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The role of basic science knowledge and clinical knowledge in diagnostic reasoning: a structural equation modeling approach.

PURPOSE: To examine four theories on the role of basic science knowledge and clinical knowledge in diagnostic reasoning. METHOD: In 2000-01, the authors tested the basic science and clinical knowledge and diagnostic performances of 59 family physicians and 184 second- to sixth-year medical students at Maastricht University, The Netherlands. Structural equation modeling was used to analyze the data. Four theoretical models were tested. In the first model only basic science knowledge is involved in diagnostic reasoning; in the second model only clinical knowledge is related to diagnostic reasoning; in the third model, clinical knowledge is related to diagnostic reasoning, but basic science knowledge is integrated in clinical knowledge; and in the fourth model, both basic science knowledge and clinical knowledge independently influence diagnostic reasoning. RESULTS: Forty-four (75%) of the family physicians and 184 (100%) of the students responded. The results indicated that the third model, which is based on the knowledge encapsulation theory, provided the best fit to the data, whereas the models that had directly related basic science knowledge with diagnostic performance did not fit the data adequately. CONCLUSION: The results generally supported the third model by Schmidt and Boshuizen of knowledge encapsulation theory suggesting that basic science knowledge is activated in expert diagnostic reasoning through its relation with clinical knowledge.

Clinical Competence↗

Shared representations between self and other: a social cognitive neuroscience view.

The abilities to identify with others and to distinguish between self and other play a pivotal role in intersubjective transactions. Here, we marshall evidence from developmental science, social psychology and neuroscience (including clinical neuropsychology) that support the view of a common representation network (both at the computational and neural levels) between self and other. However, sharedness does not mean identicality, otherwise representations of self and others would completely overlap, and lead to confusion. We argue that self-awareness and agency are integral components for navigating within these shared representations. We suggest that within this shared neural network the inferior parietal cortex and the prefrontal cortex in the right hemisphere play a special role in interpersonal awareness.

Journal Article↗

Health psychology. The science and the field.

Reviews scientific and professional trends in the field of health psychology. I discuss recent research on health promotion, psychological factors in the development of illness, cognitive representations of health and illness, stress and coping, social support, interventions to promote coping, and trends that will affect progress in the field, such as the need for cost containment and the aging of the population.

Cognition↗

Lead exposure and cognitive development: persistence and a dynamic pattern.

OBJECTIVES: Although enormous effort has been focused over the past two decades on examining the potential adverse effects of exposure to environmental lead on human health, there has been a debate over the persistence and dynamic pattern of these effects. METHODOLOGY: Articles relevant to this issue which were published between January 1982 and December 1996 were retrieved from Medline and adjunct searching methods (i.e. hand searching of key journals, review of the bibliographies of reports known to be relevant, consulting with experts, and use of Science Citation Index). RESULTS: Currently available epidemiological evidence suggests that 'low' level exposure to lead in early childhood is likely to cause a moderate but real and detectable effect on cognitive development, and this effect appears to persist into later childhood. The findings from four long-term prospective studies seem to support the constant decrement model which assumes that cognitive deficits resulting from early lead exposure persist over an extended period of time even when exposure decreases. CONCLUSION: From a public health perspective, it is highly desirable and prudent to reduce the dispersive uses of lead. Since lead is ubiquitous and persistent in the environment and may have a subtle and persistent effect on cognitive development, how to set the environmental standards for lead exposure is an important scientific issue still open for debate.

Child↗

Psychological skills training for sport-related outcomes: An umbrella review of evidence credibility and methodological quality.

