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PubMed2006

Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey.

OBJECTIVE: To determine medical students' perceptions of having been harassed or belittled and their correlates, for the purposes of reducing such abuses. DESIGN: Longitudinal survey. SETTING: 16 nationally representative US medical schools. PARTICIPANTS: 2884 students from class of 2003. MAIN OUTCOME MEASURES: Experiences of harassment and belittlement at freshman orientation, at entry to wards, and in senior year by other students, by residents or fellows, by preclinical professors, by clinical professors or attendings, or by patients. RESULTS: 2316 students provided data (response rate 80.3%). Among seniors, 42% (581/1387) reported having experienced harassment and 84% (1166/1393) belittlement during medical school. These types of abuse were caused by other students (11% (158/1389) and 32% (443/1390) of students experienced such harassment or belittlement, respectively). Harassment and belittlement was also caused by residents (27% (374/1387) and 71% (993/1393)), preclinical professors (9% (131/1386) and 29% (398/1385)), clinical professors (21% (285/1386) and 63% (878/1390)), and patients (25% (352/1387) and 43% (592/1388)). Only 13% (181/1385) of students classified any of these experiences as severe. Medical students who reported having been harassed or belittled did not differ significantly from those not reporting such experiences by sex, ethnicity, political orientation, or religion. They did differ significantly by chosen specialty and were significantly more likely to be stressed, depressed, and suicidal, to drink alcohol or to binge drink, and to state that their faculty did not care about medical students. They were also significantly less likely to be glad they trained to become a doctor. CONCLUSION: Most medical students in the United States report having been harassed or belittled during their training. Although few students characterised the harassment or belittlement as severe, poor mental health and low career satisfaction were significantly correlated with these experiences.

Aggression↗
PubMed1993

Attitudes of medical students to HIV and AIDS.

OBJECTIVE--To assess the knowledge and attitudes of medical students to HIV/AIDS and whether attitudes correlate with knowledge and clinical experience. To determine if students felt adequately prepared to deal with medical and psychological aspects of HIV/AIDS. SUBJECTS AND METHODS--The subjects consisted of 190 London and 99 Cambridge medical students at the end of their genitourinary medicine attachment, plus 230 Cambridge medical students at the end of their second pre-clinical year. Between March 1991 and February 1992 all were asked to complete an anonymous questionnaire, covering factual knowledge and attitudes towards HIV/AIDS. MAIN RESULTS--Cambridge genitourinary medicine students, despite spending less time studying HIV infection than their London counterparts gave more correct answers to the factual questions, although this difference did not reach significance (52.4% vs. 47.5%, p = 0.14). One third of students believed that many health care workers were at high risk of acquiring HIV at work and one fifth thought doctors should have the right to refuse to treat people with HIV. Fourteen percent of Cambridge genitourinary medicine students indicated that most British people with HIV have only themselves to blame, by comparison with 4% of London students (p = 0.003). Thirty-nine per cent of Cambridge genitourinary medicine students expressed reluctance to care for someone with AIDS by comparison with 10% of London students (p = 0.0001). CONCLUSIONS--It is important that medical educators convey accurate information about HIV, including the actual risks posed by occupational exposure and try to ensure that medical students spend sufficient time seeing patients with HIV/AIDS during their training.

Acquired Immunodeficiency Syndrome↗
PubMed2006

International student exchange and the medical curriculum: evaluation of a medical sciences translational physiology course in Brazil.

The objective of the present study was to conduct a short-term international course on translational physiology for medical students from Wright State University and the University of Iowa. The goals were to 1) provide students with an exposure to the academic, cultural, and medical environments in Brazil; 2) promote awareness of the global medical community; and 3) provide an academic course focused on translational physiology. An evaluation of the students was conducted to determine whether such a short-term course might be useful in the medical curriculum. The 2-wk course was held in the summer of 2005 at the University of São Paulo School of Medicine in Ribeirão Preto, Brazil, for 23 American students. The program included presentations of basic and clinical topics, meetings with medical students, and clinical presentations. The program finished with student attendance at a scientific meeting sponsored by the Brazilian Society of Hypertension. Student surveys evaluated issues related to perceived treatment, Brazilian medical school environment, culture and personal attributes, and career aspirations. The international Medical Sciences Translational Physiology course for medical students provided a brief, but intense, experience. It gave students a picture of the medical environment in Brazil and an appreciation for the differences and similarities in cultures. Most students reported that it was a positive experience that would be beneficial to their careers. In conclusion, a short-term international course provides an efficient means for medical students to experience aspects of global medical science.

