"This strange disease": adolescent transference and the analyst's sexual orientation.

The treatment of adolescents by gay analysts is uncharted territory regarding the impact of the analyst's sexuality on the analytic process. Since a core challenge of adolescence involves the integration of the adult sexual body, gender role, and reproductive capacities into evolving identity, and since adolescents seek objects in their environment to facilitate both identity formation and the establishment of autonomy from primary objects, the analyst's sexual orientation is arguably a potent influence on the outcome of adolescent development. However, because sexual orientation is a less visible characteristic of the analyst than gender, race, or age, for example, the line between reality and fantasy is less clearly demarcated. This brings up special considerations regarding discovery and disclosure in the treatment. To explore these issues, the case of a late adolescent girl in treatment with a gay male analyst is presented. In this treatment, the question of the analyst's sexual orientation, and the demand by the patient for the analyst's self-disclosure, became a transference nucleus around which the patient's individual dynamics and adolescent dilemmas could be explored and clarified.

Mechanism-based diagnostic reasoning: thoughts on teaching introductory clinical pathology.

Teaching introductory clinical pathology to veterinary students is a challenging endeavor that requires a shift in learning strategies from rote memorization to diagnostic reasoning. Educational research has identified discrete cognitive stages required to achieve the automated, unconscious thinking process used by experts. Building on this knowledge, we developed a case-based approach to clinical pathology instruction that actively engages students in the learning process and links performance with positive reward. Simulated cases provide context and create a structure, or "schema", which enhances the learning process by enabling students to synthesize facts and link them with their causal mechanism to reach a defensible diagnostic conclusion. Web-based tools, including the "Problem List Generator" and tutorials, have been developed to facilitate this process. Through the collaborative Biomedical Informatics Research Group, we are working to further develop and evaluate Web-based instructional tools and new educational methods, to clarify the diagnostic reasoning processes used by experienced clinical pathologists, and, ultimately, to better educate our future students to be effective diagnosticians.