Selecting Instruments for Measuring the Clinical Learning Environment of Medical Education: A 4-Domain Framework.

Learning environments shape the experiences of learners and practitioners, making them an important component of program evaluation. However, educators find it challenging to decide whether to measure clinical learning environments with existing instruments or to design their own new instrument and, if using an existing instrument, which to choose. To assist educators with these decisions, the authors compared clinical learning environment instruments based on their characteristics, underlying constructs, and degree to which items reflect 4 domains (personal, social, organizational, material) from a recently developed model for conceptualizing learning environments in the health professions. Building on 3 prior literature reviews as well as a literature search, the authors identified 6 clinically oriented learning environment instruments designed for medical education. They collected key information about each instrument (e.g., number of items and subscales, conceptual frameworks, operational definitions of the learning environment) and coded items from each instrument according to the 4 domains. The 6 instruments varied in number of items, underlying constructs, subscales, definitions of clinical learning environment, and domain coverage. Most instruments focused heavily on the organizational and social domains and less on the personal and material domains (half omitted the material domain entirely). The variations in these instruments suggest that educators might consider several guiding questions. How will they define the learning environment and which theoretical lens is most applicable (e.g., personal vitality, sociocultural learning theory)? What aspects or domains of the learning environment do they most wish to capture (e.g., personal support, social interactions, organizational culture, access to resources)? How comprehensive do they want the instrument to be (and correspondingly how much time do they expect people to devote to completing the instrument and how frequently)? Whose perspective do they wish to evaluate (e.g., student, resident, fellow, attending, team, patient)? Each of these considerations is addressed.

Measurement invariance of the moral vitalism scale across 28 cultural groups.

Moral vitalism refers to a tendency to view good and evil as actual forces that can influence people and events. The Moral Vitalism Scale had been designed to assess moral vitalism in a brief survey form. Previous studies established the reliability and validity of the scale in US-American and Australian samples. In this study, the cross-cultural comparability of the scale was tested across 28 different cultural groups worldwide through measurement invariance tests. A series of exact invariance tests marginally supported partial metric invariance, however, an approximate invariance approach provided evidence of partial scalar invariance for a 5-item measure. The established level of measurement invariance allows for comparisons of latent means across cultures. We conclude that the brief measure of moral vitalism is invariant across 28 cultures and can be used to estimate levels of moral vitalism with the same precision across very different cultural settings.

Art-making and lived experience of schizophrenia: a vitalist materialist analysis.

BACKGROUND: This paper responds to calls for more lived experience research with a vitalist-materialist style of analysis inspired by Deleuze and Guattari. It challenges traditional understandings of art as a therapy associated with medical and psychological perceptions of schizophrenia, which have been found to be reductive. METHODS: Using Deleuze and Guattari's relational assemblages, the flows of affect are mapped as bodies and things, ideas and sensations connect and disconnect through the community arts sense-event "Schizy Jam". RESULTS: Opening a much broader territory for understanding the many ways that art can express, affirm and communicate difference, enables exploration of new ways in which art-makers are activating changes in feeling and thinking about schizophrenia. CONCLUSIONS: Art-makers can be supported to connect with others with shared experience to find expression for things that have previously been inexpressible and create a world that is more inclusive of them.

Quality of life in Swedish patients with post-polio syndrome with a focus on age and sex.

To investigate the health-related quality of life (QOL) in Swedish patients with post-polio syndrome (PPS), with a focus on sex and age. A total of 364 patients were recruited from five Swedish post-polio clinics. Analysis was carried out using SF-36 and data were compared with those of a normal population. QOL was significantly lower in PPS patients for all eight subdomains and the two main scores (physical compound score and mental compound score) when compared with the controls. Male patients had a significantly higher QOL than female patients for all subdomains and also for mental compound score and physical compound score, a phenomenon also observed in the normal population. There was a decrease in QOL in the physical domains and an increase in vitality with age. PPS decreases health-related QOL in both sexes, more in female patients. QOL for physical domains decreases whereas vitality increases with age in both sexes.

Vitalistic thinking in adults.

Vitalistic thinking has traditionally been associated with reasoning about biological phenomena. The current research aimed to investigate a broader range of vitalistic thinking than previously studied. Esoteric notions of 'energy' are frequently used by individuals when making causal attributions for strange occurrences, and previous literature has linked such thinking with paranormal, magical, and superstitious beliefs. Two experiments are described that aim to investigate whether adults are vitalistic when asked to make causal judgments, and whether this can be predicted by thinking styles and prior paranormal belief. Experiment 1 asked participants to rate three causal options (one of which was vitalistic) for six vignettes. Scores on one dimension of paranormal belief (New Age Philosophy) and analytical thinking significantly predicted vitalism, but scores on intuitive thinking and Traditional Paranormal Beliefs did not. Experiment 2 extended the findings by asking participants to generate their own causal responses. Again, paranormal belief was found to be the best predictor of vitalism, but this time Traditional Paranormal Beliefs were associated with vitalistic responses whilst both intuitive and analytical thinking were unable to significantly predict classification. Results challenge previous findings, suggesting that vitalistic thinking may operate differently when applied to everyday causal reasoning.

Cultural differences in the relationships among autonomy support, psychological need satisfaction, subjective vitality, and effort in British and Chinese physical education.

Using basic psychological needs theory (BPNT; Ryan & Deci, 2000) as our guiding framework, we explored cultural differences in the relationships among physical education students' perceptions of teacher autonomy support, psychological need satisfaction, subjective vitality and effort in class. Seven hundred and fifteen students (age range from 13 to 15 years) from the U.K. and Hong Kong, China, completed a multisection inventory during a timetabled physical education class. Multilevel analyses revealed that the relationships among autonomy support, subjective vitality and effort were mediated by students' perceptions of psychological need satisfaction. The relationship between autonomy support and perceptions of competence was stronger in the Chinese sample, compared with the U.K. sample. In addition, the relationship between perceptions of relatedness and effort was not significant in the Chinese students. The findings generally support the pan-cultural utility of BPNT and imply that a teacher-created autonomy supportive environment may promote positive student experiences in both cultures.