Tony Hak

Group process: the black box of studies on problem-based learning.

A considerable number of medical schools worldwide have implemented, at least in part, a problem-based learning (PBL) approach in their curricula. Research to date has largely neglected the issue of the actual activities and learning processes that mediate and moderate the relationship between these programs and their cognitive outcomes. In this essay the authors discuss the few studies that have empirically investigated what students actually do in PBL tutorials, which arguably is the pivotal mediating process. These studies demonstrate that it is possible to observe, identify, and describe group activities (such as brainstorming and the joint identification of learning issues) that promote interactionally shared and achieved cognition. However, such studies have been confined to case studies in which isolated fragments of tutorials have been analyzed and described. Future studies need to provide a broader description and analysis of actually performed cognitive activities in all relevant phases of the entire PBL process.

Formulations in first encounters

Abstract The paper describes and compares the use and function of the formulation-decision pair in three types of diagnostic interviewing. The investigatory type of interviewing, which typically occurs in the medical interview, is characterized by the absence of formulations. In the exploratory type of interviewing, which typically occurs in the psychiatric interview, the interviewer uses the formulation-decision pair for exploring the patients experiences. He does not, however, formulate his professional assessment in the interview. In the collaborative type, which typically is found in psychotherapy, the formulation-decision pair is the main interactional device used by the interviewer for translating the patients troubles into a professional problem definition. It is suggested that the patients protoprofessionalization, which is typical for psychotherapy, already begins in the initial interview and that it is an effect of the interviewers specific use of the formulation-decision device in the interview.

Coder training: Theoretical training or practical socialization?

Usually the effectiveness of coder training as a means to improve the inter-coder-reliability of the coding of responses to open-ended questions is considered a result of (successfully) communicating the coding scheme to coders. However, the actual practice of coder training has never been studied empirically. In this article we present fragments of a transcript of a coder training that suggest that inter-coder-reliability is improved not only by communicating the coding instructions to coders (theoretical training) but also bysocializing coders into practical rules which are not part of the coding instructions and are not warranted by them. Hence, it cannot be excluded that the improvement of the inter-coder-reliability by means of coder training is atraining artifact: an artificial outcome affected through the training process. It follows that, in each particular case, the researcher must make plausible that the actual coding process has yielded valid data.

Problems eliciting cues in SEIQoL-DW : quality of life areas in small-cell lung cancer patients

The Schedule of Individual Quality of Life - Direct Weighting (SEIQoL-DW) is an individualized approach in the measurement of quality of life in which patients can choose, value and weight five areas that they consider important for their quality of life. Although a number of studies have reported on the feasibility of the administration of the instrument, little is known about how patients choose and define these five areas, the so-called ‘cues’. This article describes problems in the elicitation of cues experienced in a qualitative, exploratory study among small-cell lung cancer patients (n = 31) in the Netherlands. Cues originate from patient-interviewer interaction which is best described as an area of tension between the patient’s answers and the instrument instructions. As a result, the interviewer may inadvertently introduce bias while attempting to elicit cues, ultimately affecting patients’ SEIQoL-DW measures. In order to prevent possible unnoticed interviewer bias special attention should be paid to the interviewer behaviour. Methods to record the meaning of cues should be considered. More research is needed in order to investigate differences in nominating cues with and without the use of the prompt list.

Ceilings and Floors : Where Are There No Observations?

There are situations where the data or the theory suggest or require, respectively, that one estimate the boundary lines that separate regions of observations from regions of no observations. Of particular interest are ceiling or floor lines. For example, many theories use terms such as veto player, constraint, only if, and so on, which suggest ceilings. Ceiling hypotheses have a nonstandard form claiming the probability of Y will be zero for all values of Y greater than the ceiling value of Yc for a given value of X. Conversely, ceiling hypotheses make no specific prediction about the value of Y for a given value of X except that it will be less than the ceiling value. Floors work by guaranteeing minimum levels. The article gives numerous examples of theories that imply ceiling or floor hypotheses and numerous examples of data that fit such hypotheses. The article proposes quantile regression as a means of estimating the boundaries of the no-data zone as well as criteria for evaluating the importance of the boundary variable. These techniques are illustrated for ceiling and floor hypotheses relating gross domestic product/capita and democracy.

