Module 6 Flashcards
(87 cards)
1
Q
What is the scientist-practitioner model?
A
A pragmatic multi-method approach to translational research.
ie. evidence informs delivery
2
Q
What is another name for the scientist-practitioner model?
When was it ‘conceived’?
A
Boulder Model
1947
3
Q
What does the scientist-practitioner model do?
A
Initially as a training model for graduates which integrated science and practice, privileging science which should inform practice.
Relies on the premise that individuals should both utilise and produce scientific research, and that this research should in turn inform their practice.
4
Q
How did universities adopt the scientist-practitioner model of training?
A
Through teaching both core research-related skills (i.e. critical thinking, higher-order skills) and pre-clinical and clinical skills through undergraduate and postgraduate training courses.
5
Q
How is APAC linked to the scientist-practitioner model?
A
Adopting a scientist-practitioner model of training is mandated under current Australian Psychology Accreditation Council (APAC) course accreditation requirements for all accredited Psychology post-graduate courses.
6
Q
What are some of the criticisms of the SP model?
A
Tends to be aspirational in its approach and not always clearly applicable to different work contexts (Stricker, 2002).
Eg. not all individuals will engage in a combination of clinical practice and research throughout their career
Also, unclear how the SP model may ‘look’ beyond the completion of postgraduate training
7
Q
What is the LCS model?
A
Local Clinical Science Model
Begins with assumption that science is not defined by activities or generalisations, but by attitudes.
The LCS carries these attitudes into the practice setting, raising hypotheses in the consulting room and seeking confirmatory or disconfirmatory evidence in the immediate response of the patient (hence the local component of the LCS model).
8
Q
According to Stricker (2002), what are 4 ways in which S-Ps can integrate science into practice?
A
- In the process of doing clinical work, they display a questioning attitude and search for confirmatory evidence - Apply research findings directly to practice
- Evaluate their individual practices
- Produce research themselves
9
Q
What is EBP?
A
Evidence-based practice
Relatively new (since 1990s) - prior to this, psychologists used evidence-based treatment (EBT) to inform the type of intervention offered.
10
Q
What is EBT?
How does it differ from EBP?
A
Evidence-based treatment.
Starts with a treatment and examines whether it works for a certain disorder/presenting problem under specified circumstances.
EBP starts with the client and examines what research evidence will assist the practitioner in achieving the best outcome for this client.
11
Q
What are the 3 elements of EBP?
A
- Research evidence
- Clinical expertise
- Client values
All set within an organisational/environmental context of the practice
12
Q
According to EBP, what 4 processes should you go through with a client?
A
- Psychological assessment
- Case formulation
- Therapeutic relationship
- Interventions
13
Q
What are the 6 steps of EBP?
A
- Assess
- Ask the right question
- Access the evidence
- Appraise the evidence
- Apply the evidence
- Audit the clinical practice
14
Q
What does equipoise mean?
A
In an Randomised Controlled Trials (RCT), treatment in any group should be consistent with competent care and there should be genuine uncertainty among experts as to which treatment (or control) is preferred
15
Q
What is ‘best’ research evidence?
A
Defn: Methodologically sound, clinically relevant research about effectiveness / safety of assessment and intervention strategies, and various clinical problems studied both experimentally and in situ
Measurement / Method: RCTs that show:
- Statistical & clinical significance
- Reasonable effect sizes (Cohen’s d at least medium)
16
Q
According to the NHMRC, what are the 6 levels of research evidence?
A
(National Health and Medical Research Council)
I Systematic review of RCTs
II RCT
III-1 Pseudo-RCT (eg: alternate allocation)
III-2 Cohort studies
III-3 Comparative studies with hsitorical control
IV Case series
17
Q
What are the 4 main review bodies?
A
- Cochrane
- NICE (UK)
- APS
- WHO
18
Q
Outline the ‘Evidence Pyramid’ from top to bottom
A
Systematic Reviews and Meta-Analyses Randomised Controlled Double-Blind Studies Cohort Studies Case studies Case reports Idea, Editorials, Opinions Animal Research In vitro 'test tube' research
19
Q
Moriana et al. (2017): What disorders had excellent agreement among the four organisations?
A
- Generalised anxiety
- Specific phobias
- Bulimia nervosa
- OCD
20
Q
Moriana et al. (2017); What disorders had good agreement among the four organisations?
