Background: Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students’ experiences during the first (...) semester of an undergraduate problem-based learning medical program at an African medical school. Method: We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. Results: Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. Conclusions: Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem based learning process. (shrink)

Background:Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints.Objectives:To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil.Method:Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south of Brazil answering the scale. (...) The data were analyzed in the statistical software SPSS version 22.0, through descriptive statistical analysis, association tests (t-test and analysis of variance), and linear regression models.Ethical considerations:Approval for the study was obtained from the Research Ethics Committee at Universidade Federal do Rio Grande.Findings:The mean intensity of moral distress in the constructs ranged from 1.60 to 2.55. As to the occurrence of situations leading to moral distress in the constructs, the frequencies ranged from 1.21 to 2.43. The intensity level of moral distress showed higher averages in the more advanced grades of the undergraduate nursing course, when compared to the early grades of this course (between 5 and 10 grade, average = 2.60–3.14, p = 0.000).Conclusion:The demographic and academic characteristics of the undergraduate nursing students who referred higher levels of moral distress were being enrolled in the final course semesters, were at a federal university, and had no prior degree as an auxiliary nurse/nursing technician. (shrink)

Academic programs in the medical/health humanities have proliferated widely in recent years, and the professional, academic, and cultural drivers of this growth promise sustained new program development. In this article, we present the results of a survey sent to representatives of one hundred twenty-four baccalaureate and ten graduate programs in the medical/health humanities to assess the experiences and needs of existing programs. Survey results confirm the interest in and need for a descriptive toolkit as opposed to a prescriptive manual; indicate (...) what data and materials are most needed to support the successful development of new academic programs in the field; and identify areas for future research. Recognizing a need for program development resources, the Health Humanities Consortium has initiated the creation of a comprehensive online toolkit. We discuss survey results and the toolkit in relation to the drivers of new program growth. Finally, we describe resources now available through the HHC’s new online program toolkit, including existing programs; sample syllabi; sample curricula templates; program rationale; proposal templates; and graduation data. (shrink)

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making study (...) nested in a Thai acute HIV research cohort. In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks. These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. (shrink)

In their target article, Nielsen Busch and Mjaaland (2023) address a longstanding debate within the bioethics and organ transplantation community regarding whether controlled donation after circula...

Guilt and shame are self-conscious emotions with implications for mental health, social and occupational functioning, and the effectiveness of sports practice. To date, the assessment and role of athlete-specific guilt and shame has been under-researched. Reporting data from 174 junior elite cricketers, the present study utilized exploratory factor analysis in validating the Athletic Perceptions of Performance Scale, assessing three distinct and statistically reliable factors: athletic shame-proneness, guilt-proneness, and no-concern. Conditional process analysis indicated that APPS shame-proneness mediated the relationship between general (...) and athlete-specific distress. While APPS domains of guilt-proneness and no-concern were not significant mediators, they exhibited correlations in the expected direction with indices of psychological distress and well-being. The APPS may assist coaches and support staff identify players who may benefit from targeted interventions to reduce the likelihood of experiencing shame-prone states. (shrink)

The expansion of ethics review, beyond its origins in medical research, is the subject of growing critical analysis internationally, especially from social science researchers. Our study builds on this analysis by considering ethics review specifically within tertiary-based educational research. As a foundation for a larger study, we explore the reporting of ethics review within articles from a snapshot of education journals. A cross-sectional review considered 125 articles from 24 journals spanning medical and nurse education, the Scholarship of Teaching and Learning, (...) and educational technology. Among similar types of research our findings highlight variation in institutional ethical review processes and outcomes. Despite most journals providing guidelines for reporting ethics review, adherence to these guidelines by authors or editors was not always evident, but more likely in health-related education journals. We argue that identified areas of variation may reflect the differing influence and proximity of biomedical values. This influence has been under examined in tertiary-based educational research but may contribute to inequitable learning, researching and publishing experiences, potentially adding to negative sentiment about ethics review. (shrink)

