To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Here, the authors present two justifications usually cited as sufficient to warrant patients‘ trust in physicians: professional status and individual merit. Whereas in ‘status trust’ professionalism is taken as a guarantor of trustworthiness, in ‘merit trust’ a physician’s trustworthiness is assessed individually. On either account, trust is justified by the physician’s professionalism. ‘Professionalism’ may be defined as ‘acting trustworthily’ in exchange for autonomy of decision-making, whereas trustworthiness refers to ‘competence’ in terms of episteme (theoretical knowledge), techne (craft or skill), and phronesis (practical knowledge or experience), and ‘commitment’ as ‘to act in a way that the truster approves’. The authors argue that although in principle trust in physicians is justified, since both professionalism and individually assessed trustworthiness grant derivative authority, the reality is different. because an increasing number of patients reject the concept of professionalism and, accordingly, find it difficult (or even impossible) to assess physicians’ trustworthiness. Hence, they no longer believe that their trust in physicians is justified.
This chapter examines how memory function enables agency and how memory dysfunction disables agency. Because some memory systems mediating goal-directed behavior may be intact while others are dysfunctional, neurological and psychiatric disorders that impair some of these systems can impair agency to varying degrees. The chapter also analyzes the role of memory in personal identity. Updating the content of episodic memories is necessary to adapt to the environment. But adaptability may come at the expense of identity over an extended period. The chapter discusses precedent autonomy in dementia. It discusses whether the ethical and legal force of an advance directive about medical care in a demented state holds from the time when a person is competent to a time when she is no longer competent and no longer the same person.
This study identified underlying career orientation types of clinical research coordinators (CRCs) using cluster analysis. Select career (satisfaction, engagement, and planning) and competency-related (perceived competence) information was used to identify four distinct career orientation types.
A web-based survey was administered to CRCs employed in one of four research institutions affiliated with a National Institutes of Health-funded Clinical and Translational Research Award (CTSA) in the southeastern USA. Each respondent completed a survey containing questions about personal background, individual attributes, perceived professional competence, and career orientation.
The first CRC type (35.2%) possessed a positive, knowledge-seeking orientation, characterized by high career-related scores but a conservative assessment of perceived competence. The second CRC type (18.6%) represented an optimistic and confident career orientation reflected in moderate to high scores on each of the four identifying factors. The third CRC type (27.6%) reflected an inconsistent career orientation highlighted by lowered perceived competence. The final CRC type (18.6%) reflected a disengaged orientation characterized by negative responses to all career and competence factors.
Understanding the career orientation of CRCs can be helpful to institutional administrators and clinical investigators as they seek to support the professional development of CRCs through tailored training efforts or work-related supports. Knowledge of career orientation may also inform individual CRCs as they manage their personal career paths by assessing current levels of functioning, career-related strengths or weaknesses, and training needs.
With a growing interest in heritage languages from researchers of bilingualism and linguistic theory, the field of heritage-language studies has begun to build on its empirical foundations, moving toward a deeper understanding of the nature of language competence under unbalanced bilingualism. In furtherance of this trend, the current work synthesizes pertinent empirical observations and theoretical claims about vulnerable and robust areas of heritage language competence into early steps toward a model of heritage-language grammar. We highlight two key triggers for deviation from the relevant baseline: the quantity and quality of the input from which the heritage grammar is acquired, and the economy of online resources when operating in a less dominant language. In response to these triggers, we identify three outcomes of deviation in the heritage grammar: an avoidance of ambiguity, a resistance to irregularity, and a shrinking of structure. While we are still a ways away from a level of understanding that allows us to predict those aspects of heritage grammar that will be robust and those that will deviate from the relevant baselines, our hope is that the current work will spur the continued development of a predictive model of heritage language competence.
Objectives: Research on developmental outcomes of preterm birth has traditionally focused on adverse effects. This study investigated the prevalence and correlates of resilience in 146 extremely preterm/extremely low birth weight (EPT/ELBW) children (gestational age <28 weeks and/or birth weight <1000 g) attending kindergarten and 111 term-born normal birth weight (NBW) controls. Methods: Adaptive competence (i.e., “resilience” in the EPT/ELBW group) was defined by scores within grade expectations on achievement tests and the absence of clinically elevated parent ratings of child behavior problems. The “adaptive” children who met these criteria were compared to the “maladaptive” children who did not on child and family characteristics. Additional analyses were conducted to assess the conjoint effects of group (ELBW vs. NBW) and family factors on adaptive competence. Results: A substantial minority of the EPT/ELBW group (45%) were competent compared to a majority of NBW controls (73%), odds ratio (95% confidence interval)=0.26 (0.15, 0.45), p<.001. Adaptive competence was associated with higher cognitive skills, more favorable ratings of behavior and learning not used to define adaptive competence, and more advantaged family environments in both groups, as well as with a lower rate of earlier neurodevelopmental impairment in the EPT/ELBW group. Higher socioeconomic status and more favorable proximal home environments were associated with competence independent of group, and group differences in competence persisted across the next two school years. Conclusions: The findings document resilience in kindergarten children with extreme prematurity and highlight the role of environmental factors as potential influences on outcome. (JINS, 2019, 25, 362–374)
There is international interest in the training of psychological therapists to deliver evidence-based treatment for common mental health problems. The UK Improving Access to Psychological Therapies (IAPT) programme, one of the largest training initiatives, relies on competent therapists to successfully deliver cognitive behaviour therapy (CBT) and promote good patient outcome.