Brazil↗
PubMed2006

Peer instruction enhanced student performance on qualitative problem-solving questions.

We tested the hypothesis that peer instruction enhances student performance on qualitative problem-solving questions. To test this hypothesis, qualitative problems were included in a peer instruction format during our Physiology course. Each class of 90 min was divided into four to six short segments of 15 to 20 min each. Each short segment was followed by a qualitative problem-solving scenario that could be answered with a multiple-choice quiz. All students were allowed 1 min to think and to record their answers. Subsequently, students were allowed 1 min to discuss their answers with classmates. Students were then allowed to change their first answer if desired, and both answers were recorded. Finally, the instructor and students discussed the answer. Peer instruction significantly improved student performance on qualitative problem-solving questions (59.3 +/- 0.5% vs. 80.3 +/- 0.4%). Furthermore, after peer instruction, only 6.5% of the students changed their correct response to an incorrect response; however, 56.8% of students changed their incorrect response to a correct response. Therefore, students with incorrect responses changed their answers more often than students with correct responses. In conclusion, pausing four to six times during a 90-min class to allow peer instruction enhanced student performance on qualitative problem-solving questions.

Cooperative Behavior↗
PubMed1999

How accurate are our assumptions about our students' background knowledge?

Teachers establish prerequisites that students must meet before they are permitted to enter their courses. It is expected that having these prerequisites will provide students with the knowledge and skills they will need to successfully learn the course content. Also, the material that the students are expected to have previously learned need not be included in a course. We wanted to determine how accurate instructors' understanding of their students background knowledge actually was. To do this, we wrote a set of multiple-choice questions that could be used to test students' knowledge of concepts deemed to be essential for learning respiratory physiology. Instructors then selected 10 of these questions to be used as a prerequisite knowledge test. The instructors also predicted the performance they expected from the students on each of the questions they had selected. The resulting tests were administered in the first week of each of seven courses. The results of this study demonstrate that instructors are poor judges of what beginning students know. Instructors tended to both underestimate and overestimate students' knowledge by large margins on individual questions. Although on the average they tended to underestimate students' factual knowledge, they overestimated the students' abilities to apply this knowledge. Hence, the validity of decisions that instructors make, predicated on the basis of their students having the prerequisite knowledge that they expect, is open to question.

Educational Measurement↗
PubMed2000

Helping undergraduates repair faulty mental models in the student laboratory.

Over half of the undergraduate students entering physiology hold a misconception concerning how breathing pattern changes when minute ventilation increases. Repair of this misconception was used as a measure to compare the impact of three student laboratory protocols on learning by 696 undergraduate students at 5 institutions. Students were tested for the presence of the misconception before and after performing a laboratory activity in which they measured the effect of exercise on tidal volume and breathing frequency. The first protocol followed a traditional written "observe and record" ("cookbook") format. In the second treatment group, a written protocol asked students to complete a prediction table before running the experiment ("predictor" protocol). Students in the third treatment group were given the written "predictor" protocol but were also required to verbalize their predictions before running the experiment ("instructor intervention" protocol). In each of the three groups, the number of students whose performance improved on the posttest was greater than the number of students who performed less well on the posttest (P < 0.001). Thus the laboratory protocols helped students correct the misconception. However, the remediation rate for students in the "instructor intervention" group was more than twice that observed for the other treatment groups (P < 0.001). The results indicate that laboratory instruction is more effective when students verbalize predictions from their mental models than when they only "discover" the outcome of the experiment.

Exercise↗
PubMed2000

Health outcomes of elementary school students in New Brunswick. The education perspective.

With data from the New Brunswick School Climate Study (N = 6,883 students from 147 schools), this study examined individual differences in and school effects on health outcomes of students. Results of hierarchical linear modeling showed that females reported experiencing more physical health problems, eating less healthy food, and doing fewer exercises than males. Students of high socioeconomic status (SES) reported eating more healthy food and doing more exercises than students of low SES. Native students reported experiencing more physical health problems and eating less healthy food than nonnative students. Students of single parents reported eating more healthy food and exercising more than students of both parents. Schools showed effects on health outcomes over and above the effects of students. Students in schools with high SES and positive disciplinary climate reported fewer physical and mental health problems. Students in large schools reported less healthy food intake and fewer physical exercises.

