Theory L1 - Science-Practitioner Model Flashcards
(36 cards)
1
Q
What are the origins of the scientist-practitioner model?
A
- Boulder Conference, 1949 - wanted to bring order to psychologists’ practicing
- background of WWII - new roles for psychs, there was increased demand.
2
Q
What were the initial reasons for joint scientist-practitioner training?
A
- to develop interest and motivation in both areas.
- improve practice as rapidly as possible
- select a particular ‘type’ of graduate student and thus create a unique professional identity - an identity for psychs that wasn’t just assessment.
- encourage researchers to work in the real world.
3
Q
What does the scientist-practitioner model put forward?
A
- the s-p model for education and training in psychology is an integrative approach to science and practice, where each must continually INFORM EACH OTHER.
- model represents more than a summation of both parts
- s-p psychs embody a research orientation in their practice and a practice relevant in their research.
4
Q
What are the implications for training from the scientist-practitioner model?
A
- All psychs should be trained to CONDUCT RESEARCH - thus a research thesis is a requirement of professional training programs.
- The practice of psych should be grounded in EVIDENCE-BASED PROCEDURES - thus, students must be trained in evidence-based principles, and trained to evaluate research to determine if a particular treatment has sufficient scientific credibility.
5
Q
What does “scientist-practitioner” mean?
A
- psychological science is foundational to the work of the professional psychologist
- basic principles of psych should be derived from scientific investigation, not just experience.
- represents a style of thinking - practitioner is a data gatherer and a hypothesis tester (testing hypotheses in relation to clients)
- privileged position of scientific knowledge
6
Q
Critique of the scientist-practitioner model?
A
(O’Gorman Reading)
(a) that the philosophy of science that underpins it is now out of date - What is science? Positivism/Constructionism.
(b) that it fails to pay due regard to the tacit knowledge of the practitioner - practitioners acquire and apply knowledge that does not derive from psychological and/or scientific research.
(c) that there is a lack of knowledge in psychological science and its research that is valuable to practice.
(d) that professionals trained in programs applying the model do not perform as scientists, as indicated by their low publication rates.
7
Q
What does the critique of s-p refer to when it cites the changing view of science?
A
- When the model was first proposed, there was a belief that there were knowable facts in psychology, like in physics for example.
- This was challenged and it was believed that our knowledge of the world is constructed and influenced by prior experience, especially cultural experience - the way we view the world changes with biases and experiences and culture - so can we really KNOW things?
- With this shift in our understanding of science, the notion of scientific facts providing a foundation for psychology has been challenged.
- However, there may be some interpretations of the world that have more evidence than others - some interpretations may be better, on the basis that they’re more coherent and have more evidence.
8
Q
What does the critique of s-p refer to when it cites the role of tacit knowledge in practice?
A
‘Tacit’ = knowledge gained from practice.
- the pure science model claims that only the knowledge the practitioner can own is that which comes through science.
- appears to reject tacit knowledge that comes from practice!
- but research has now shown the importance of interpersonal and communication skills. This shows that tacit knowledge can also be research scientifically, however.
9
Q
What does the critique of s-p refer to when it cites that practitioners don’t research?
A
- argued that practitioners rarely publish their research
- practitioner can still use approaches that are evidence-based, however.
- “Every clinical intervention is a research project”
10
Q
What is the argument for clinical judgement?
A
- Zeldow, 2009
- too many problems that a clinician will encounter is outside the realm of scientific evidence
- no escape for the subjectivity and the patient, preferences and values and expectations
- decisions about the way we characterise people’s problems, con- duct therapy, and assess outcomes are not determined by scientific criteria alone.
- clinicians disagree how to integrate research practice with clinical judgement and patient expectations and values
11
Q
What is the reflective practitioner?
A
- the reflective practitioner deals with problems that are messy and indeterminate, that is, real-world problems that are not simply amenable to the application of technical rationality
–> importance of tacit knowledge in practice.
12
Q
Zeldow defended clinical judgement. What were the responses to this?
A
Fago (2009)
- tried to find a way of bringing the opposing ideas together. Both are acceptable and important.
- Proposed that there were two levels of issues/research: micro and macro levels
micro - therapeutic relationship - issues of transference, therapist expressing empathy or confrontation, and the timing of interpretation or suggestions. More amenable to single-case analysis.
Macro - psychotherapy outcome research - essential to validation of new therapeutic techniques and procedures, and are more interest to policy specialists.
13
Q
Reconceptualisation of the s-p model?
A
Stricker - 2002.
LOCAL CLINICAL SCIENCE MODEL (LCS)
- begins with the assumption that is science is not defined by activities or generalisation but by ATTITUDES (your approach to what you do).
- all scientists should be keen observers who are characterised by:
disciplined thinking
critical thinking
imagination
rigor
scepticism
openness to change in the face of evidence.