To evaluate an IAPT CBT training course by assessing if trainees’ clinical skills improve during training and reach competency standards, and to report patient outcome for submitted training cases. To investigate a possible relationship between trainee competence and patient outcome. To explore professional differences during training.
CBT trainee (n = 252) competence was assessed via audio recordings of therapy sessions at the beginning, middle and end of training. Patient pre- to post-treatment outcomes were extracted from submitted training cases (n = 1927). Differences in professional background were examined across competence, academic final grade and tutorial support.
CBT trainees attained competence by the end of the course with 77% (anxiety recordings) and 72% (depression recordings) improving reliably. Training cases reported pre- to post-treatment effect sizes of 1.08–2.26 across disorders. CBT competence predicted a small variance in clinical outcome for depression cases. Differences in professional background emerged, with clinical psychologists demonstrating greater competence and higher academic grades. Trainees without a core professional background required more additional support to achieve competence.
Part of a new CBT therapist workforce was successfully trained to deliver relatively brief treatment effectively. Trainees without a core profession can be successfully trained to competence, but may need additional support. This has implications for workforce training.
The public health nutrition workforce has been reported to be underprepared for practice. The present study aimed to test the ability of an unfolding case study approach to support the public health nutrition workforce for the workplace, with a focus on improved access to nutritious food.
Two unfolding case studies were trialled with undergraduate students in two-hour workshops to enhance their capability to address access to nutritious food as a social determinant of health. The approach provided information about the case using a staged approach that supported learners to review and reply to information and then continue this process as the case became increasingly complex.
Thirty-eight undergraduate nutrition and dietetics students.
The analysis revealed that the unfolding case study approach provided a place to challenge and deepen knowledge and think about the application of theory. As the cases developed and became more challenging, students were supported to consider appropriate approaches and recognised the constant evolution and dynamic nature of practice.
This learning activity challenged students and supported deep learning about possible solutions. It may also be useful at a graduate level and for continuous education of nutritionists and/or dietitians to empower the workforce to address the social determinants of health, rather than just acknowledging them as a set of barriers that prevent people and communities from achieving optimal health. Further work is required to investigate how unfolding case studies in curricula shape preparedness for practice of public health nutrition.
The precedents of creativity comprise an important research topic that could help organisations survive fierce competition. To contribute to the literature on creativity, the authors examined the roles of competence and perceived organisational support (POS) in the relationship between servant leadership and follower creative behaviour. The authors proposed and tested a moderated mediation model with data from leader-follower dyads collected in a Vietnamese engineering firm. The results showed that follower competence is a significant mediator of the relationship between servant leadership and follower creativity. Furthermore, POS has a moderated mediating role, such that the mediated relationship (i.e., servant leadership, competence, and creativity) is more salient under high POS than under low POS. Theoretical and practical implications are discussed.
Neuropsychiatric symptoms (NPI) of dementia are important determinants of caregiver burden, while caregiver coping styles and competences can relieve burden. Caregivers differ in coping with the demands made on them and in experienced burden. What changes in caregivers explain recovery from burden, and which caregiver characteristics predict recovery from burden over time, and does treatment make a difference?
This study into recovery from burden was a secondary analysis of data collected in a formerly conducted randomized controlled trial (RCT) on the integrated reactivation and rehabilitation (IRR) programme in a psychiatric-skilled nursing home, compared to usual care (UC; i.e. day care, assisted living arrangements, and nursing home wards). For this secondary analysis, longitudinal data on persons with dementia and caregivers were used from baseline (T1), end of treatment (T2), and at nine months (T3).
Caregivers with an improved sense of competence (SCS) who care for persons with dementia with a decreased severity of NPI have the highest chance of recovering from burden (CSI). Caregivers with a tendency to feel involved with others and sympathize with others (affiliation, ICL-R) have a slightly lower probability of improvement with respect to their sense of competence in the short term. The number of improved caregivers was higher in IRR than UC.