Introduction, comparison, and validation of Meta-Essentials : A free and simple tool for meta-analysis

We present a new tool for meta‐analysis, Meta‐Essentials, which is free of charge and easy to use. In this paper, we introduce the tool and compare its features to other tools for meta‐analysis. We also provide detailed information on the validation of the tool. Although free of charge and simple, Meta‐Essentials automatically calculates effect sizes from a wide range of statistics and can be used for a wide range of meta‐analysis applications, including subgroup analysis, moderator analysis, and publication bias analyses. The confidence interval of the overall effect is automatically based on the Knapp‐Hartung adjustment of the DerSimonian‐Laird estimator. However, more advanced meta‐analysis methods such as meta‐analytical structural equation modelling and meta‐regression with multiple covariates are not available. In summary, Meta‐Essentials may prove a valuable resource for meta‐analysts, including researchers, teachers, and students.

Recognising the importance of ‘family time-out’ in consultations: an exploratory qualitative study

Objectives Patients are often accompanied by family or companions during consultations, but little is known about how this might influence the process. We explored how the presence of a companion in a consultation contributes to communication and the decision-making process. Design Observational study. Setting A teaching hospital and a district general hospital in south-west England. Participants 31 patients and their physicians were observed during consultations in which decisions to undergo palliative chemotherapy were made. Each patient was accompanied by at least one companion. Outcome measures Communication patterns between physicians, patients and companions. Results In addition to standard patient/physician interactions, patients and companions were often found to discuss medical information and exchange opinions between themselves without the physician actively participating. We called these instances ‘family time-out’. On the occasion of disagreement between patients and companions about preferred treatment options, physicians and patients were able to agree the decision while acknowledging the differences in opinion. Conclusions Instances of ‘family time-out’ may contribute to better consultation outcomes because they are understood and supported by the patients social system. This study highlights the potentially important role of exchanges between patients and companions during consultations and how physicians may benefit from observation of such exchanges. We recommend testing the value of making space for family time-out during consultations. Also, we recommend further study into the medical ethics of family time-out. While the focus here is on palliative chemotherapy, this finding has implications for other consultations, particularly those involving difficult treatment decisions.

Developing a text-sociological analysis

In this article I will read Carlo Ginzburgs study, The Cheese and the Worms (1980), as a contribution to sociology, considered as text sociology — i.e., as exemplary for studies in which a social-scientific question is examined by means of a method of textual analysis. In The Cheese and the Worms a method of textual analysis is used; although Ginzburg does not define his method in so many words, it can be easily deduced from his extensive description of how he arrives at his conclusions. In this article I will reconstruct that method, and on the basis of that reconstruction I will examine what contribution Ginzburg is making to (text) sociology with it. Specifically, I will use the reconstruction of Ginzburgs method as a starting point for the description of how a textsociological method should be developed.

Hoe denken patiënten met vergevorderd hartfalen over het sterven

SamenvattingWillems DL, Hak A, Visser F, Van der Wal G. Hoe denken patiënten met vergevorderd hartfalen over het sterven? Huisarts Wet 2005;48(12):608-14.Doel Wij onderzochten over een periode van 1 jaar de gedachten en opvattingen van patiënten in het eindstadium van hartfalen over het sterven.Methode Prospectief longitudinaal multipel gevalsonderzoek met kwalitatieve interviewtechnieken. We sloten 31 patiënten uit 2 ziekenhuizen in die voldeden aan een of meer van de volgende criteria: NYHA-klasse III of IV, ejectiefractie <25%, minstens één ziekenhuisopname voor hartfalen. Wij verzamelden uitspraken van patiënten met vergevorderd hartfalen, gedaan in semi-gestructureerde interviews, over de kwaliteit van sterven en medische beslissingen rond het levenseinde.Resultaten Veel respondenten dachten alleen tijdens exacerbaties na over het sterven. Zij noemden onder andere de volgende aspecten van een gepast sterven: enige mate van nuttigheid, prognostische informatie, een gepaste duur van het sterven en een helder bewustzijn. Slechts weinig respondenten spraken zich uit voor euthanasie of zelfdoding, maar ze wilden allemaal dat levensverlengende behandeling op een zeker moment gestaakt of niet gestart zou worden.Conclusies In ons onderzoek werden enkele elementen van gepast sterven genoemd die anders waren dan in andere onderzoeken naar opvattingen over sterven en die specifiek lijken voor hartfalen. De neiging van patiënten om niet aan het sterven te denken, roept ethische vragen op.