Child↗
PubMed2004

Perceptions of first and third year medical students on self-study and reporting processes of problem-based learning.

BACKGROUND: The objective of this study is to investigate the perceptions of first and third year medical students on self-study and reporting processes of Problem-based Learning (PBL) sessions and their usage of learning resources. METHODS: The questionnaire applied to the students consisted of; questions about students' perceptions on searching and preparing phases of the self-study process, the breadth and depth of discussion during reporting phase and the usage of learning resources. RESULTS: First-year students spent more time for self-study and more highly rated the depth of discussion compared to third-year students. The searching and preparing phases of the self-study process were considered as statistically important factors strongly influencing the breadth and depth of discussion during the reporting phase. The effect of extensiveness of searching on the depth of discussion was negative among the first-year students, and positive among third-year students. CONCLUSIONS: The relative shortness of third-year students' self-study periods can be related to their mental weariness, decreased motivation or first-year students' slowness in accessing appropriate resources. The third-year students' more frequent use of textbooks may be due to the improvement of their abilities in reaching relevant learning resources. The findings implied that the increase in students' PBL experience paralleled the development of their discussion skills using different learning resources.

Attitude of Health Personnel↗
PubMed2006

Student perspectives on curricular change: lessons from an undergraduate lower-division biology core.

Inquiry-based laboratories are acknowledged as the preferred method of instruction for development of research skills. Much has been written about changes in student performance associated with inquiry, but less is known about how students view the inquiry-based format or whether they perceive a benefit from this type of instruction. The Student Assessment of Learning Gains (SALG) survey was used to evaluate and compare student reactions to the new, inquiry-based laboratories of a lower-division undergraduate curriculum, from implementation to the present (an interval of 3 yr). Initial student response to the format and value of the inquiry labs improved over time. The quality of the graduate teaching assistants and the clarity of the laboratory manual were important variables influencing student perception. A student's perception of his/her retention of lab-related skills was strongly associated with perceptions of gains in those skills. Student responses reflect their most current laboratory experience and not a cumulative effect of participation in the core series of courses. Student success in the inquiry format was not associated with gender or status as a transfer student. The majority of students believe that their experiences in the lower-division inquiry labs have prepared them for upper-division course work.

Adolescent↗
PubMed2006

Evaluating the believability and effectiveness of the social norms message "most students drink 0 to 4 drinks when they party".

In an effort to reduce dangerous drinking levels among college students, university health educators have initiated social norms campaigns based on the rationale that students will be more likely to reduce their own drinking behaviors if they think that most students on campus are not heavy or binge drinkers. Within the framework of social comparisons theory, this study reports the findings of a survey of 277 college students and explores the correlates of accuracy and bias in students' estimates of whether or not most other students think that binge drinking on campus is a problem and whether or not most other students believe the campaign message. The overwhelming majority (72.6%) of students did not believe the norms message that most students on campus drink "0 to 4" drinks when they party, and 52.7% reported drinking "5 or more" drinks in a sitting. The social norms campaign was effective in motivating 61% of the respondents to think about binge drinking as a problem. For the most part, group or social network norms were more influential on students' own drinking behavior than were their estimates of the campus drinking norm. The findings also clarify that accuracy in estimating the campus social norm in and of itself does not necessarily lead to an increase or reduction in alcohol consumption. The social comparisons approach underscores the complex and social nature of human interaction and reinforces the need for the development of multiple approaches to alcohol education with messages that are designed to target the specific needs of students based on their orientations toward alcohol consumption.

Adult↗
PubMed2005

A survey of attitudes toward homosexuality in Hong Kong chinese medical students.

