Challenges of Cognitive Interviewing in Sensitive Health Topic Research.

BACKGROUND: Cognitive interviewing is a qualitative methodology for generating valid, reliable patient-centered outcome measures. There are challenges inherent in research on sensitive topics that require thoughtful approach by the scientist for data collection methods, analysis, and interpretation. OBJECTIVE: The purpose of this article is to provide principles of cognitive interviewing for sensitive health topics. METHODS: We review the challenges inherent in cognitive interviewing for sensitive topics scale development. We illustrate adaptations to general cognitive interviewing for sensitive topics through the presentation and analysis of a research exemplar. RESULTS: Researchers must consider threats to quality of sensitive topic data collection and potential harms to participants and researchers. We provide specific examples of how these risks were mitigated in a sensitive topic scale development study. DISCUSSION: Unique challenges of cognitive interviewing for sensitive health topics can be addressed with a well-planned data collection strategy, anticipating participant safety concerns, and consideration to researcher well-being.

Profiles of Normal Cognition in Essential Tremor.

OBJECTIVES: Patients with essential tremor exhibit heterogeneous cognitive functioning. Although the majority of patients fall under the broad classification of cognitively "normal," essential tremor is associated with increased risk for mild cognitive impairment and dementia. It is possible that patterns of cognitive performance within the wide range of normal functioning have predictive utility for mild cognitive impairment or dementia. These cross-sectional analyses sought to determine whether cognitive patterns, or "clusters," could be identified among individuals with essential tremor diagnosed as cognitively normal. We also determined whether such clusters, if identified, were associated with demographic or clinical characteristics of patients. METHODS: Elderly subjects with essential tremor (age >55 years) underwent comprehensive neuropsychological testing. Domain means (memory, executive function, attention, visuospatial abilities, and language) from 148 individuals diagnosed as cognitively normal were partitioned using k-means cluster analysis. Individuals in each cluster were compared according to cognitive functioning (domain means and test scores), demographic factors, and clinical variables. RESULTS: There were three clusters. Cluster 1 (n = 64) was characterized by comparatively low memory scores (p < .001), Cluster 2 (n = 39) had relatively low attention and visuospatial scores (p < .001), and Cluster 3 (n = 45) exhibited consistently high performance across all domains. Cluster 1 had lower Montreal Cognitive Assessment scores and reported more prescription medication use and lower balance confidence. CONCLUSIONS: Three patterns of cognitive functioning within the normal range were evident and tracked with certain clinical features. Future work will examine the extent to which such patterns predict conversion to mild cognitive impairment and/or dementia.

Informatics and Cognitive Assessment: A RUDAS Scale Paradigm.

BACKGROUND: Cognitive assessment is an essential element of the screening process of Alzheimer's disease. The prevalence of dementia is increasing and so are the numbers of immigrants and elderly population relocating and in need for health diagnosis and treatment. However, most of the psychometric tools used in psychological assessments are time-consuming and suffer from biases of language and cultural restrictions. OBJECTIVES: Our objective was to create a computerized version of a multicultural cognitive screening test, which would simplify cognitive assessment of elderly multicultural population, as routine part of health check-up procedures. METHODS: The application was implemented in Android Studio and was written in Java code with the use of a home PC and a tablet. Rowland Universal Dementia Assessment Scale (RUDAS) was chosen. RUDAS is a cognitive screening tool with good psychological characteristics, which was created for multicultural and bilingual populations and was free to download. The collaboration with an authorized psychologist was essential for the ethics of the psychometric science. RESULTS: The complete computerized version of RUDAS will include the six-item questionnaire, assessing specific cognitive domains which are in high correlation with Alzheimer's screening process, such as registration, visuospatial orientation, praxis, visuo-constructional drawing, judgment, memory recall and language. CONCLUSION: The utilization of informatics in making cognitive assessment a user-friendly, validated, not time- or cost-consuming procedure would add value to psychometric tools which still are administered with "pen and paper", when this proceeds with respect to the ethics of the science.

Psychometric properties of the Chinese version of the instrument for measuring different types of cognitive load (MDT-CL).