A
- Anorexia
- Schizophrenia
- ADHD
21
Q
What reasons did Moriana et al. (2017) propose for the discrepencies between organisations?
A
- Procedures or committees are biased
- Different RCTs and meta-analyses are reviewed
- Different criteria
- Reviews are made at different time periods
22
Q
What are 2 recommendations Moriana et al. (2017) made?
A
- Unify the criteria for assesing evidence
- Improve the coordination between orgnaisations
23
Q
What are some of Healy’s (and others) critiques of systematic reviews and clinical trials?
A
- Ghost writing of BigPharma
- Lack of access to data
- Only publishing positive results
- Greater funding for different research
- Negative outcomes attributed to first arm of study
- RCTs are based on specific experimental groups and may lack ecological validity
24
Q
In PBE, who determines the efficacy of the treatment?
Practice-Based Evidence
A
Practitioner
25
What are 3 alternatives to EBP?
- Practice-based evidence (PBE)
- Practice-oriented research (POR)
- Research practice networks (PRN)
26
What kind of measures do PBE practitioners use?
Use common ‘universal’ outcome measures, like Health of the Nation Outcome Scales (HoNOS), to monitor and evaluate client progress.
Enables a more systematic comparison between practitioners for a given client issue and therapy type.
27
What is Practice-Based Evidence?
Evidence of efficacy is generated by the practitioner rather than the treatment framework (bottom up vs top down approach)
eg. efficacy of a treatment begins with the practitioners and client and is adopted 'upwards'
28
How is Practice-Based Evidence evaluated?
- Clinically effective practice (outcome) determines evidence
- Common outcome measures (eg. CORE-OM in the UK and OQ-45 in the US
29
What are the clinical implications of Practice-Based Evidence?
Therapy should be:
- Collaborative
- Based on clinically relevent evidence
- Weighs costs vs benefits
Psych makes ultimate judgement on treatment or treatment plan, however client needs to be informed, involved and consulted throughout treatment
30
How does ratings work for the HoNOS scale?
| Health of the Nation Outcome Scales
Psych rates client (at the end of each session) on 12 outcomes, on a modified 5-point Likert scale (0 = no problem to 4 = severe to very severe problem).
The sum of scale range 0-48 and a decreasing trend reflects a reduction of symptoms
31
Holmqvist: What are some key arguments for practice-based studies?
Patients - patients are more hetrogenous psychopathy than RCT accounts for
Therapists - therapists may have more hetrogenous competencies
Treatment Length - treatment duration may differ considerably from the manuals’recommendations
Under represented treatments - Some treatments are rarely or never studied in systematic trials although they represent a large part of actual thera- peutic work in routine psychiatry
Therapist effects and training - What is the level of training and experience that contributes to outcome?
Patient-treatment matching - in natural clinical setting, efforts made to match patient to suitable treatment, unlike the randomisation procedure used in clinical trials.
Dropouts
Service Effects - services differ in quality and extent of delivery of treatment
32
Holmqvist: What are some methodoligical issues associated with Practice-Based Evidence?
Devise a measure that is informed and/or endorsed by practitioners and service users, whilst also delivering to a national agenda in an increasingly outcome-oriented and politicized health delivery system
33
What is Practice-Oriented Research (POR)?
Practice-oriented research (POR) or practice-based research (another form of PBE) = conducting research in routine practice setting (naturalistic and ecologically valid) but also attempts to remove the power differential between researcher and the researched.
Instead of conducting research on a group, POR involves conducting research WITH a group/community.
Provides unique opportunities for two-way learning (between the researcher and the practitioner) and employs the complementary expertise, knowledge, and experiences of each stakeholder to conduct studies that are both clinically relevant and scientifically rigorous
34
In POR, who derives the research questions?
| Practice-Orientated Research
The community
Researchers work with community members rather than simply acting from outside and ‘helicoptering’ into a community to research on a community and ‘mine’ data.
35
What are some of the benefits of POR?
- Naturalistic
- Ecologically valid
- Allows for two-way learning
36
What is the Nuremberg Code
Set of key principles for human research ethics that was finalised as a result of the Nuremberg trials after World War II in 1947.
"The most authoritative legal and human rights code on the subject of human experimentation"
Negotiated as part of the US military trials of the Nazi doctors, the Code sought to provide a set of overarching principles to govern human research ethics such that human rights could be upheld.