^ a psychologist who adopts these attitudes is a LOCAL CLINICAL SCIENTIST.
- an LCS must raise hypotheses (e.g. what’s wrong with the patient) in the consulting room, and seek confirmatory/discomfirmatory evidence in the immediate response of the patient (the ‘local’ component of the LCS model).
14
Q
What is the Local Science Model?
A
A remodel of the S-P model.
- begins with the assumption that is science is not defined by activities or generalisation but by ATTITUDES (your approach to what you do).
- all scientists should be keen observers who are characterised by:
disciplined thinking
critical thinking
imagination
rigor
scepticism
openness to change in the face of evidence.
^ a psychologist who adopts these attitudes is a LOCAL CLINICAL SCIENTIST.
- an LCS must raise hypotheses (e.g. what’s wrong with the patient) in the consulting room, and seek confirmatory/discomfirmatory evidence in the immediate response of the patient (the ‘local’ component of the LCS model).
15
Q
What are the four things that the LCS model says psychologists should do broadly?
A
- when doing clinical work, they display a QUESTIONING attitude and search for CONFIRMATORY evidence
- they APPLY research findings directly to practice
- they undertake EVALUATION of their actual practices - they assess the problem and the extent of it (prior to intervention), and assess if their treatment helped.
- they PRODUCE RESEARCH either collaboratively or more traditionally.
can also do this in treatment selection.
16
Q
What does the LCS model propose about treatment selection?
A
- need to try to distinguish the distinctive and effective parts of treatment
- apply them systematically to individual patients in a differentiated manner
- use an approach that draws from efficacy research and manualisation of treatments but transcends it and moves into effectiveness by allowing flexibility and application
- then use quantitative assessments to see if treatment is working (s-p model approach here)
17
Q
What is a local clinical scientist?
A
a practitioner that
- reflects on each case
- treats it as a scientist would a research problem
- without abandoning the empathic stance neccessary for effective alliance formation and treatment
- incorporates whatever information is available in a flexible and thoughtful manner.
- is a scientist practitioner.
- emphasises the interactional processes within decision making processes and the timing of things - very dependent on clinical experience
- also emphasises on the use of EBPs
18
Q
What was Gelso’s critique of the s-p model?
A
- the model is not well implemented in universities
- students enter the course to train to become practitioners not researchers - research is not attractive and desirable.
- rather than the s-p model outliving its usefulness, it may not have been given yet it’s fair trail.
- research training practices have had profound deficiencies.
19
Q
why is the production of more and better research desirable?
A
Gelso (2006)
- greater involvement by more psychologists increases extent to which practice will be based on scientific findings
- involving more practitioners will facilitate research that is clinically meaningful.
20
Q
What does Gelso (2006) propose the effective graduate training environment needs to aim at?
A
- eliminating ambivalence towards research
- enhancing students attitudes and sense of efficacy
- training must go beyond skill level and influence people at the MOTIVATIONAL level - showing students that research can be exciting/rewarding.
- lack of research how to achieve this!!!!
21
Q
What are some ways Gelso suggests training can influence people at a motivational level, to research?
A
- staff modelling appropriate scientific behaviour and attitudes.
- scientific activity to be positively reinforced in the enviro
- students to be involved in research early in their training in a minimally threatening way
- research to be emphasised during training that all research studies are limited and flawed in some way
- varied approaches to research should be taught and valued
- students need to be shown how science and practice are wedded.
22
Q
What are the influences on clinical decision making?
A
MOST
- previous experience - if you’ve done it before, you’re more likely to do it again
- customs and practice always doing things that way
- undergraduate/pre-registration training
- discussion with colleagues
- clinical guidelines
LEAST.
23
Q
What are the difficulties in a practitioner ‘staying up to date’?
A
- practitioners may have the mindset of ‘this is how we have always done it’
- without current best evidence, clinical practice risks becoming rapidly out of date
- consequently, healthcare practices suffer.
24
Q
What are the demands for evidence-based practice?
A
- PROFESSIONALS ARE MORE ACCOUNTABLE NOW (relates to what others think of our treatment)
- professions demand you meet certain criteria, and registraiton boards’ role in protecting the public.
- funding sources want evidence that you do a good job eg. medicare
- consumers want confidence that they’re getting the best available therapy
- insurers insist on risk minimisation in practice
- empirically supported treatments show good quality control. - ETHICALLY, therapist must (relates to YOUR ETHICS)
- act to offer the client the best treatment available.
- not diminish its effectiveness in any way
- ensure that the client is not harmed. - LEGALLY, the courts recognise
- the principle of standards of due care - whether you’re giving an appropriate treatment and whether others in the profession would do the same
- professions establish those standards.