Recovery depends on both an improved sense of competence and a decreased severity of NPI. Combined interventions that address both NPI and focus on enhancing caregiver's sense of competence have added value when it comes to decreasing caregiver burden.
In Finland, parenting-related anxiety increased in the 1990s during a deep economic recession and subsequent widespread cutbacks to family services. Despite these cutbacks, resources allocated to services underlining the role of parents – namely, parenting support – increased, manifesting in the establishment of family support projects in the 2000s. Employing positioning theory and pragmatic modalities, I explore how key attributes of good parenting – responsibility and competence – are discussed within family support projects (n = 310). Given discussions regarding the relationship between parenting-related anxiety and the increasing number of parenting-related experts, this article explores parents’ positions within such discussions and overall parenting support in Finland. The analysis of projects clarifies the role of the parenting-related experts, but also provides a nuanced view of the position of parents. In some projects, for instance, parents are positioned as experts whose parenting responsibilities and competence are strengthened within peer-parent relationships and shared within the surrounding community.
Voters are more likely to support candidates whose faces and voices are perceived as competent. However, what is the simultaneous influence of these two characteristics? Here this question is examined with an observational study and an experiment. In the observational study, subjects rated the facial competence of Members of the U.S. House of Representatives. The most and least competent faces identified were paired with recordings of competent (i.e., lower pitched) and incompetent (i.e., higher pitched) voices to create simulated candidates. For the experiment, a separate set of subjects voted between randomly generated pairs of these simulated candidates. The results show that candidates with competent faces or competent voices won more votes, but the influence of facial competence was nearly three times that of vocal competence.
Valid consent for treatment or research participation requires that an individual has decision-making capacity (DMC), which is the ability to make a specific decision. There is evidence that the psychopathology of schizophrenia can compromise DMC. The objective of this review was to examine the presence or absence of DMC in schizophrenia and the socio-demographic/psychopathological factors associated.
We searched three databases Embase, Ovid MEDLINE(R), and PsycINFO for studies reporting data on the proportion of DMC for treatment and research (DMC-T and DMC-R), and/or socio-demographic/psychopathological associations with ability to make such decisions, in people with schizophrenia and related illnesses.
A total of 40 studies were identified. While high levels of heterogeneity limited direct comparison, meta-analysis of inpatient data showed that DMC-T was present in 48% of people. Insight was strongly associated with DMC-T. Neurocognitive deficits were strongly associated with lack of DMC-R and to a lesser extent DMC-T. With the exception of years of education, there was no evidence for an association with socio-demographic factors.
Insight and neurocognitive deficits are most closely associated with DMC in schizophrenia. The lack of an association with socio-demographic factors dispels common misperceptions regarding DMC and characteristics such as age. Although our results reveal a wide spectrum of DMC-T and DMC-R in schizophrenia, this could be partly due to the complexity of the DMC construct and the heterogeneity of existing studies. To facilitate systematic review research, there is a need for improvement within research study design and increased consistency of concepts and tools.
Evaluating and enhancing supervisee competence is a key function of supervision and can be aided by the use of direct assessments of clinical competence, e.g. the Cognitive Therapy Scale – Revised (CTS-R). We aimed to review the literature regarding inter-rater reliability and training on the CTS and CTS-R to present exploratory data on training raters to use this measure. We employed a systematic review. An exploratory study evaluated the outcomes of a CTS-R supervisor training workshop (n = 34), including self-reported familiarity with and confidence in using the tool, and inter-rater consistency on three CTS-R subscales, pre- and post-training. CTS and CTS-R inter-rater reliability was variable, with evidence of rater training enhancing reliability, although the form, duration and frequency of such training is unclear. The exploratory study found that supervisors rated themselves as more familiar with and confident in using the CTS-R at the end of training compared to at the beginning. However, inter-rater reliability was poor at the beginning and end of the training. Rating competence requires supervisors to make qualitative judgements, which is inherently variable. Training raters has been shown to improve rater reliability, although this was not demonstrated in the exploratory study. Practice implications and future research priorities are identified.
Warmth and competence are two important dimensions that facilitate career success (e.g., building relationships, providing novel solutions to problems). We investigated how situational reminders of money affect warmth and competence. Specifically, we propose that reminders of new (vs. used) money increase people's warmth and competence. In five studies of working adults, inducing participants to think about new (vs. used) banknotes promoted creative idea generation (Study 1) (reflecting competence), increased concern for coworkers (Study 2), decreased self-serving behavior (Study 3), and increased helping intentions (Study 5) and behavior (Study 4) (reflecting warmth). Study 4 showed that the effect of priming new money on warmth occurs by activating a norm of social conscientiousness. Our findings suggest that money's appearance can impact problem solving, prorelationship behavior, and perceived norms. We discuss implications for research on money, norm salience, and organizational behavior.