AIM: To translate the instrument for measuring different types of cognitive load (MDT-CL) into Chinese and assess the reliability and validity of the Chinese version of the MDT-CL. BACKGROUND: The MDT-CL is needed for hospital administrators to identify which nursing staff are prone to high cognitive load and to provide tailored interventions for specific types of cognitive load. METHODS: The MDT-CL was translated into Chinese using forward and back translation, cultural adaptation and pilot tested. The reliability and validity of the instrument were assessed with intensive care unit (ICU) nurses in three tertiary hospitals in China. RESULTS: A total of 222 ICU nurses were recruited. The scale-content validity index of the Chinese version of the MDT-CL was 0.966. Confirmatory factor analysis indicated that all the goodness-of-fit indicators were acceptable. Cronbach's α coefficient was 0.818. Test-retest reliability was 0.785. CONCLUSIONS: The Chinese version of the MDT-CL is a valid and reliable instrument for evaluating the cognitive load of ICU nurses in China. IMPLICATIONS FOR NURSING MANAGEMENT: The validated Chinese version of the MDT-CL is a feasible, quantitative tool for evaluating different types of cognitive load in busy clinical practice, suggesting significant clinical application value.

Discriminant power of socio-demographic characteristics and mood in distinguishing cognitive performance clusters in older individuals: a cross-sectional analysis.

OBJECTIVES: Identification of predictors of cognitive trajectories has been a matter of concern on aging research. For this reason, it is of relevance to infer cognitive profiles based on rapid screening variables in order to determine which individuals will be more predisposed to cognitive decline. METHOD: In this work, a linear discriminant analysis (LDA) was conducted with socio-demographic variables and mood status as predictors of cognitive profiles, computed in a previous sample, based on different cognitive dimensions. Data were randomly split in two samples. Both samples were representative of the Portuguese population in terms of gender, age and education. The LDA was performed with one sample (n = 506, mean age 65.7 ± 8.98 years) and tested in the second sample (n = 548, mean age 68.5 ± 9.3 years). RESULTS: With these variables, we were able to achieve an overall hit rate of 65.9%, which corresponds to a significant increment in comparison to classification by chance. CONCLUSION: Although not ideal, this model may serve as a relevant tool to identify cognitive profiles based on a rapid screening when few variables are available.

Nonparametric Calibration of Item-by-Attribute Matrix in Cognitive Diagnosis.

A nonparametric technique based on the Hamming distance is proposed in this research by recognizing that once the attribute vector is known, or correctly estimated with high probability, one can determine the item-by-attribute vectors for new items undergoing calibration. We consider the setting where Q is known for a large item bank, and the q-vectors of additional items are estimated. The method is studied in simulation under a wide variety of conditions, and is illustrated with the Tatsuoka fraction subtraction data. A consistency theorem is developed giving conditions under which nonparametric Q calibration can be expected to work.

[Cognitive Functioning and Work Outcome Among People with Schizophrenia Spectrum Disorder: The Contribution of the International Classification of Functioning]. / Le fonctionnement cognitif et le travail chez les personnes souffrant de troubles du spectre schizophrénique : l'apport de la Classification internationale du fonctionnement.

Objectives Cognitive impairment can be a barrier to employment of people with a schizophrenia spectrum disorder (SSD). However, other factors have also been identified as potentially hindering work integration and job tenure. But the links between all these factors remain unknown. The objective of this article is to propound an integrative model, using the International Classification of Functioning (ICF), of how cognitive impairment associated with SSD is related to other factors involved in difficulties in work integration and job tenure.Methods The description of the theoretical framework of the ICF enables to organize these factors in a comprehensive model. Then, a review of recent literature allows us to identify factors associated with employment of people with SSD, and to see the link between cognitive functioning and other factors.Results Most of reviewed studies find moderate correlations or no correlation between cognitive impairments and work integration or job tenure. Stronger correlations were nevertheless found between cognitive factors and work behavior or performance. Considering other factors, like personal or environmental factors, and the framework of the ICF, a comprehensive view of the vocational rehabilitation for people with SSD is developed. Interactions between some personal (e.g. self-efficacy or self esteem) and environmental (e.g. job coach or layout of workstation) factors may influence the translation of cognitive difficulties into work participation restrictions.Conclusion Vocational rehabilitation programs should further consider the complexity of interactions between cognitive, personal and environmental factors, and how they impact work functioning. As defined in ICF, activity limitations may represent an interesting mediator between cognitive variables and work functioning. Future research should be conducted to bring a better understanding of these patterns of interactions.

Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial.

BACKGROUND: Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme. METHODS: Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886). FINDINGS: Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42-0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42-0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7-19], control 10 days [6-18]). INTERPRETATION: Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units. FUNDING: State Health Research Advisory Council, Department of Health, Government of Western Australia.

Joint modeling of repeated multivariate cognitive measures and competing risks of dementia and death: a latent process and latent class approach.

Joint models initially dedicated to a single longitudinal marker and a single time-to-event need to be extended to account for the rich longitudinal data of cohort studies. Multiple causes of clinical progression are indeed usually observed, and multiple longitudinal markers are collected when the true latent trait of interest is hard to capture (e.g., quality of life, functional dependency, and cognitive level). These multivariate and longitudinal data also usually have nonstandard distributions (discrete, asymmetric, bounded, etc.). We propose a joint model based on a latent process and latent classes to analyze simultaneously such multiple longitudinal markers of different natures, and multiple causes of progression. A latent process model describes the latent trait of interest and links it to the observed longitudinal outcomes using flexible measurement models adapted to different types of data, and a latent class structure links the longitudinal and cause-specific survival models. The joint model is estimated in the maximum likelihood framework. A score test is developed to evaluate the assumption of conditional independence of the longitudinal markers and each cause of progression given the latent classes. In addition, individual dynamic cumulative incidences of each cause of progression based on the repeated marker data are derived. The methodology is validated in a simulation study and applied on real data about cognitive aging obtained from a large population-based study. The aim is to predict the risk of dementia by accounting for the competing death according to the profiles of semantic memory measured by two asymmetric psychometric tests.

Correlation of EEG slowing with cognitive domains in nondemented patients with Parkinson's disease.

BACKGROUND: Cognitive deficits in Parkinson's disease (PD) are heterogeneous and can be classified into cognitive domains. Quantitative EEG is related to and predictive of cognitive status in PD. In this cross-sectional study, the relationship of cognitive domains and EEG slowing in PD patients without dementia is investigated. METHODS: A total of 48 patients with idiopathic PD were neuropsychologically tested. Cognitive domain scores were calculated combining Z-scores of test variables. Slowing of EEG was measured with median EEG frequency. Linear regression was used for correlational analyses and to control for confounding factors. RESULTS: EEG median frequency was significantly correlated to cognitive performance in most domains (episodic long-term memory, rho = 0.54; overall cognitive score, rho = 0.47; fluency, rho = 0.39; attention, rho = 0.37; executive function, rho = 0.34), but not to visuospatial functions and working memory. CONCLUSION: Global EEG slowing is a marker for overall cognitive impairment in PD and correlates with impairment in the domains attention, executive function, verbal fluency, and episodic long-term memory, but not with working memory and visuospatial functions. These disparate effects warrant further investigations.

Bloom's taxonomy of cognitive learning objectives.

Information professionals who train or instruct others can use Bloom's taxonomy to write learning objectives that describe the skills and abilities that they desire their learners to master and demonstrate. Bloom's taxonomy differentiates between cognitive skill levels and calls attention to learning objectives that require higher levels of cognitive skills and, therefore, lead to deeper learning and transfer of knowledge and skills to a greater variety of tasks and contexts.

Cognitive subtypes in non-affected siblings of schizophrenia patients: characteristics and profile congruency with affected family members.