The U.S. Food and Drug Administration's rationale for supporting the development and approval of BiDil for heart failure specifically in black patients was based on under-powered, post hoc subgroup analyses of two relatively old trials , which were further complicated by substantial covariate imbalances between racial groups. Indeed, the only statistically significant difference observed between black and white patients was found without any adjustment for potential confounders in samples that were unlikely to have been adequately randomized. Meanwhile, because the accepted (...) baseline therapy for heart failure has substantially improved since these trials took place, their results cannot be combined with data from the more recent trial amongst black patients alone. There is therefore little scientific evidence to support the approval of BiDil only for use in black patients, and the FDA's rationale fails to consider the ethical consequences of recognizing racial categories as valid markers of innate biological difference, and permitting the development of group-specific therapies that are subject to commercial incentives rather than scientific evidence or therapeutic imperatives. This paper reviews the limitations in the scientific evidence used to support the approval of BiDil only for use in black patients; calls for further analysis of the V-HeFT I and II data which might clarify whether responses to H-I vary by race; and evaluates the consequences of commercial incentives to develop racialized medicines. We recommend that the FDA revise the procedures they use to examine applications for race-based therapies to ensure that these are based on robust scientific claims and do not undermine the aims of the 1992 Revitalization Act. (shrink)

This book focuses on group behaviour in developing countries. It includes studies of producer and community organizations, NGOs, and some public sector groups. Despite the fact that most economic decisions are taken by people acting within groups -- families, firms, neighbourhood or community associations, and networks of producers -- the analysis of group functioning has not received enough attention, particularly among economists. Some groups function well, from the perspectives of equity, efficiency, and well-being, while others do not. This book explores (...) why. It covers groups that perform three types of function: overcoming market failures ; improving the position of their members, and distributing resources to the less well-off. It contrasts three modes of group behaviour: power and control; cooperation; and the use of material incentives. It explores what determines modes of behaviour of groups, and the consequences for efficiency, equity, and well-being. The book includes eleven case studies by different authors, including producers' associations in Brazil, farmers' organizations in Korea and Taiwan, community forestry groups in South Asia, organizations of sex-workers in Calcutta, and health NGOs in Uganda. Claims groups tended to be the most cooperative, cooperation fostering empowerment and self-esteem. Distributive or pro bono groups mostly operated according to power and control, while market failure groups often combined all three modes.The studies show the strong impact of norms in society as a whole on group behaviour. The recent shift towards a stronger role for market incentives has exerted powerful pressures on groups to use more material incentives, undermining the cooperation essential to sustain efficiency and equity. The universal presumption in favour of monetary incentives needs to be abandoned. Non-market behaviour needs to be valued and protected as well. (shrink)

When covering traumatic events, novice journalists frequently face situations they are rarely prepared to resolve. This paper highlights ethical dilemmas faced by journalists who participated in a focus group exploring the news media's trauma coverage. Major themes included professional obligations versus ethical responsibilities, journalists' perceived status and roles, permissible harms, and inexperience. Instructional classroom simulations based on experiential learning theory can bridge the gap between the theory of ethical trauma reporting and realities journalists face when covering events that are often (...) chaotic and unpredictable by their very nature. A simulation outline that can be used by journalism instructors is provided. (shrink)

Dissociative experiences have been associated with diachronic disunity. Yet, this work is in its infancy. Dissociative identity disorder is characterized by different identity states reporting their own relatively continuous sense of self. The degree to which patients in dissociative identity states experience diachronic unity has not been empirically explored. This study examined the degree to which patients in dissociative identity states experienced diachronic unity. Participants were DID adults assessed in adult and child identity states, adults with a psychotic illness, adults (...) from the general population, children from the general population and adults imagining themselves as children. They completed the Diachronic Disunity Scale, the Dissociative Experiences Scale, and the Self-Concept Clarity Scale. Diachronic disunity was not limited to psychiatric groups, but evident to some degree in all adult and child samples. The DID adult sample experienced more dissociation and self-confusion than the psychosis and adult comparison groups, but did not differ on the diachronic measure. DID patients in their child identity states and child comparisons showed disunity and were significantly different from child simulators, who showed relatively more unity. Results suggest that DID patients in either adult or child dissociative identity states, like those in other samples, do not universally experience themselves as having a consistent sense of self over time. (shrink)

Summary A number of elite boys? schools in England have admitted girls for over 30 years, some thereby becoming mixed schools. In other schools, girls remain a very small minority. This paper focuses upon prospectuses from the latter type of school, arguing that prospectuses are particularly valuable as a basis for judging schools? policies and practices in their own terms. The researchers ask questions about the nature of this form of ?co-education?, particularly as it affects girls? educational and social opportunities. (...) On balance, the prospectuses paint a picture of boys? schools which happen to have girls in them rather than of schools whose policies and practices have become genuinely co-educational. (shrink)

"The most authoritative version of Hegel's "Introduction" to his lectures on the history of philosophy.

