The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective

Context: The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsumes ideas with regard to how individuals learn. Such a model is being accepted almost without debate from physicians to explain the ‘acquisition’ of clinical skills. Objectives: This paper reviews such a model, discusses several controversial points, clarifies what kind of knowledge the model is about, and examines its coherence in terms of problem-solving skills. Dreyfus’ main idea that intuition is a major aspect of expertise is also discussed in some detail. Relevant scientific evidence from cognitive science, psychology, and neuroscience is reviewed to accomplish these aims. Conclusions: Although the Dreyfus model may partially explain the ‘acquisition’ of some skills, it is debatable if it can explain the acquisition of clinical skills. The complex nature of clinical problem-solving skills and the rich interplay between the implicit and explicit forms of knowledge must be taken into consideration when we want to explain ‘acquisition’ of clinical skills. The idea that experts work from intuition, not from reason, should be evaluated carefully

Social cohesion, mental wellbeing and health-related quality of life among a cohort of social housing residents in Cornwall: a cross sectional study

Background: Research and policy have identified social cohesion as a potentially modifiable determinant of health and wellbeing that could contribute to more sustainable development. However, the function of social cohesion appears to vary between communities. The aim of this study was to analyse the levels of, and associations, between social cohesion, mental wellbeing, and physical and mental health-related quality of life among a cohort of social housing residents from low socioeconomic status communities in Cornwall, UK. Social housing is below market-rate rental accommodation made available to those in certain health or economic circumstances. These circumstances may impact on the form and function of social cohesion. Methods: During recruitment, participants in the Smartline project completed the Short Warwick-Edinburgh Mental Wellbeing Scale, SF-12v2 and an eight item social cohesion scale. Cross sectional regression analyses of these data adjusted for gender, age, national identity, area socioeconomic status, rurality, education, employment, and household size were undertaken to address the study aim. Results: Complete data were available from 305 (92.7%) participants in the Smartline project. Univariable analyses identified a significant association between social cohesion, mental wellbeing and mental health-related quality of life. Within fully adjusted multivariable models, social cohesion only remained significantly associated with mental wellbeing. Sensitivity analyses additionally adjusting for ethnicity and duration of residence, where there was greater missing data, did not alter the findings. Conclusions: Among a relatively homogeneous cohort, the reported level of social cohesion was only found to be significantly associated with higher mental wellbeing, not physical or mental health-related quality of life. The efforts made by social housing providers to offer social opportunities to all their residents regardless of individual physical or mental health state may support the development of a certain degree of social cohesion. Sense of control or safety in communities may be more critical to health than social cohesion. Additional observational research is needed before attempts are made to alter social cohesion to improve health.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.The Smartline project is receiving up to £4,188,318 of funding from the England European Regional Development Fund as part of the European Structural and Investment Funds Growth Programme 2014–2020. The Ministry of Housing, Communities and Local Government (and in London the intermediate body Greater London Authority) is the Managing Authority for European Regional Development Fund. Established by the European Union, the European Regional Development Fund helps local areas stimulate their economic development by investing in projects which will support innovation, businesses, create jobs and local community regenerations. For more information visit https://www.gov.uk/european-growth-funding. Additional funding is from the South West Academic Health Science Network. KW is supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula. KMa was funded by a National Institute for Health Research (NIHR) Knowledge Mobilisation Research Fellowship and ESRC Smartline Project for this research. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. The funders did not contribute to the design of the study or collection, analysis, and interpretation of data or in writing the manuscript in any way.published version, accepted versio

Remote Sensing Tropical Coral Reefs: The View from Above

Carbonate precipitation has been a common life strategy for marine organisms for 3.7 billion years, as, therefore, has their construction of reefs. As favored by modern corals, reef-forming organisms have typically adopted a niche in warm, shallow, well-lit, tropical marine waters, where they are capable of building vast carbonate edifices. Because fossil reefs form water aquifers and hydrocarbon reservoirs, considerable effort has been dedicated to understanding their anatomy and morphology. Remote sensing has a particular role to play here. Interpretation of satellite images has done much to reveal the grand spatial and temporal tapestry of tropical reefs. Comparative sedimentology, whereby modern environments are contrasted with the rock record to improve interpretation, has been particularly transformed by observations made from orbit. Satellite mapping has also become a keystone technology to quantify the coral reef crisis-it can be deployed not only directly to quantify the distribution of coral communities, but also indirectly to establish a climatology for their physical environment. This article reviews the application of remote sensing to tropical coralgal reefs in order to communicate how this fast-growing technology might be central to addressing the coral reef crisis and to look ahead at future developments in the science

Extending the team component of the Latimer ethical decision-making model for palliative care

Mary Ellen Purkis1, Elizabeth Borycki1,2, Craig Kuziemsky3, Fraser Black4, Denise Cloutier-Fisher5, Lee Ann Fox6, Patricia MacKenzie7, Ann Syme1,8, Coby Tschanz1,41School of Nursing, 2School of Health Information Science, University of Victoria, Victoria, British Columbia; 3Telfer School of Management, University of Ottawa, Ottawa, Ontario; 4Victoria Hospice Society, Victoria, British Columbia; 5Department of Geography, University of Victoria, Victoria, British Columbia; 6Kingston General Hospital, Kingston, Ontario; 7School of Social Work, University of Victoria, Victoria, British Columbia; 8British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, CanadaBackground: Each year more than 240,000 Canadians die from terminal and chronic illnesses. It is estimated that 62% of those deaths require palliative care. Palliative care is a specialized domain of health professional team practice that requires discipline-specific knowledge, skills, judgment, and expertise in order to address patient hopes, wishes, symptoms, and suffering. With the emergence of palliative care as a specialized area of interdisciplinary practice, new practice models have also emerged, eg, the Latimer ethical decision-making model for palliative care. The purpose of this research was to undertake a descriptive ethnographic field study of palliative care team practices to understand better the interdisciplinary team communication and the issues that arise when members of different health professions work together as a team.Methods: Study data were collected by observing and videotaping palliative care team meetings. Data were then analyzed using direct content analysis.Results: The study findings substantiated many of the team practice concepts outlined in Latimer's model. Palliative care teams engage in a number of processes that address patient symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were not explicit in Latimer's original model. Teams employed five additional emergent team processes when addressing patient symptoms and suffering while attempting to fulfill patient hopes and plans. Those five team processes included explicating practice norms, leadership, provider assumptions, interdisciplinary teaching, and patient safety.Conclusion: Although many team processes have been identified by practice models in the literature, there is a need to study the applicability of these models empirically to validate their representation of aspects of team practice.Keywords: interprofessional team practice, palliative care, ethics, ethnograph