BACKGROUND: Homosexuality is now considered an alternative lifestyle occurring with some regularity as a variant of human sexuality, rather than a pathological disorder. It is important to understand the attitudes of medical professionals toward homosexuality, as their attitudes may influence their approach to gay men and lesbians as patients. It is also important to understand the current attitudes of medical students who will be the future generation of health care providers. PURPOSE: To study Chinese medical students' attitudes toward and personal experiences with homosexuality. METHODS: A cross-sectional study was conducted at a university medical school. Medical students were asked 16 questions according to an anonymous survey questionnaire. RESULTS: Of the 780 medical students (42% male, 49% female, 10% sex anonymous) who received the questionnaire, 627 (80%) returned it. Of these students, 72% were age 18 to 22 years; 38% reported that they had homosexual friends. Only 16 students described themselves as homosexuals and 20 as bisexuals. A total of 249 students (40%) reported that they had a religion; 542 (86%) reported that they would accept their friends to be homosexuals. Two thirds thought that homosexual and heterosexual partners should have equal legal rights in terms of marriage, whereas slightly less than half (46%) thought they should have equal legal rights in adopting children. With regard to learning or working abilities, 93% thought homosexuals are not any different from heterosexuals. Two thirds thought homosexuals are not different from heterosexuals in terms of sexual behaviour such as promiscuity or loyalty. One fourth thought homosexuality is a psychological disorder that requires therapy. These findings did not differ significantly with seniority, but students with a religion held different attitudes than those without, and were more likely to believe that homosexuality is a psychological disorder, odds ratio (OR) = 2.33, 95% confidence interval (CI) = 1.59 .43, p < .001. Female students were more likely to have homosexual friends, OR = 1.72, 95% CI = 1.20 .48, p = .003, and more accepting attitudes, OR = 1.78, 95% CI = 1.24 .57, p = .002. CONCLUSIONS: The attitudes and experiences do not vary significantly between the 5 classes of medical students, but religious beliefs and gender might influence these attitudes. These findings can help medical teachers to be more sensitive in terms of educating their students.

Adolescent↗
PubMed2006

Faculty, students, and actors as standardized patients: expanding opportunities for performance assessment.

BACKGROUND: In an effort to expand preclinical formative assessments, our medical school has implemented additional simulated encounters using faculty members and students in addition to actors to portray standardized patients (SP). This report focuses on the implementation of this strategy. In addition, a preliminary evaluation of the fidelity of the simulated clinical encounters based on SP type is reported. DESCRIPTION: Three new performance-based assessments were added to the second-year curriculum; each was associated with specific content in the problem-based learning curriculum. The training of student and faculty SPs was modeled after an existing training program for another assessment event. EVALUATION: To determine the impact of SP type on students' experiences, 313 students completed a 9-item anonymous questionnaire after each performance assessment; items were rated on a 5-point scale. Faculty members and students who were SPs also completed a brief satisfaction questionnaire. Faculty SPs were most intimidating to students, but they provided students with the most helpful feedback. Students were less anxious when peers were SPs, but they rated the encounter as a less valuable simulation. There was no difference in students' ratings of confidence in their diagnosis or the extent to which SP type inhibited their performance. CONCLUSIONS: Students and faculty benefited from their SP experience. A combination of SP types can provide a broad range of cost-effective preclinical learning experiences. Students, faculty, and actors as SPs each have specific strengths and weaknesses related to cost, training needs, feedback quality, and simulation fidelity. The goals of the encounter should guide the choice of SP type.

Clinical Competence↗
PubMed2005

Survey of the levels of satisfaction with pharmacy practice among third-year students in the Faculty of Pharmaceutical Sciences, Health Sciences University of Hokkaido--influence of experience in voluntary training at a community pharmacy and plans after graduation.

Pharmacy practice, which is executed in the taught of pharmaceutical sciences in Japan, has been assessed and improved student questionnaires. The levels of student satisfaction with the practice are expected to be influenced by their plans after graduation and their experience of training in pharmacies. However, there are few reports analyzing the information in the questionnaires from these viewpoints. In this report, we surveyed the levels of satisfaction of 148 third-year students in the Faculty of Pharmaceutical Sciences of the Health Sciences University of Hokkaido using questionnaires and analyzed the influence of the students' background on the levels of satisfaction with pharmacy practice. Almost half of the students had received voluntary training in hospital and/or community pharmacies. Concerning plans after graduation, 36.5%, 27.7%, and 21.6% wanted to become community pharmacists, hospital pharmacists, and graduate students, respectively. More than 70% of the students were well satisfied with all the programs of practice. The levels of satisfaction with the overall practice and prescription analysis were significantly higher among students who had experienced training in pharmacies than among those who had not. Students who planned to become hospital pharmacists were more satisfied with manners seminars, one-dose package practice, and practice in a simulated pharmacy than the students who planned to enter the other field. Such surveys are useful for finding points for improvement and the development of new curricula when the assessment of pharmacy practice takes student background into consideration.