We introduce a distinct type of choice that has yet to be addressed by self-control research: Choosing between activities that offer both delayed and immediate rewards. We describe when and why such mixed-reward choices pose challenges to self-control, and suggest that self-control in mixed-reward choices may be supported by delay discounting.

The purpose of this study was to determine the development of moral judgement in first-year and senior baccalaureate nursing students. These students were enrolled in three separate nursing programmes, each of which differed significantly in ethical content. The sample totalled 180 students enrolled in three New England programmes. Programme A included an ethics course taught by a professor of ethics. Programme B integrated ethical issues into all nursing theory courses. Programme C did not include ethical content in theory courses. The (...) design was of a developmental cross-sectional study. The dependent variable was the development of moral judgement, as measured by Rest’s Defining Issues Test. The independent variable was the amount of ethics taught in the nursing programmes and the level of academic education. The senior nursing students from programme A scored significantly higher than the other senior groups on the Defining Issues Test. The conclusion is that an ethics course with group participation and a decision-making element significantly facilitated nursing students’ development of moral judgement. (shrink)

This article (in German) discusses the scope and content of John McDowell's famous claim that human perception is "conceptual all the way out". I motivate the claim by explaining its role within McDowell's transcendental concern to account for the mind's "openness to the world", i. e. the immediate presence or givenness (no capital "G") of objective reality in human perception. I argue that (a) dissolving this problem requires us to understand human perception as a rational power, that (b) a rational (...) power is a power whose actualizations involve the actualization of conceptual capacities, and that (c) the actualizations of powers that involve the actualizations of conceptual capacities have conceptual contents. I discuss the different versions of this claim to be found in McDowell's writings since "Mind and World". Furthermore, I distinguish between two ways of reading the claim which I call the "apperceptive" and the "phenomenal" reading respectively. The first reading, I argue, is the one McDowell actually endorses, whereas the second reading, which is not a part of his position, is the one foisted on him in many of the critical engagements with his work. (shrink)

How we integrate the astounding advances that genetics makes possible into our language, our conceptions of health and disease, and our systems to collect, control, and protect health-related information is a key question facing health law and policy-makers this decade.For example, the prospect that all of us may harbor the genetic seeds of our own demise forces us to confront the blurring of the lines between “health,” “predisposition,” and “disease.” How will we modify our conceptions of health and disease in (...) response to this new distinction?That these questions must be answered using, at least in part, new approaches seems unassailable. Yet, we run the risk of becoming mired in an old debate—exceptionalism—in which we haggle over the precise nature and scope of the similarities and differences between genetic information and all other health-related information. (shrink)

How we integrate the astounding advances that genetics makes possible into our language, our conceptions of health and disease, and our systems to collect, control, and protect health-related information is a key question facing health law and policy-makers this decade.For example, the prospect that all of us may harbor the genetic seeds of our own demise forces us to confront the blurring of the lines between “health,” “predisposition,” and “disease.” How will we modify our conceptions of health and disease in (...) response to this new distinction?That these questions must be answered using, at least in part, new approaches seems unassailable. Yet, we run the risk of becoming mired in an old debate—exceptionalism—in which we haggle over the precise nature and scope of the similarities and differences between genetic information and all other health-related information. (shrink)

Rosemary Hennessy confronts some of the impasses in materialist feminist work on rethinking `woman' as a discursively constructed subject. She argues for a theory of discourse as ideology taking into account the work of Kristeva, Foucault and Laclau.