BACKGROUND: Although cognitive subtypes have been suggested in schizophrenia patients, similar analyses have not been carried out in their non-affected siblings. Subtype classification may provide more insight into genetically driven variation in cognitive function. We investigated cognitive subtypes in siblings. METHOD: Cluster analyses were performed in 654 non-affected siblings, on a cognitive battery that included tests of attention, intellectual function and episodic memory. Resulting subtypes in the siblings were analyzed for cognitive, demographic and clinical characteristics and compared with those of their probands. RESULTS: Three sibling subtypes of cognitive function were distinguished: 'normal', 'mixed' and 'impaired'. Normal profile siblings (n = 192) were unimpaired on cognitive tests, in contrast to their proband (n = 184). Mixed profile siblings (n = 228) and their probands (n = 222) had a more similar performance pattern. Impaired profile siblings had poorer functional outcomes (n = 234) and their profile was almost identical to that of their proband (n = 223). Probands with cognitively impaired siblings could be distinguished from other schizophrenia patients by their own cognitive performance. They also had poorer clinical characteristics, including achievement of symptomatic remission. CONCLUSIONS: Unaffected siblings of patients with schizophrenia are heterogeneous with respect to cognitive function. The poorer the cognitive profile of the sibling, the higher the level of correspondence with the proband. The sibling's cognitive subtype was predictive for disease course in the proband. Distinguishing cognitive subtypes of unaffected siblings may be of relevance for genetic studies.

Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment.

BACKGROUND: This longitudinal study describes the five year trajectories of health-related quality of life (HR-QOL) and life satisfaction in long term colorectal cancer survivors. PATIENTS AND METHODS: A population-based sample of 1966 colorectal cancer survivors were surveyed at six time points from five months to five years post-diagnosis. Predictor variables were: socio-demographic variables, optimism; cancer threat appraisal; perceived social support. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Colorectal (HR-QOL); and the Satisfaction with Life Scale. Growth mixture models were applied to identify trajectory classes and their predictors. RESULTS: Distinct adjustment trajectories were identified for HR-QOL and life satisfaction. Lower optimism, poorer social support, a more negative cognitive appraisal, and younger age were associated with poorer life satisfaction, while survivors with less than 8 years of education had higher life satisfaction. This pattern was similar for overall HR-QOL except that educational level was not a significant predictor and later stage disease and female gender emerged as related to poorer outcomes. One in five survivors reported poorer constant HR-QOL (19.2%) and a small group had poor life satisfaction (7.2%); 26.2% reported constant high HR-QOL and 48.8% had high constant life satisfaction. Socioeconomic disadvantage and remoteness of residence uniquely predicted poorer outcomes in the colorectal cancer specific HR-QOL sub domain. CONCLUSION: Although HR-QOL and subjective cognitive QOL share similar antecedents their trajectory patterns suggested they are distinct adjustment outcomes; with life satisfaction emerging as temporally stable phenomenon. Unique patterns of risk support suggest the need to account for heterogeneity in adjustment in longitudinal QOL studies with cancer survivors.

Decoding subject-driven cognitive states with whole-brain connectivity patterns.

Decoding specific cognitive states from brain activity constitutes a major goal of neuroscience. Previous studies of brain-state classification have focused largely on decoding brief, discrete events and have required the timing of these events to be known. To date, methods for decoding more continuous and purely subject-driven cognitive states have not been available. Here, we demonstrate that free-streaming subject-driven cognitive states can be decoded using a novel whole-brain functional connectivity analysis. Ninety functional regions of interest (ROIs) were defined across 14 large-scale resting-state brain networks to generate a 3960 cell matrix reflecting whole-brain connectivity. We trained a classifier to identify specific patterns of whole-brain connectivity as subjects rested quietly, remembered the events of their day, subtracted numbers, or (silently) sang lyrics. In a leave-one-out cross-validation, the classifier identified these 4 cognitive states with 84% accuracy. More critically, the classifier achieved 85% accuracy when identifying these states in a second, independent cohort of subjects. Classification accuracy remained high with imaging runs as short as 30-60 s. At all temporal intervals assessed, the 90 functionally defined ROIs outperformed a set of 112 commonly used structural ROIs in classifying cognitive states. This approach should enable decoding a myriad of subject-driven cognitive states from brief imaging data samples.

Brain activity during a visuospatial working memory task predicts arithmetical performance 2 years later.

