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.     

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.     

Career decision-making,career exploration behaviors,and self-regulated learning

Helping individuals make a career decision is a key aim of career counseling. Determining how to encourage self-regulated learning and behaviors needed to achieve this goal often underlies career interventions. The English version of the Career Exploration Behavior survey (CEB-E) measures activities individuals engage in to learn about career options. The present study explored the psychometric properties of the CEB and its impact on various career outcomes. In the first study (N = 498), a good-fitting second-order factor model with four group-level scales and loadings was retained as the best model. In the second study (N = 143), convergent validity and incremental validity of the CEB dimensions were explored through correlation and regression analyses. The CEB predicted commitment making, metacognitions, and vocational identity. Results suggest the CEB-E is a psychometrically sound assessment of career exploration behaviors with potential utility for theory development, program evaluation, and monitoring client progress.     

Exiting shelter: an epidemiological analysis of barriers and facilitators for families

This study examines the role of individual- and family-level factors in predicting the length of shelter stays for homeless families. Interviews were conducted with all families exiting one of six emergency family shelters in Worcester, Massachusetts, between November 2006, and November 2007. Analyses, using an ordinary least squares regression model, find that families with a positive alcohol or drug screen in the year prior stay 85 days longer than those without a positive screen; families leaving shelter with a housing subsidy stay 66 days longer than those leaving without a subsidy. Demographic factors, education, employment, health, and mental health are not found to predict shelter stay duration. Consistent with prior research, housing resources relate to families' time in shelter; with the exception of a positive substance abuse screen, individual-level problems are not related to their time in shelter. Efforts to expand these resources at the local, state, and national levels are a high priority.