37
What are the 10 points of the Nuremberg Code?
1. Voluntary consent of the human subject is essential.
2. Experiment should yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature.
3. Experiment should be based on results of animal experimentation and a knowledge of the natural history of the disease or other problem under study, that the anticipated results will justify the performance of the experiment.
4. Experiment should be conducted as to avoid all unnecessary physical and mental suffering and injury.
5. No experiment should be conducted, where there is an a priori reason to believe that death or disabling injury will occur; except, perhaps, in those experiments where the experimental physicians also serve as subjects.
6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.
7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.
8. Experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment.
9. During the course of the experiment, the human subject should be at liberty to bring the experiment to an end, if he has reached the physical or mental state, where continuation of the experiment seemed to him to be impossible.
10. During the course of the experiment, the scientist in charge must be prepared to terminate the experiment at any stage, if he has probable cause to believe, in the exercise of the good faith, superior skill and careful judgement required of him, that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject.
38
What are 2 strengths of the Nuremberg Code?
- It's based on natural law and human rights that have universal application
- It's articulation of informed consent
39
What are some of the deficiencies of the Nuremberg Code?
- Its origin as a response to Nazi medicine
- Emphasis on consent didn't fit Nazi crimes
- Emphasis on informed consent as most important aspect of ethical research
- Doesn't take into account consent for children, elderyly etc
40
After the 1954 Resolution, what was the essential feature of all versions of the Declaration of Helsinki?
Balancing the need to generate useful medical and therapeutic knowledge with the need to protect the health and interests of research participants.
This is how it differed from the Nuremburg Code
41
What are some of the strengths of the Declaration of Helsinki?
- Most well known and widely available guideline on medical research ethics
- Sound basic structure
- Recognition of the need to ensure that research produces genuine medical advance, not repetitious or imitative work
42
What are some of the weaknesses of the Declaration of Helsinki?
- Politicised (eg: weakening the centrality of informed consent to permit a wider range of research)
- Internal contradictions and vagueness
43
The Belmont Report sought to tie together the provisions for human research ethics under 3 broad principles. What were they?
- Respect for persons
- Beneficence
- Justice
44
What does Respect for persons relate to?
Informed consent
45
What does Beneficence relate to?
Do no harm
46
What does Justice relate to?
Making sure subjects arent exploited
47
Inventing data
Fabrication
48
Twisting data
Falsification
49
Incorrect methodology, statistical procedures etc.
Incompetence
50
Poor record keeping or project monitoring
Careless work habits
51
Deliberate misreporting of data
Intentional bias
52
Publishing different components of the same data in different journals
Questionable publication practices / authorship
53
Not following federal research policy, not providing informed consent etc.
Failure to follow the regulations of science
54
Harassment or exploitation
Difficult of stressful work environment
55
Lack of consideration of existing conflicts of interest
Dishonest act indirectly related to being a researcher
56
What is the main reason why junior academics inadvertently plagiarise?
Inexperience, tied to lack of education
57
What is the main reason for research misconduct in senior academics? What type of misconduct do they often do?
- Linked to pressure for frequent high-level research output
- Fabrication of data, falsification of findings
58
List the timeline of ethical codes / laws
```
1947 - Nuremburg Code
1963 - Food and Drug Administration
1964 - Declaration of Helsinki
1974 - National Research Act
1979 - The Belmont Report
```
59
What are the key characteristics of the Nuremburg Code?
1947
1. Developed after atrocities of Nazi Germany during WWII
2. First effort to define ethical guidelines for research
3. Placed restrictions on investigational research
60
What are the key characteristics of the Declaration of Helsinki?
1964
1. Developed by World Medical Association
2. Statement of ethical purpose for medical research
3. Mostly applied to physicians
4. Began to emphasise importance of clinical research in humans
61
What are the key characteristics of the Belmont Report?
1979
1) Respect for persons
2) Beneficience
3) Justice
4) Explains the difference btw research and clinical practice
62
What is the primary purpose of the Belmont Report?
To protect the rights of all research subjects or participants
63
What are the 2 ethical concepts based on respect?
Autonomy
| Make allowances for vulnerable persons who require even more protection
64
What is HREC?
Human Research Ethics Commitee
65
Analysing the same data many different ways until stat sig is found?
