A comparison of objective and subjective measures of clinical competence

The purpose of this study was to determine if objective performance measures from a simulated patient practical examination were related to faculty subjective assessments of surgery students' performance. Another purpose was to determine if those students performing well on a simulated patient practical examination were the same students awarded honor ratings by faculty. Faculty ratings of students (n = 72) on history taking ability, physical exam skills, problem identification, use of investigations, problem integration, patient management, and patient relations skills were correlated with objective measures on these same criteria achieved on a practical exam employing three simulated patient cases. Correlations were also calculated to study the relationship between practical exam scores and honor rating recipients. Results indicated significant relationships between faculty subjective ratings and practical exam outcomes on all practical examination skills except physical exam skills and patient management skills. Findings also indicated the performance of honor students on the practical examination was significantly better than non-honor students on two skills: history-taking and patient relations. The implications of these research findings are discussed.     

As Good as it Gets? A Life Course Perspective on Marital Quality

Marital relationships, like individuals, follow a developmental trajectory over time with ups and downs and gains and losses. We work from a life course perspective and use growth curve analysis to look at trajectories of change in marital quality over time. Although the tendency is for marital quality to decline over time, some groups begin with much higher levels of marital quality than others. Moreover, a number of life course and contextual factors can accelerate or slow this path of change. Our findings point to the importance of considering the multi-dimensionality of time (e.g., age, marital duration, the passage of years) as well as family transitions (e.g., having children, emptying or refilling the nest) in creating the meanings and experiences of marriage over time.     

The Cost-Effectiveness of Alternative Advance Mailings in a Telephone Survey

Advance letters are being used increasingly to combat the declinein response rates, but their effectiveness depends partly ontheir being read. In the face of the post-9/11 anthrax mailingscare, the Office for Survey Research (OSR) converted to usingadvance postcards rather than advance letters. Subsequently,the OSR conducted an experiment to test the effectiveness ofsending letters, postcards, or nothing to directory-listed numbersselected in a large random digit dial (RDD) telephone survey.In terms of response rates, the results clearly indicate thatsending advance letters is more effective than sending postcards,which, in turn, is more effective than sending nothing. A detailedcost-effectiveness evaluation indicates that sending lettersactually saves money, despite the increased costs associatedwith the mailings, compared to sending postcards; sending postcardsis also more cost-effective than not sending anything.     

In a Nervous Voice: Acoustic Analysis and Perception of Anxiety in Social Phobics’ Speech

This study investigated the effects of anxiety on nonverbal aspects of speech using data collected in the framework of a large study of social phobia treatment. The speech of social phobics (N = 71) was recorded during an anxiogenic public speaking task both before and after treatment. The speech samples were analyzed with respect to various acoustic parameters related to pitch, loudness, voice quality, and temporal aspects of speech. The samples were further content-masked by low-pass filtering (which obscures the linguistic content of the speech but preserves nonverbal affective cues) and subjected to listening tests. Results showed that a decrease in experienced state anxiety after treatment was accompanied by corresponding decreases in (a) several acoustic parameters (i.e., mean and maximum voice pitch, high-frequency components in the energy spectrum, and proportion of silent pauses), and (b) listeners’ perceived level of nervousness. Both speakers’ self-ratings of state anxiety and listeners’ ratings of perceived nervousness were further correlated with similar acoustic parameters. The results complement earlier studies on vocal affect expression which have been conducted on posed, rather than authentic, emotional speech.     

Predictors of retention in an alcohol, tobacco, and other drug prevention study

This article explored retention patterns, as well as factors that predicted these patterns, in the evaluation of a relationship-based substance abuse prevention intervention study that targeted inner-city African American youth. A total of 851 contacts were made to retain 82% (n = 104) of the baseline sample (N = 127) in the evaluation. Results from multinomial regression analyses indicated that participants who were retained in the evaluation were more likely to perceive alcohol, tobacco, and other drug use as less risky and were more likely to report higher levels of family supervision than were evaluation attrits. Those who were easy to retain reported lower family conflict and fewer family relocations during the past year than those who were difficult to retain. Implications of these findings for developing retention strategies, as well as future research, are discussed.     

Internal and External Factors Underlying Variations in Adolescents’ Daily Optimal Experiences

This study investigated how the internal psychological states (i.e., challenge–skill perception, positive and negative affect, and effortless attention) and contextual features (i.e., activity and company) of momentary experiences relate to optimal experience in adolescents’ lives. Data were collected from 245 Portuguese adolescents (14–19 years old, 63% female) by using the experience sampling method. Multilevel modeling revealed that challenge–skill and positive affect were positively associated with optimal experience, while negative affect was negatively associated with optimal experience. Effortless attention mediated the associations between internal states and optimal experience, while activity and company only moderated some of these associations. These findings will inform practitioners about the factors that should be addressed in interventions with adolescents to promote optimal experiences in their lives.