Psychological skills training (PST) is widely used in sport, but review-level evidence remains fragmented across interventions, populations, outcomes, and methodological standards. This umbrella review synthesized evidence on PST-related interventions for sport-related outcomes, including athletic performance, psychological outcomes, cognitive performance, and sports injury, and evaluated evidence credibility, certainty, and methodological quality. A systematic literature search was conducted on 21 May 2025 in MEDLINE, PsycInfo, PubMed, Scopus, SportDiscus, Web of Science, and CINAHL Complete. Overall, 61 reviews involving 42,106 participants were included; 35 meta-analyses involving 28,076 participants were eligible for quantitative synthesis, and 26 reviews or meta-analyses involving 14,030 participants were summarized qualitatively. Quantitative findings showed generally positive point estimates for mindfulness-based interventions, imagery practice, music-based interventions, neurofeedback, perceptual-cognitive training, and multiple PST interventions, but most findings were weak or non-significant and certainty was generally very low. Qualitative evidence suggested potential benefits, but conclusions varied according to intervention definition, delivery, outcome measurement, and methodological quality. Evidence was more developed for athletic performance and psychological outcomes than for cognitive performance and sports injury. Overall, PST-related interventions may benefit sport-related outcomes, but conclusions should remain cautious because of low certainty, methodological heterogeneity, and limited evidence credibility.

Humans↗

The HOCS paradigm shift from disciplinary knowledge (LOCS)--to interdisciplinary evaluative, system thinking (HOCS): what should it take in science-technology-environment-society oriented courses, curricula and assessment?

Given the current world state of affairs, striving for sustainability and the consequent paradigm shift: growth-to-sustainable development, correction-to-prevention and options selection-to-options generation: the corresponding paradigm shift in science-technology-environment-society (STES) education is unavoidable. Accordingly, the essence of the current reform in STES education, worldwide, is a purposed effort to develop students' higher-order cognitive skills (HOCS) capability; i.e., question-asking, critical system thinking, decision making and problem solving, at the expense of the "delivery" of lower-order cognitive skills (LOCS)-oriented knowledge. This means a paradigm shift from the contemporary prevalent LOCS algorithmic teaching to HOCS evaluative learning and HOCS-promoting courses, curricula, teaching strategies and assessment methodologies, leading, hopefully to evaluative thinking and transfer. Following the formulation of selected relevant axioms, major paradigm shift in STES research and education for sustainability have been identified. The consequent shift, in the STES context, from disciplinary to inter- and transdisciplinary learning, in science technology and environmental engineering education is discussed, followed by selected examples of successfully implemented HOCS-promoting courses, and assessment methodologies. It is argued, that transferable "HOCS learning" for sustainability can and should be done.

Clinical Competence↗

Cortical activations during the mental rotation of different visual objects.

Whole-head functional magnetic resonance imaging was applied to nine healthy right-handed subjects while they were performing three different mental rotation tasks and two visual control tasks. The mental rotation tasks comprised stimuli pairs derived from the "classical" 3D cube figures first used by R. N. Shepard and J. Metzler (1971, Science 171, 701-703), pairs of letters, and pairs of abstract figures developed by J. Hochberg and L. Gellmann (1977, Memory Cognit. 5, 23-26). In some cases, the paired objects were identical except that they were rotated in a certain plane. In other cases, the two objects were incongruent. Subjects were shown one pair of objects at a time and asked to judge whether the two were the same. In line with previous studies we found that decision times increased linearly with the degree of separation between the two objects. Cortical activation converged to demonstrate bilateral core regions in the superior and inferior parietal lobe (centered on the intraparietal sulcus), which were similarly activated during all three mental rotation tasks. Thus, our results suggest that different kinds of stimuli used for mental rotation tasks did not inevitably evoke activations outside the parietal core regions. For example we did not find any activation in brain areas known to be involved in lexical or verbal processing nor activations in cortical regions known to be involved in object identification or classification.

Adult↗

A credo for a revitalized behaviorism: characteristics and emerging principles.

The fundamental assumptions of scientific psychology are examined by asking three key questions concerning the accessibility, analyzability, and reducibility of mental processes. It is concluded that current research does not support the premises of mentalistic cognitive psychology and that we should return to a modernized version of behaviorism if psychology is to prosper as a valid science.