Clinical Clerkship↗
PubMed2000

The role of repetition in the processes of memorising and understanding: a comparison of the views of German and Chinese secondary school students in Hong Kong.

BACKGROUND: Previous research has found that students and teachers in countries of the Far East often see memorization and understanding as working together to produce higher quality outcomes. In contrast, in the West it is more common to associate memorizing with 'surface' and understanding with 'deep' approaches to learning. AIM: The main purpose of this study was to explore and describe the experiences of the role of repetition in the processes of memorizing and understanding among students with Western (German) and Asian (Chinese) backgrounds. In particular, we were interested in finding indications of possible cultural differences in the experiences of the two ethnic groups. SAMPLE: The participants were 48 Chinese (HKC) and 18 German senior secondary school students in Hong Kong. METHOD: The study used a qualitative research approach. Data were gathered by semi-structured in-depth interviews. Interview transcripts were analysed in order to uncover, categorize and describe the variation of experiences and conceptions of the role of repetition. The two ethnic groups were then compared as to how many interviews were found in each category. RESULTS: A similar proportion of both groups remembered being encouraged to recite by their parents, but the HKC students more often said they were made to recite by their primary teachers. While the HKC students focused on the value of the content of these early memories, the German students focused on the value of the activity itself. Moreover, while the German students tended to downplay the role of repetition in the process of understanding, the HKC students sometimes emphasized repetition combined with 'attentive effort'. By such effort they tried to discover new meanings in the materials studied, in order to deepen their understanding. CONCLUSION: While the findings of this study cannot be considered definitive, it is suggested that the emphasis on attentive effort among HKC students is consistent with a traditional, Confucian perspective on learning. The results also indicate that 'the intention to both memorize and understand', found in previous investigations of the study approaches of HKC students, may arise out of being simultaneously aware of two possibilities inherent in repetition: creating a deep impression on the mind and discovering new meaning. Finally, it is argued that the differences between the two ethnic groups are consistent with earlier research findings that Chinese, unlike Western, students tend to consider effort attributions more salient than ability attributions.

Adolescent↗
PubMed2001

Changes in conceptions of learning for indigenous Australian university students.

BACKGROUND: Conceptions of learning have been investigated for students in higher education in different countries. Some studies found that students' conceptions change and develop over time while others have found no changes. Investigating conceptions of learning for Australian Aboriginal and Torres Strait Islander university students is a relatively new area of research. AIMS: This study set out to investigate conceptions of learning for Aboriginal and Torres Strait Islander university students during the first two years of their undergraduate degree courses in three Australian universities. Conceptions for each year were compared. Knowing more about learning as conceived by this cultural group may facilitate more productive higher educational experiences. SAMPLE: The sample comprised 17 students studying various degrees; 11 were male and 6 were female. Ages ranged from 18 to 48 years; mean age was 26 years. METHOD: This was a phenomenographic, longitudinal study. Individual semistructured interviews were conducted each year to ascertain students' conceptions of learning. Conceptions for second year were derived independently of those from first year. A comparative analysis then took place to determine any changes. RESULTS: These students held conceptions of learning that were similar to those of other university students; however there were some intrinsic differences. On a group level, conceptions changed somewhat over the two years as did core conceptions reported by some individual students. Some students also exhibited a greater awareness of learning during their second year that resulted in three dimensions of changed awareness. CONCLUSIONS: We believe the changed conceptions and awareness resulted from learning at university where there is some need to understand and explain phenomena in relation to theory. This brought about new understandings which allowed students to see their own learning in a relational sense.

Adolescent↗
PubMed2005

A longitudinal study of students' academic self-concept in a streamed setting: the Singapore context.