Data torturing
66
Koocher: What are some types of deceptions?
misinforming participants
concealing information
enlisting confederates (e.g., ‘‘stooges’’ pose or interact with the participants in some pre-determined way)
making false guarantees (e.g., failing to maintain confidentiality or not ultimately providing a promised prize or compensation)
misrepresenting one’s identity (e.g., referring to oneself falsely as a medical doctor or an actor)
creating false feedback (e.g., giving participants inaccurate performance or untrue evaluations)
concealing observations or recordings
not informing participants that they are being assessed or observed for research purposes
67
Instances of academic misconduct can involve violations of many different ethical principles and standards. List some.
```
A.1. Justice
A.2. Respect
B.1. Competence
B.2. Record keeping
B.3. Professional responsibility
B.12. Conflicting demands
B.14. Research
C.1. Reputable behaviour
C.2. Communication
C.3. Conflict of interest
C.4. Non-exploitation
C.5. Authorship
C.6. Financial arrangements
C.7. Ethics investigations and concerns
```
68
making up results, but wanting the hoax at some stage to be discovered
hoaxing
69
fabricating research outcomes
forging
70
manipulating data
trimming
71
unjustifiable selection of data
cooking
72
Franco et al: What were some of the benefits of their analytic strategy?
- They had a known population of conducted studies, and therefore a full account of what is published and unpublished
- TESS studies undergo rigorous peer review
- All survey experiments were conducted by the same firm, thus the studies are remarkably similar
- TESS requires studies to have statistical power, meaning failure to get significant results is not due to insufficient sample
73
What were the main findings of Franco et al. study on publication bias?
- There is a strong relationship between the results of a study and whether it was published (40% increase in probability of being published from moving from null to strong results)
- So few studies with null results are even written up
74
Franco et al: What are 2 problems associated with not writing up null results?
- Researchers may be wasting time and resources conducting studies that have already been done where the treatments weren't efficacious
- If future research obtains significant results by chance, then the published literature on the topic will erroneously suggest stronger effects
75
Franco et al: What can be done to reduce publication bias going forward?
- Better understand the motivations of researchers who choose to pursue projects as a function of results
- 2-stage review
76
What does TESS stand for?
Time-sharing Experiments in the Social Sciences
77
What 4 situations can cause ethical drift?
- Intense competition for your resources eg: time
- There is little tangible reward for making an ethical decision and acting on it
- You perceive others acting in ways that are ethically compromised
- You are coerced by others to act unethically
78
Koocher: What types of scientific misconduct receive most attention?
Severe cases of fabrication, falsification and plagiarism.
79
Koocher: Who is more likely to intervene on suspected research misconduct? Senior or junior?
Someone senior to the offender
80
Koocher: Someone working closely with a suspected individual was more or less likely to take action?
Less
81
When is informal intervention not recommended? (and formal intervention may be required)
Major cases of misconduct that would:
- damage the reputation of one's workplace
- significantly corrupt a body of knowledge
- result in serious harm to participants or
- diminish the public trust in science
In addition, people:
- with combative or excessively arrogant personalities,
- known to have a track record of scientific misbehaviour, - extreme incompetence,
- mental or substance-abuse problems
- with much to lose
...should be approached only after careful consideration of the available options
82
Koocher: If you decide to make an informal intervention, how should you approach this?
Adopt a non-adversarial tone.
Do not send an anonymous note
83
What were the top 5 incidents reported in Koocher's 'Catalogue of Wrongs?'
1. Fabrication or falsification
2. Questionable publication practices (eg. 'gift' authorship)
3. Plagerism
4. Creating an unsuitable work environment (eg. sexual harrassment)
5. Incompetence (eg. inappropriate data analysis)
84
Love: What are 'Rest's' 4 moral imperatives?
1. moral sensitivity - identify that there's a moral or ethical problem
3. know the rules and regulations,
4. be able to make a decision.
5. have the moral courage to do the right thing
85
What traits and behaviours are negatively associated with burnout?
- Extraversion
- Openness
- Agreeableness
- Conscientiousness
- Task-focused coping
86
What are 4 interventions for psychologists to better value themselves?
- CBT
- Positive psychology
- Mindfulness
- ACT (acceptance and commitment therapy)
87
What are some barriers for psychologists seeking help?
- Social stigma
- Treatment concerns
- Fear of exposing emotion
- Anticipated risks
- Self-disclosure