Emotional intelligence (EI) and its measures have been widespread across several countries and cultures and the need for valid and robust measures that could expand research on international settings is on the current agenda. This study aimed to assess the measurement invariance of a widely used self-report EI measure, Emotional Skills and Competence Questionnaire (ESCQ), in two cultural contexts (Portugal vs. Croatia). The ESCQ, a 42-item self-report EI scale which comprises three dimensions – Perceive and Understand Emotion, Express and Label Emotion and Manage and Regulate Emotion - was administered to 1,188 Portuguese and Croatian secondary students. The results showed that the ESCQ had satisfactory reliability and the three-factor structure was replicated on both country samples. Configural (χ2 = 308.71, df = 220, p < .01; RMSEA = .030, CFI = .956, TLI = .948) and partial metric (Δχ2 = 9.102, Δdf = 10, p = .522; ΔCFI = −.01, ΔRMSEA = .002) and scalar (Δχ2 = 15.290, Δdf = 21, p = .083; ΔCFI = .001, ΔRMSEA = .006) invariances were supported across groups. This EI measure invariance cross-cultural study highlighted cultural particularities related to emotional competence in Portugal and Croatia contexts and contributed to bring awareness to the validity of cross-cultural studies in the emotional abilities field.
Geriatric patients represent a large and complex subgroup seen in emergency departments (EDs). Competencies in geriatric emergency medicine (EM) training have been established. Our objectives were to examine Canadian postgraduate year (PGY)-5 EM residents’ comfort with the geriatric EM competency domains, assess whether Canadian EM residents become more comfortable through residency, and determine whether geriatric educational exposures are correlated with resident comfort with geriatric EM.
A national, cross-sectional study of PGY-1 and PGY-5 Royal College EM residents was conducted to determine their comfort in geriatric EM clinical competency domains. Residents reported their level of comfort in satisfying each competency domain using a seven-point Likert scale. Residents were also asked about the location of their medical education as well as the type and number of different geriatric exposures that they had received to date.
Of the 141 eligible residents from across Canada, 77% (109) consented to participate. None of the PGY-1 EM residents and 34% (14) of PGY-5 EM residents reported that they were comfortable with all eight geriatric EM competency domains. PGY-5 EM residents were significantly more comfortable than PGY-1 EM residents. Residents reported a highly variable range of geriatric educational exposures obtained during training. No relationship was found between resident-reported comfort and the nature or number of geriatric exposures that they had received.
Current Royal College EM residency training in Canada may not be adequately preparing graduates to be comfortable with defined competencies for the care of older ED patients.
Background: Scales for assessing competence in CBT make an important contribution to research and practice. Aims: To develop a novel scale. Method: A new structured assessment tool is described, which draws on a widely-used CBT competence framework to identify relevant areas of clinical practice. Results: Scale content was clarified through piloting and review by a range of stakeholders. Conclusion: Pending formal testing of the psychometric properties, the scale is ready for use to assess competences in cognitive and behavioural therapy.
Task-sharing is the involvement of non-specialist providers to deliver mental health services. A challenge for task-sharing programs is to achieve and maintain clinical competence of non-specialists, including primary care workers, paraprofessionals, and lay providers. We developed a tool for non-specialist peer ratings of common factors clinical competency to evaluate and optimize competence during training and supervision in global mental health task-sharing initiatives.
The 18-item ENhancing Assessment of Common Therapeutic factors (ENACT) tool was pilot-tested with non-specialists participating in mental health Gap Action Programme trainings in Nepal. Qualitative process evaluation was used to document development of the peer rating scoring system. Qualitative data included interviews with trainers and raters as well as transcripts of pre- and post-training observed structured clinical evaluations.
Five challenges for non-specialist peer ratings were identified through the process evaluation: (1) balance of training and supervision objectives with research objectives; (2) burden for peer raters due to number of scale items, number of response options, and use of behavioral counts; (3) capturing hierarchy of clinical skills; (4) objective v. subjective aspects of rating; and (5) social desirability when rating peers.
The process culminated in five recommendations based on the key findings for the development of scales to be used by non-specialists for peer ratings in low-resource settings. Further research is needed to determine the ability of ENACT to capture the relationship of clinical competence with client outcomes and to explore the relevance of these recommendations for non-specialist peer ratings in high-resource settings.