configuration of the contextual stimuli was changed to more subtle appearances, and the number of variations in the contextual stimuli was increased. Measures of percent correct and response latency were used to show the negative influence on second language performance. Percent correct responses decreased with the subtle contextual stimuli for 11 out of 14 participants, and average response latency increased with the increased number of variations in the last phase. These findings indicate that the change in environmental stimuli will be a significant participatory factor in training of second languages.

An Analog Study of First Language Dominance and Interference over Second Language.

The purpose of this study was to design a model for "first language" dominance over "second language" performance and the interference of one language over the other. Two sets of equivalence relations showing a common element (i.e., the reference) were established under different contextual conditions. One set ("first language") was over trained relative to the other ("second language"). Dominance of the "first language," as demonstrated in relations involving the common element, was determined by examining performances in the absence of contextual stimuli. Interference by one language over the other was modeled by examining the degree to which resurgence of "first language" and "second language" relations would occur in extinction, following a period of exposure to inconsistent test trials. In addition, both selection-based (i.e., copy text) and topography-based (i.e., intraverbal) equivalence were examined in these areas. The results demonstrated that the development of an analog for a bilingual repertoire, the domination of the "first language" over the "second language" and the interference of one language over the other, were established.