Claudio Violato

A meta-analysis of the published research on the effects of child sexual abuse

Abstract A meta-analysis of the published research on the effects of child sexual abuse (CSA) was undertaken for 6 outcomes: posttraumatic stress disorder (PTSD), depression, suicide, sexual promiscuity, victim-perpetrator cycle, and poor academic performance. Thirty-seven studies published between 1981 and 1995 involving 25,367 people were included. Many of the studies were published in 1994 (24; 65%), and most were done in the United States (22; 59%). All six dependent variables were coded, and effect sizes (d) were computed for each outcome. Average unweighted and weighted ds for each of the respective outcome variables were .50 and .40 for PTSD, .63 and .44 for depression, .64 and .44 for suicide, .59 and .29 for sexual promiscuity, .41 and .16 for victim-perpetrator cycle, and .24 and .19 for academic performance. A file drawer analysis indicated that 277 studies with null ds would be required to negate the present findings. The analyses provide clear evidence confirming the link between CSA and subsequent negative short- and long-term effects on development. There were no statistically significant differences on ds when various potentially mediating variables such as gender, socioeconomic status, type of abuse, age when abused, relationship to perpetrator, and number of abuse incidents were assessed. The results of the present meta-analysis support the multifaceted model of traumatization rather than a specific sexual abuse syndrome of CSA.

The predictive validity of the MCAT for medical school performance and medical board licensing examinations: a meta-analysis of the published research.

Purpose To conduct a meta-analysis of published studies to determine the predictive validity of the MCAT on medical school performance and medical board licensing examinations. Method The authors included all peer-reviewed published studies reporting empirical data on the relationship between MCAT scores and medical school performance or medical board licensing exam measures. Moderator variables, participant characteristics, and medical school performance/medical board licensing exam measures were extracted and reviewed separately by three reviewers using a standardized protocol. Results Medical school performance measures from 11 studies and medical board licensing examinations from 18 studies, for a total of 23 studies, were selected. A random-effects model meta-analysis of weighted effects sizes (r) resulted in (1) a predictive validity coefficient for the MCAT in the preclinical years of r = 0.39 (95% confidence interval [CI], 0.21–0.54) and on the USMLE Step 1 of r = 0.60 (95% CI, 0.50–0.67); and (2) the biological sciences subtest as the best predictor of medical school performance in the preclinical years (r = 0.32 95% CI, 0.21–0.42) and on the USMLE Step 1 (r = 0.48 95% CI, 0.41–0.54). Conclusions The predictive validity of the MCAT ranges from small to medium for both medical school performance and medical board licensing exam measures. The medical profession is challenged to develop screening and selection criteria with improved validity that can supplement the MCAT as an important criterion for admission to medical schools.

Changing physicians' practices: the effect of individual feedback.

OBJECTIVE To determine whether physicians who received feedback from six peers, six referring/referral physicians, six co-workers, and 25 patients about 55 aspects of their medical practices (e.g., able to reach doctor by phone after office hours) would make changes to their practices based on that feedback. METHOD In an earlier study, 308 physicians were given feedback about 106 aspects of their practices in the form of mean Likert-scale ratings that (1) the peers made on 26 aspects; (2) the referring/referral physicians made on 23 aspects; (3) the co-workers made on 17 aspects; and (4) the patients made on 40 aspects. Three months later 255 of these physicians responded when asked to indicate whether they had contemplated or initiated changes, or whether no change had been necessary, regarding 31 practice aspects, each of which was a summary of one or more of 55 of the original 106 aspects on which they had received ratings. These 55 were considered the aspects most amenable to change over a short period. The physicians were also asked about the educational interventions that they felt would help them make changes. Multivariate analysis of variance was used to see whether the types of changes reported for the specific aspects of practice were associated with the feedback ratings received for those aspects. RESULTS An examination of the responses showed that 83% of the 255 physicians reported having contemplated a change, and 66% reported having initiated a change for at least one aspect of practice. Changes were contemplated most frequently for aspects of practice associated with clinical skills and resource use. Changes were initiated most frequently for aspects of practice associated with communication with patients and support of patients. Physicians who contemplated or initiated changes had lower (i.e., more negative) mean ratings than did physicians who reported that no change was necessary, which suggests that the physicians did use their feedback ratings to decide about changes, although their qualitative comments indicated other sources as well. Printed material was chosen most often as a method of receiving continuing medical education related to making changes in the practice areas examined.