Visuospatial working memory (WM) capacity is highly correlated with mathematical reasoning abilities and can predict future development of arithmetical performance. Activity in the intraparietal sulcus (IPS) during visuospatial WM tasks correlates with interindividual differences in WM capacity. This region has also been implicated in numerical representation, and its structure and activity reflect arithmetical performance impairments (e.g., dyscalculia). We collected behavioral (N = 246) and neuroimaging data (N = 46) in a longitudinal sample to test whether IPS activity during a visuospatial WM task could provide more information than psychological testing alone and predict arithmetical performance 2 years later in healthy participants aged 6-16 years. Nonverbal reasoning and verbal and visuospatial WM measures were found to be independent predictors of arithmetical outcome. In addition, WM activation in the left IPS predicted arithmetical outcome independently of behavioral measures. A logistic model including both behavioral and imaging data showed improved sensitivity by correctly classifying more than twice as many children as poor arithmetical performers after 2 years than a model with behavioral measures only. These results demonstrate that neuroimaging data can provide useful information in addition to behavioral assessments and be used to improve the identification of individuals at risk of future low academic performance.

Profiles of cognitive functioning in a population-based sample of centenarians using factor mixture analysis.

UNLABELLED: BACKGROUND/STUDY CONTEXT: The goal of the study was to identify and characterize latent profiles (clusters) of cognitive functioning in centenarians and the psychometric properties of cognitive measures within them. METHODS: Data were collected from cross-sectional, population-based sample of 244 centenarians (aged 98 to 108, 15.8% men, 20.5% African American, 38.0% community-dwelling) from 44 counties in northern Georgia participating in the Georgia Centenarian Study (2001-2008). Measures included the Mini-Mental State Examination (MMSE), Severe Impairment Battery (SIB), Wechsler Adult Intelligence Scale-III Similarities subtest (WAIS), Hand Tapping, Behavioral Dyscontrol Scale (BDS), Controlled Oral Word Association Test (COWAT), and Fuld Object Memory Evaluation (FOME). The Global Deterioration Rating Scale (GDRS) was used to independently evaluate criterion-related validity for distinguishing cognitively normal and impaired groups. Relevant covariates included directly assessed functional status for basic and instrumental activities of daily living (DAFS), race, gender, educational attainment, Geriatric Depression Scale Short Form (GDS), and vision and hearing problems. RESULTS: Results suggest two distinct classes of cognitive performance in this centenarian sample. Approximately one third of the centenarians show a pattern of markedly lower cognitive performance on most measures. Group membership is independently well predicted (area under the curve [AUC] = .83) by GDRS scores (sensitivity 67.7%, specificity 82.4%). Membership in the lower cognitive performance group was more likely for individuals who were older, African Americans, had more depressive symptoms, lower plasma folate, carriers of the apolipoprotein E (APOE) ε4 allele, facility residents, and individuals who died in the 2 years following interview. CONCLUSIONS: In a population expected to have high prevalence of dementia, latent subtypes can be distinguished via factor mixture analysis that provide normative values for cognitive functioning. The present study allows estimates for normative cognitive performance in this age group.

Is there an association between subjective and objective measures of cognitive function in patients with affective disorders?

BACKGROUND: Patients with affective disorders experience cognitive dysfunction in addition to their affective symptoms. The relationship between subjectively experienced and objectively measured cognitive function is controversial with several studies reporting no correlation between subjective and objective deficits. AIMS: To investigate whether there is a correlation between subjectively reported and objectively measured cognitive function in patients with affective disorders, and whether subjective complaints predict objectively measured dysfunction. METHODS: The study included 45 participants; 15 with bipolar disorder (BD), 15 with unipolar disorder (UD) and 15 healthy individuals. Participants' subjectively experienced cognitive function and objective cognitive function were assessed with the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) and the Screen for Cognitive Impairment in Psychiatry (SCIP), respectively. Patients were rated for affective symptoms with Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). RESULTS: Patients demonstrated subjective and objective cognitive dysfunction relative to controls (P-values ≤ 0.01) but there were no differences between patient groups (P > 0.1). We found no correlation between subjectively experienced and objectively measured cognitive dysfunction in BD (P = 0.7), and a non-significant trend towards a correlation in UD (P = 0.06), which disappeared when controlling for gender (P = 0.1). CONCLUSION: Our results suggest that it is not necessarily patients who have cognitive complaints that are most impaired. If confirmed in a larger sample, our findings suggest that neuropsychological assessment is warranted to elucidate the potential role of cognitive dysfunction in patients' everyday lives and to inform treatment strategies targeting these difficulties.