BACKGROUND: Although several studies support the existence of a negative stream effect on lower-ability stream students' academic self-concept, there is not enough longitudinal research evidence to preclude the possibility that the stream effect may only be temporary. In addition, not much is known about the effect of streaming on changes in students' academic self-concept over time. AIMS: The main aims of the study were to examine the effect of streaming on (a) the students' academic self-concept immediately after the streaming process, and at yearly intervals for 3 consecutive years, and (b) the changes in students' academic self-concept over a 3 year period. SAMPLE: The sample comprised 495 Secondary 1 students (approximate age 13) from three government coeducational schools in Singapore. METHOD: A longitudinal survey using a self-reported questionnaire. RESULTS: Results showed that the lower-ability stream students had a more negative academic self-concept than the higher-ability stream students immediately after streaming, but they had a more positive academic self-concept 3 years after being streamed. In addition, it was established that the students' academic self-concept declined from Secondary 1 to Secondary 3. Nonetheless, the decline was more pronounced for the higher-ability stream students than the lower-ability stream students. CONCLUSIONS: Streaming may have a short-term negative impact on lower-ability stream students' academic self-concept. However, in the long run, being in the lower-ability stream may not be detrimental to their academic self-concept.

Achievement↗
PubMed2004

Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine.

BACKGROUND: Over the last 10 years the number of medical students choosing family medicine as a career has steadily declined. Studies have demonstrated that career preference at the time that students begin medical school may be significantly associated with their ultimate career choice. We sought to identify the career preferences students have at entry to medical school and the factors related to family medicine as a first-choice career option. METHODS: A questionnaire was administered to students entering medical school programs at the time of entry at the University of Calgary (programs beginning in 2001 and 2002), University of British Columbia (2001 and 2002) and University of Alberta (2002). Students were asked to indicate their top 3 career choices and to rank the importance of 25 variables with respect to their career choice. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choice were also calculated. A logistic regression was performed using career choice (family v. other) as the criterion variable and the factors plus demographic characteristics as predictor variables. RESULTS: Of 583 students, 519 (89%) completed the questionnaire. Only 20% of the respondents identified family medicine as their first career option, and about half ranked family medicine in their top 3 choices. Factor analysis produced 5 factors (medical lifestyle, societal orientation, prestige, hospital orientation and varied scope of practice) that explained 52% of the variance in responses. The 5 factors demonstrated acceptable internal consistency and correlated in the expected direction with the choice of family medicine. Logistic regression revealed that students who identified family medicine as their first choice tended to be older, to be concerned about medical lifestyle and to have lived in smaller communities at the time of completing high school; they were also less likely to be hospital oriented. Moreover, students who chose family medicine were much more likely to demonstrate a societal orientation and to desire a varied scope of practice. INTERPRETATION: Several factors appear to drive students toward family medicine, most notably having a societal orientation and a desire for a varied scope of practice. If the factors that influence medical students to choose family medicine can be identified accurately, then it may be possible to use such a model to change medical school admission policies so that the number of students choosing to enter family medicine can be increased.

Adult↗
PubMed2006

Evaluating two brief substance-use interventions for mandated college students.

OBJECTIVE: This study evaluated two brief personal feedback substance-use interventions for students mandated to the Rutgers University Alcohol and Other Drug Assistance Program for Students (ADAPS): (1) a brief motivational interview (BMI) intervention and (2) a written feedback-only (WF) intervention. A key question addressed by this study was whether there is a need for face-to-face feedback in the context of motivational interviewing to affect changes in substance-use behaviors or whether a written personal feedback profile is enough of an intervention to motivate students to change their substance use. METHOD: The sample consisted of 222 students who were mandated to ADAPS, were eligible for the study, and completed the 3-month follow-up assessment. Eligible students completed a baseline assessment from which a personal feedback profile was created. They were then randomly assigned to the BMI or WF condition. Students were followed 3 months later. RESULTS: Students in both interventions reduced their alcohol consumption, prevalence of cigarette and marijuana use, and problems related to alcohol and drug use between baseline and follow-up. There were no differences between the two intervention conditions in terms of any substance-use outcomes. CONCLUSIONS: The results suggest that, under these circumstances and with these students, assessment and WF students changed similarly to those who had an assessment and WF within the context of a BMI. Given the fact that the former is less costly in terms of time and personnel, written profiles may be found to be a cost-effective means of reducing alcohol and drug use and related problems among low- to moderate-risk mandated college students. More research is needed with mandated students to determine the efficacy of feedback interventions and to isolate the effects of interventions from the effects of being caught and being reprimanded to treatment.

Adolescent↗