Journal Article↗

Treatment of pain in acutely burned children.

The child with burns suffers severe pain at the time of the burn and during subsequent treatment and rehabilitation. Pain has adverse physiological and emotional effects, and research suggests that pain management is an important factor in better outcomes. There is increasing understanding of the private experience of pain, and how children benefit from honest preparation for procedures. Developmentally appropriate and culturally sensitive pain assessment, pain relief, and reevaluation have improved, becoming essential in treatment. Pharmacological treatment is primary, strengthened by new concepts from neurobiology, clinical science, and the introduction of more effective drugs with fewer adverse side effects and less toxicity. Empirical evaluation of various hypnotic, cognitive, behavioral, and sensory treatment methods is advancing. Multidisciplinary assessment helps to integrate psychological and pharmacological pain-relieving interventions to reduce emotional and mental stress, and family stress as well. Optimal care encourages burn teams to integrate pain guidelines into protocols and critical pathways for improved care.

Analgesia, Patient-Controlled↗

[Computer models of personality: implications for measurement].

Computer models of human behavior have long existed in the world of science fiction; however, in reality, progress has been slow. Research has concentrated, in recent years, on the simulation of memory and cognition. Computer models of personality, although fascinating and potentially useful, have been neglected. This paper reviewed the research done to date, categorizing it under five headings: (a) models of belief systems; (b) models of interpersonal behavior; (c) models of decision-making processes; (d) prediction models; and (e) theory-based simulations of specific processes. One practical application was then explored in depth, that of using the computer models in personality measurement. Although some practical development of the working simulations would have to precede their application to personality measurement, it was felt that such an application would be feasible and useful.

Attitude↗

Field dependence/independence and performance in school: an argument against neutrality of cognitive style.

To ascertain whether there is any relationship between field dependence/independence and performance in school, the Children's Embedded Figures Test and Embedded Figures Test were applied to 103 10- to 14-yr.-olds (55 boys and 48 girls) in Grades 5 to 8 of primary education and Grade 1 of secondary education in Santiago de Compostela (Spain), and the scores were compared with their school marks in Mathematics, Spanish, Natural Sciences, and Social Sciences, and with their over-all mark. Field-independent children performed better in all subjects, especially boys. This finding appears unsupportive of the supposed neutrality of field dependence/independence and suggests that this dimension of cognitive style should be taken into account in education.

Achievement↗

The predictive utility of computer-simulated exercises for preclinical technique performance.

The objective of this research was to determine if a computerized simulated dental exercise predicts students' subsequent performance in preclinical technique courses. Twenty-nine first-year dental students voluntarily participated in the investigation prior to their first experience with a dental handpiece. These students prepared an ideal Class I amalgam on an ivorine mandibular first molar tooth after viewing ten-minute videotaped instructions. Students completed the Class I amalgam on a computerized dental treatment simulator (SIM). All participants' SIM scores were correlated with sub-test scores of the Dental Admission Test (DAT), predental overall grade point average (GPA), predental Biology/Chemistry/Physics grade point average (BCP), and grades from the first two preclinical laboratory technique courses (Lab 1 and Lab 2). The results showed a significant correlation between the simulator scores and DAT sub-test scores of Academic Average and Total Science, as well as Lab 1 scores. Based on these results, the simulator appears to be a good measure of general cognitive ability, including cognitive ability required to complete uncomplicated preclinical exercises.

Aptitude Tests↗

New perspectives in EEG/MEG brain mapping and PET/fMRI neuroimaging of human pain.