Taxonomic counts of cognition in the wild.

In 1985, Kummer & Goodall pleaded for an ecology of intelligence and proposed that innovations might be a good way to measure cognition in the wild. Counts of innovation per taxonomic group are now available in hundreds of avian and primate species, as are counts of tactical deception, tool use and social learning. Robust evidence suggests that innovation rate and its neural correlates allow birds and mammals to cope better with environmental change. The positive correlations between taxonomic counts, and the increasing number of cognitive and neural measures found to be associated with ecological variables, suggest that domain general processes might be more pervasive than previously thought in the evolution of intelligence.

Latent Profile Analysis of Cognition in a Non-Demented Diverse Cohort: A Focus on Modifiable Cardiovascular and Lifestyle Factors.

BACKGROUND: Cognitively-defined subgroups are well-documented within neurodegeneration. OBJECTIVE: We examined such profiles in diverse non-demented older adults and considered how resulting subgroups relate to modifiable factors associated with neurodegeneration. METHODS: 121 non-demented (MMSE = 28.62) diverse (46%non-Latino Black, 40%non-Latino White, 15%Latino) community-dwelling adults (age = 67.7 years) completed cognitive, cardiovascular, physical activity, and diet evaluations. Latent profile analyses (LPA) employed six cognitive scores (letter fluency, letter-number sequencing, confrontational naming, 'animal' fluency, list-learning delayed recall, and recognition discriminability) to characterize cognitively-defined subgroups. Differences between resulting subgroups on cardiovascular (composite scores of overall health; specific health components including fasting blood levels) and lifestyle (sedentary behavior; moderate-to-vigorous physical activity; Mediterranean diet consumption) factors were examined using ANCOVAs adjusting for relevant confounders. RESULTS: Based on sample means across cognitive scores, LPA resulted in the following cognitive subgroups: 1) high-average cognition, 55%non-Latino White and 64%female participants; 2) average cognition, 58%non-Latino Black and 68%male participants; 3) lower memory, 58%non-Latino Black participants; and 4) lower executive functioning, 70%Latinos. The high-average subgroup reported significantly higher Mediterranean diet consumption than the average subgroup (p = 0.001). The lower executive functioning group had higher fasting glucose and hemoglobin A1c than all other subgroups (p-values<0.001). CONCLUSION: LPA revealed two average subgroups reflecting level differences in cognition previously reported between non-Latino White and Black adults, and two lower cognition subgroups in domains similar to those documented in neurodegeneration. These subgroups, and their differences, suggest the importance of considering social determinants of health in cognitive aging and modifiable risk.

Professional competencies in health sciences education: from multiple intelligences to the clinic floor.

Nontechnical competencies identified as essential to the health professional's success include ethical behavior, interpersonal, self-management, leadership, business, and thinking competencies. The literature regarding such diverse topics, and the literature regarding "professional success" is extensive and wide-ranging, crossing educational, psychological, business, medical and vocational fields of study. This review is designed to introduce ways of viewing nontechnical competence from the psychology of human capacity to current perspectives, initiatives and needs in practice. After an introduction to the tensions inherent in educating individuals for both biomedical competency and "bedside" or "cageside" manner, the paper presents a brief overview of the major lines of inquiry into intelligence theory and how theories of multiple intelligences can build a foundation for conceptualizing professional and life skills. The discussion then moves from broad concepts of intelligence to more specific workplace skill sets, with an emphasis on professional medical education. This section introduces the research on noncognitive variables in various disciplines, the growing emphasis on competency based education, and the SKA movement in veterinary education. The next section presents the evidence that nontechnical, noncognitive or humanistic skills influence achievement in academic settings, medical education and clinical performance, as well as the challenges faced when educational priorities must be made.