At no time in the past century have there been fiercer battles over our public schools than there are now. Parents and educational reformers are challenging not only the mission, content, and structure of mass compulsory schooling but also its underlying premise—that the values promoted through public education are neutral and therefore acceptable to any reasonable person. In this important book, Rosemary Salomone sets aside the ideological and inflammatory rhetoric that surrounds today’s debates over educational values and family choice. (...) She offers instead a fair-minded examination of education for democratic citizenship in a society that values freedom of conscience and religious pluralism. And she proposes a balanced course of action that redefines but does not sever the relationship between education and the state. Salomone demonstrates how contemporary conflicts are the product of past educational and social movements. She lays bare some of the myths that support the current government monopoly over education and reveals how it privileges those of economic means. Through a detailed case study of recent controversy in a suburban New York school district, the author explores the legal and policy issues that arise when widely disparate world views stand in the way of political compromise on educational materials, techniques, and programs. Salomone builds a case for educational governance that places the developmental needs of the child at the center of family autonomy. She advances a plan that respects diverse values and visions of schooling while preserving the core commitments that bind our nation. (shrink)

We investigate how the perceived uncertainty of a conditional affects a person's choice of conclusion. We use a novel procedure to introduce uncertainty by manipulating the conditional probability of the consequent given the antecedent. In Experiment 1, we show first that subjects reduce their choice of valid conclusions when a conditional is followed by an additional premise that makes the major premise uncertain. In this we replicate Byrne. These subjects choose, instead, a qualified conclusion expressing uncertainty. If subjects are given (...) a third statement that qualifies the likelihood of the additional premise, then the uncertainty of the conclusions they choose is systematically related to the suggested uncertainty. Experiment 2 confirms these observations in problems that omit the additional premise and qualify the first premise directly. Experiment 3 shows that the qualifying statement also affects the perceived probability of the consequent given the antecedent of the conditional. Experiment 4 investigates the effect of suggested uncertainty on the fallacies and shows that increases in uncertainty reduce the number of certain conclusions that are chosen while affirming the consequent but have no effect on denying the antecedent. We discuss our results in terms of rule theories and mental models and conclude that the latter give the most natural account of our results. (shrink)

In this timely book, Rosemary Salomone offers a reasoned educational and legal argument supporting single-sex education as an alternative to coeducation, particularly in the case of disadvantaged minority students. “A carefully organized, often lively... compendium of everything that matters in the debate: how boys and girls do in classes and on tests, their differing learning styles, and the legal tussles.”—Timothy A. Hacsi, _New York Times_ “Smart, objective, evenhanded. Must reading in this important debate.”—Susan Estrich, University of Southern California Law (...) School “Everyone concerned about inequalities in our schools and our society should want to read it.”—Michael Duffy, _Times Educational Supplement _ “If you have time for only one book and you really want to be informed about single-sex education, then make it _Same, Different, Equal._”—John Borst, _Education Today_ “The single best book I have read about single-sex education. A must-read for every educator who is concerned about the different outcomes for boys and girls in school.”—Michael Thompson, Ph.D, coauthor of _Raising Cain: Protecting the Emotional Life of Boys_. (shrink)

This collection of essays, which includes a revised version of a famous article on the "male lesbian," addresses such issues as race, gender, and sexuality, and explores the body as a physical, psychological, and cultural construct.

Cost-benefit analysis is commonly understood to be intimately connected with utilitarianism and incompatible with other moral theories, particularly those that focus on deontological concepts such as rights. We reject this claim and argue that cost-benefit analysis can take moral rights as well as other non-utilitarian moral considerations into account in a systematic manner. We discuss three ways of doing this, and claim that two of them (output filters and input filters) can account for a wide range of rights-based moral theories, (...) including the absolute notions of moral rights proposed by Hayek, Mayo, Nozick, and Shue. We also discuss whether the use of output filters and input filters can be generalized to cover other non-utilitarian theories, such as Kantian duty ethics and virtue ethics. (shrink)

This paper reflects on masculinist biases affecting scientific research on the Premenstrual Syndrome. Masculinist bias is examined on the level of observation language and in the choice of explanatory frameworks. Such bias is found to be further reinforced by the social construction of “the clinical body” as an object of medical interrogation. Some of the political implications of the medicalization of women's premenstrual changes are also discussed.

A clear summary of Husserl's often obscure and always complex writings. . . . very instructive.-Ethics.