With the maturation of EEG/MEG brain mapping and PET/fMRI neuroimaging in the 1990s, greater understanding of pain processing in the brain now elucidates and may even challenge the classical theory of pain mechanisms. This review scans across the cultural diversity of pain expression and modulation in man. It outlines the difficulties in defining and studying human pain. It then focuses on methods of studying the brain in experimental and clinical pain, the cohesive results of brain mapping and neuroimaging of noxious perception, the implication of pain research in understanding human consciousness and the relevance to clinical care as well as to the basic science of human psychophysiology. Non-invasive brain studies in man start to unveil the age-old puzzles of pain-illusion, hypnosis and placebo in pain modulation. The neurophysiological and neurohemodynamic brain measures of experimental pain can now largely satisfy the psychophysiologist's dream, unimaginable only a few years ago, of modelling the body-brain, brain-mind, mind-matter duality in an inter-linking 3-P triad: physics (stimulus energy); physiology (brain activities); and psyche (perception). For neuropsychophysiology greater challenges lie ahead: (a) how to integrate a cohesive theory of human pain in the brain; (b) what levels of analyses are necessary and sufficient; (c) what constitutes the structural organisation of the pain matrix; (d) what are the modes of processing among and across the sites of these structures; and (e) how can neural computation of these processes in the brain be carried out? We may envision that modular identification and delineation of the arousal-attention, emotion-motivation and perception-cognition neural networks of pain processing in the brain will also lead to deeper understanding of the human mind. Two foreseeable impacts on clinical sciences and basic theories from brain mapping/neuroimaging are the plausible central origin in persistent pain and integration of sensory-motor function in pain perception.

Brain↗

The assessment of factorial invariance in need for cognition using Hispanic and Anglo samples.

The Need for Cognition Scale-Short Form (NCS-SF; J. T. Cacioppo, R. E. Petty, & C. F. Kao, 1984) is a commonly administered measure in the behavioral sciences, but little research has assessed its applicability across cultures. A sample of undergraduates in the southeastern United States and a sample of undergraduates at a southwestern U.S. university completed the NCS-SE Hispanic respondents did not differ from Anglos in their mean NCS-SF scores. Confirmatory factor analysis revealed that factor parameter estimates and item intercepts were partially measurement invariant across samples.

Adult↗

Similarity-based models of human visual recognition.

Seven models of human visual recognition from cognitive psychology, visual psychophysics and connectionism were compared. They were used to predict psychophysical classification data obtained via supervised learning with parametrised grey-level patterns (compound Gabor signals). Four sets of learning patterns, as well as foveal and extrafoveal viewing conditions, were applied. Model performance was determined by comparing observed and predicted data with respect to root mean square deviation and to signal reconstruction via multidimensional scaling. Results show that a psychophysical theory of classification requires a similarity concept that is based both on physical signal description and on cognitive bias. The latter is less pronounced in foveal recognition, where all seven models performed almost equally well, but matters in extrafoveal recognition. Virtual prototype models (Rentschler et al. (1994), Vision Research 34, 669-687), which best accommodate stimulus- and observer-dependencies, are then of advantage. Concerning computational efficiency, a hyperBF model (Poggio and Girosi (1990), Science 247, 978) was much faster, and generalized signal detection models were much slower than the average.

Cognition↗

Unrealistic optimism: a behavioural sciences classroom demonstration project.

Unrealistic optimism may contribute to risky health practices and to a delay in seeking treatment for medical conditions, as most individuals perceive themselves to be at little risk for various disorders. It is thus an important concept to present to medical students as part of their behavioural sciences training. Social psychological concepts such as unrealistic optimism may appear, on initial presentation to students, to be a misjudgement based on faulty understanding of risk estimates by the general population. This project aimed to teach the principle of unrealistic optimism by having students document their own beliefs about health risks. Students rated their own risk, relative to other classmates, of experiencing a range of 17 health problems. Questionnaires were completed by two classes of medical students (n = 257). Class results showed varying levels of unrealistic optimism for all 17 conditions. Males and females differed significantly on three of the 17 conditions. Student data were obtained rapidly in a large didactic setting and served to illustrate the concept of unrealistic optimism which was subsequently taught in class. Such exercises may be a useful teaching aid to students providing them with feedback on their own cognitive processes and illustrating that they display cognitive distortions similar to those of patients.

Attitude to Health↗