25
What is evidence-based practice?
- The conscientious and explicit use of current best evidence (must review and appraise research) in making decisions and delivering the optimum care to patients.
- This means, integrating individual clinical expertise with the best external clinical evidence from systematic research.
- It is also about ensuring that practice is kept based on up to date, valid and reliable evidence of the effectiveness of interventions being used.
therefore, good practitioners must use both clinical expertise and scientific research. neither one is good alone.
26
How is EBP established?
1. IDENTIFY a problem and clinical Q.
2. Find appriate DATA (Evidence) to address the question
3. APPRAISE the evidence - resources, searches, validity synthesis.
4. Use evidence in practice - clinical reasoning and reflection
5. evaluate the impact of the evidence on clinical practice.
27
What are the 6 levels of evidence?
Sackett (1996):
-Level I Evidence (Strongest and most reliable)
obtained from a systematic review of all relevant randomised controlled trials (free of bias). Eg. Meta-analyses
-Level II Evidence
obtained from at least one properly designed randomised controlled trial.
-Level III.1 Evidence
obtained from well designed controlled trials without randomisation (not always possible to randomise intervention groups, but try to make groups as similar as possible).
-Level III.2 Evidence
obtained from well designed cohort or case control analytic studies preferably from more than one centre or research group (or time series) - minimised bias. some reasonable effort
-Level III.3 Evidence
obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments.
-Level IV Opinion
Respected authorities, clinical experience, descriptive studies, or expert committees - group of people get together to get consensus on what should happen. This is when no data is available.
28
Why do we use randomised control trials?
- it is the closest we can get to a true experiment in an applied setting
- the concept aims to manipulate a IV (treatment) to cause change in DV (some index of health), whilst holding everything else constant.
IV ideally has 3 levels:
1. representing the effects of actual therapy (treatment group)
2. representing the effects of therapy attention (placebo group)
3. representing the effects of natural recovery (waiting list control group).
Assumes these effects are additive.
**Random allocation reduces biases and differences between groups that may affect outcome.
29
What are the levels of evaluation?
Efficacy - RCTs or studies done in carefully controlled settings. Therapy brings about change, but they're so controlled that it doesn't make way for real world variables.
Effectiveness - Does it work for -me- under -this context-? Does it work in the real world? Is the drop out rate really high? - This trial is conducted in real world settings. Participants might not meet the diagnostic criteria exactly.
Practicality - what is the bottom line, what is the cost/effectiveness ratio and how much will we save?
do EFFICACY TRIAL FIRST, THEN EFFECTIVENESS THEN PRACTICALITY.
30
What are some reasons for resistance to EBP?
- therapy should not be a straight jacket into which you force clients
- many problems are not dsm-iv category equivalents
- we kill therapies with illustrious histories, and therapy is an art not science.
-------
- focus on RCTs allows for the legacy of positivism to dominate scientific discourse (too much of a strict adherence to observed evidence)
- they can block consideration of other legitimate and essential methodologies
- EBPs are referred to as the gold standard, yet they are very flawed, and their limitations are often overlooked.
31
What are evidence levels III to IV?
Methods!!
- Correlational Studies - risk factors, prevalence, incidence etc.
- Time series analyses - process studies, single case designs
- qualitative analyses - case studies, focus groups, narrative analysis.
32
Why level IV?
?
33
What is the Cochrane Collaboration?
- An international non-profit organisation dedicated to helping people make informed decisions in health care, by publishing systematic reviews or meta-analyses of healthcare interventions
34
What are systematic reviews?
- summary that uses rigorous scientific approach to combine results from a body of original research studies into clinically meaningful whole.
- leaders of the field believe this is the most powerful and useful evidence available to guide practice.
- minimises biased, ensures reliability across studies included in the report.
35
Why are systematic reviews good?
- Reduces large quantities of information into a manageable form
- Establish generalisability across participants, settings, treatment variations and different study designs - across different sample sizes.
- Assess consistency and explain inconsistencies of relationships across studies
- increase power in suggesting cause and effect relationships
- Reduce bias from random and systematic error, improving true
reflection of reality
- Integrate existing information for decisions about clinical care, economic decisions, future research design, and policy formation
- increase efficacy in time between research and clinical implementation
- Provide format for better continuous updates of new evidence
36
Structured format of systematic review?
Abstract - Structured summary
Background – Introduction of the question
Objectives- Aims
Selection criteria- Type of study, e.g., randomised controlled trials, type of participants, type of intervention and any comparison treatments
Outcome measures
Search strategy- electronic databases, unpublished information Methods of the review- how data analysed etc. Description of studies- how many studies were found Methodological quality of included studies
Results- what did the data show
Discussion- Interpretation and assessment of results
Author’s conclusions
** if you have time look at flow charts provided**
