A social contract model of ‘disintegrity’ within the dual-process paradigm of moral psychology: Reducing the scope of the ‘belief-behavior incongruity’

Explaining why students cheat when it violates their moral beliefs, also called the ‘belief-behavior incongruity’ (BBI), is a difficult challenge most often overcome by referring to neutralization techniques, first described by Sykes and Matza (1957), whereby individuals deceive themselves with specious justifications for ignoring the moral imperative to follow rules. An underlying assumption of the neutralization view, that individuals’ abstract moral beliefs apply automatically to all contexts, is critiqued in the present work. The account of academic dishonesty developed herein is centered on the hypothesis that adolescent students’ felt moral obligation is informed by an intuitive sense of reciprocity between themselves and their learning contexts, which resembles a social contract, or ‘psychological teaching- learning contract’ (PTLC). Students who regard a class context or teacher more negatively are thus expected to feel less moral obligation to follow rules, and to cheat more as a result. The hypothesized PTLC model, which included key variables related to (A) self-concept, (B) achievement goal structure, (C) learning strategies, (D) moral obligation, and (E) social comparison theory, was tested with data from a diverse sample of secondary students in fifteen international schools across Asia, Europe, and Africa. A pilot study (N = 96) of the construct validity of psychometric measures was conducted prior to the Main Study, which included a Time 1 sample of N = 493, a Time 2 sample of N = 297 (spaced by approximately one year), and a longitudinal matched sample of N = 225. Structural equation modeling techniques were used to test the validity and invariance of the measurement model, as well as the structural relations hypothesized between variables. A small degree of gender non-invariance prompted separate analyses of gender-specific models. Results supported the PTLC hypothesis. Moral obligation overwhelmingly mediated the effects of perceived class quality on academic integrity, indicating that students felt morally obliged to be honest in a given class, as a function of their regard for its quality

Optimising chronic kidney disease management in primary care. Is shared care the answer?

Contains fulltext : 111123.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 07 juni 2013Promotor : Weel, C. van Co-promotores : Vervoort, G.M.M., Grauw, W.J.C. d

[Observing a resident doing a consultation with a patient: goal determines form]

Observation of residents by supervisors is a highly recommended, but underused educational tool in postgraduate medical education. Observation can be performed indirectly (using video recordings of residents performing clinical tasks) or directly (supervisor is present when the resident performs the task). The choice of the observation method depends on aim and context of the observation. In general practice, patients tend to involve the supervisor when the resident performs the consultation. They value such participatory direct observation because they know the supervisor and appreciate their input. For specific residents' learning aims (e.g. consultation efficiency), it may be more useful if the supervisor takes a "fly on the wall" approach. Supervisors wishing to take a "fly on the wall" approach to direct observation need to inform the patient about their role and position themselves outside the patient's field of view. Indirect observation by reviewing video-recorded consultations is an alternative for this purpose

Comparing blood pressure measurement methods: differences depend on blood pressure height.

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Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication - an observational study in general practice

Contains fulltext : 215694.pdf (publisher's version ) (Open Access)BACKGROUND: Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. METHODS: We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1 and 6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age >/= 70 years, CKD, or heart failure. From this population, we selected patients with a 'dehydration-risk' episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in 3 months after the 'dehydration-risk' episode. RESULTS: We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 'dehydration-risk' episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. CONCLUSIONS: Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during 'dehydration-risk' episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention

Generalism in medicine: not by chance but by design

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European Interprofessional Education Network Conference, Nijmegen, the Netherlands: Bridging education and practice

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