A Meta-Analysis of the Published Research on the Affective, Cognitive, and Behavioral Effects of Corporal Punishment

The present study is a meta-analysis of the published research on the effects of corporal punishment on affective, cognitive, and behavioral outcomes. The authors included 70 studies published between 1961 and 2000 and involving 47,751 people. Most of the studies were published between 1990 and 2000 (i.e., 53 or 68%) and were conducted in the United States (65 or 83.3%). Each of the dependent variables was coded, and effect sizes (ds) were computed. Average unweighted and weighted ds for each of the outcome variables were .35 and .20 for affective outcomes, .33 and .06 for cognitive outcomes, and .25 and .21 for behavioral outcomes, respectively. The analyses suggested small negative behavioral and emotional effects of corporal punishment and almost no effect of such punishment on cognition. Analyses of several potentially moderating variables, such as gender or socioeconomic status, and the frequency or age of first experience of corporal punishment, the relationship of the person administering the discipline, and the technique of the discipline all had no affect on effect size outcome. There was insufficient data about a number of the moderator variables to conduct meaningful analyses. The results of the present meta-analysis suggest that exposure to corporal punishment does not substantially increase the risk to youth of developing affective, cognitive, or behavioral pathologies.

Feasibility and psychometric properties of using peers, consulting physicians, co-workers, and patients to assess physicians

No abstract available.

Ratings of university teacher instruction: how much do student and course characteristics really matter?

Several student and course characteristics were examined in relation to student ratings of instruction. Students at a major Canadian university completed the Universal Student Ratings of Instruction instrument at the end of every course over a three‐year period, providing 371,131 student ratings. Analyses of between‐group differences indicate that students who attend class often and expect high grades provide high ratings of their instructors (p < .001). In addition, lab‐type courses receive higher ratings than lectures or tutorials, and courses in the social sciences receive higher ratings than courses in the natural sciences (p < .001). Regression analyses indicated, however, that student and course characteristics explain little variance in student ratings of their instructors (<7%). It is concluded that student ratings are more related to teaching instruction and behavior of the instructor than to these variables.

How to Use Structural Equation Modeling in Medical Education Research: A Brief Guide

Background: Structural equation modeling (SEM) is a family of statistical techniques used for the analysis of multivariate data to measure latent variables and their interrelationships. SEM has potential to advance theory and research in medical education. Purpose: The purpose of this article is to introduce SEM to medical education researchers and provide procedural information for applying SEM. Methods: We outline the basic tenets of SEM, principles of model creation, identification, estimation, and model fit to data, and the use of SEM in medical education research. Results: Although it is a powerful statistical research tool, SEM has had only limited use in medical education research. We explicate a five-step procedure for applying SEM to research problems and summarize an example of SEM to test a hypothetical model. Conclusions: Notwithstanding some pitfalls, SEM does provide promise for testing complex, integrated theoretical models and advance research in medical education.

The Reliability, Validity, and Feasibility of Multisource Feedback Physician Assessment: A Systematic Review

Purpose The use of multisource feedback (MSF) or 360-degree evaluation has become a recognized method of assessing physician performance in practice. The purpose of the present systematic review was to investigate the reliability, generalizability, validity, and feasibility of MSF for the assessment of physicians. Method The authors searched the EMBASE, PsycINFO, MEDLINE, PubMed, and CINAHL databases for peer-reviewed, English-language articles published from 1975 to January, 2013. Studies were included if they met the follow ing inclusion criteria: used one or more MSF instruments to assess physician performance in practice; reported psychometric evidence of the instrument(s) in the form of reliability, generalizability coefficients, and construct or criterion-related validity; and provided information regarding the administration or feasibility of the process in collecting the feedback data. Results Of the 96 full-text articles assessed for eligibility, 43 articles were included. The use of MSF has been shown to be an effective method for providing feedback to physicians from a multitude of specialties about their clinical and nonclinical (i.e., professionalism, communication, interpersonal relationship, management) performance. In general, assessment of physician performance was based on the completion of the MSF instruments by 8 medical colleagues, 8 coworkers, and 25 patients to achieve adequate reliability and generalizability coefficients of &agr; ≥ 0.90 and Ep2 ≥ 0.80, respectively. Conclusions The use of MSF employing medical colleagues, coworkers, and patients as a method to assess physicians in practice has been shown to have high reliability, validity, and feasibility.

Structural equation modeling in medical research: a primer

BackgroundStructural equation modeling (SEM) is a set of statistical techniques used to measure and analyze the relationships of observed and latent variables. Similar but more powerful than regression analyses, it examines linear causal relationships among variables, while simultaneously accounting for measurement error. The purpose of the present paper is to explicate SEM to medical and health sciences researchers and exemplify their application.FindingsTo facilitate its use we provide a series of steps for applying SEM to research problems. We then present three examples of how SEM has been utilized in medical and health sciences research.ConclusionWhen many considerations are given to research planning, SEM can provide a new perspective on analyzing data and potential for advancing research in medical and health sciences.

Changes in performance: a 5-year longitudinal study of participants in a multi-source feedback programme

Objectives  Multi‐source feedback (MSF) enables performance data to be provided to doctors from patients, co‐workers and medical colleagues. This study examined the evidence for the validity of MSF instruments for general practice, investigated changes in performance for doctors who participated twice, 5 years apart, and determined the association between change in performance and initial assessment and socio‐demographic characteristics.