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Linear versus Ecological Perspective in Clinical Judgments of Social Work Students
This study explores the dialectic between the older, linear-mechanistic approach of the clinical-normative-individual-system model, and the newer, ecological-systems approach of the life model. Theoretical issues are outlined as they have unfolded during several decades.
The principal independent variable is clinical-orientation of clinician-subjects with regard to degree of adherence to linear-mechanistic and/or ecological-systems approaches. Secondary independent variables are duration-severity and interpersonal-context of client problem/situations, described in four situational vignettes. Hypotheses predict positive correlations between measures of each independent variable, and degree of linear versus ecological weighting to clinicians' assessments and intervention plans for each vignette.
Data were collected in 1980 from 152 second-year graduate students in casework and direct practice, who represented an initial pool of 1,007 students from fourteen CSWE-approved schools which provided unrestricted cooperation, through lists of eligible students.
Three instruments were utilized: (a) An informational questionnaire inquired about students' willingness to participate, and characteristics which would enable the researcher to determine eligibility, and identify extraneous effects. (b) The second sought graded measures of subjects' adherence to specific theoretical principles of linear or ecological approaches. (c) The final instrument sought repeated measures of type of assessment and intervention plan (linear or ecological), formulated in response to systematically varied vignette conditions.
Findings include several positive correlations between self-rated clinical-orientation and assessment measures, and fewer positive correlations between clinical-orientation and intervention measures. The interpersonally isolated client whose problem/situation is chronic tends to pull judgments in the direction of linear-mechanistically weighted assessments and intervention plans, regardless of clinician's orientation.
Implications for teaching the ecological approach are explored. Use of the clinical-orientation instrument for student self-observation is suggested.
Research implications include refining of instrumentation, and comparison of seasoned and student clinicians, to test empirical applicability of the ecological approach
Effects of experience and reference tools on laparoscopic length measurements.
INTRODUCTION: The accuracy of surgeons, and surgeons-in-training performing laparoscopic intestinal measurements is unknown. We evaluated the accuracy and precision of laparoscopic length measurements using a box-trainer model with and without the aid of a measuring tool.
METHODS: Surgical attendings, residents, and medical students were studied. A 500 cm length of rope was placed within a laparoscopic box trainer. Subjects completed two length measurements (LM). Participants measured 150 cm of rope for LM #1 and repeated the task using a 10-cm suture as a reference for LM #2. Measurement accuracy was tested by comparing mean LM between training level groups using an independent t test. Measurement precision was tested by comparing the mean deviation of LM from 150 cm.
RESULTS: 40 attendings, 40 residents, and 50 medical students were studied. In LM #1, there were no differences in mean length accuracy measured between training level groups. Residents significantly underestimated the true 150 cm length (p \u3c 0.05). When LM #1 and LM #2 were compared, attending accuracy did not change but precision increased significantly (p \u3c 0.01). Resident precision also significantly increased with the measuring tool (p \u3c 0.001) and trended toward improved accuracy (p = 0.08). Student accuracy did not change, but a similar significant increase in precision was observed with the measurement tool (p = 0.001). Attendings performed both measurements faster than residents and students (p \u3c 0.05). Residents performed faster than the students for both measurements (p \u3c 0.05). Time for task completion significantly increased in medical students with the use of the measurement tool (p = 0.026).
CONCLUSIONS: These data suggest that use of a measurement tool in laparoscopic length measurement will yield better precision with no effect on operative time or procedural flow in more experienced operators. Standardization of methods of use and optimal training techniques remains to be determined