SAGES White Paper on the importance of diversity in surgical leadership: creating the fundamentals of leadership development (FLD) curriculum.

BACKGROUND: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has long recognized and championed increasing diversity within the surgical workplace. SAGES initiated the Fundamentals of Leadership Development (FLD) Curriculum to address these needs and to provide surgeon leaders with the necessary tools and skills to promote diversity, equity, and inclusion (DEI) in surgical practice. In 2019, the American College of Surgeons issued a request for anti-racism initiatives which lead to the partnering of the two societies. The primary goal of FLD was to create the first surgeon-focused leadership curriculum dedicated to DEI. The rationale/development of this curriculum and its evaluation/feedback methods are detailed in this White Paper. METHODS: The FLD curriculum was developed by a multidisciplinary task force that included surgeons, education experts, and diversity consultants. The curriculum development followed the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional design model and utilized a problem-based learning approach. Competencies were identified, and specific learning objectives and assessments were developed. The implementation of the curriculum was designed to be completed in short intervals (virtual and in-person). Post-course surveys used the Kirkpatrick's model to evaluate the curriculum and provide valuable feedback. RESULTS: The curriculum consisted of interactive online modules, an online discussion forum, and small group interactive sessions focused in three key areas: (1) increasing pipeline of underrepresented individuals in surgical leadership, (2) healthcare equity, and (3) conflict negotiation. By focusing on positive action items and utilizing a problem-solving approach, the curriculum aimed to provide a framework for surgical leaders to make meaningful changes in their institutions and organizations. CONCLUSION: The FLD curriculum is a novel leadership curriculum that provided surgeon leaders with the knowledge and tools to improve diversity in three areas: pipeline improvement, healthcare equity, and conflict negotiation. Future directions include using pilot course feedback to enhance curricular effectiveness and delivery.

Exploring stakeholder perspectives regarding the implementation of competency-based medical education: a qualitative descriptive study.

Introduction: Competency-based medical education (CBME) offers perceived advantages and benefits for postgraduate medical education (PGME) and the training of competent physicians. The purpose of our study was to gain insights from those involved in implementing CBME in two residency programs to inform ongoing implementation practices. Methods: We conducted a qualitative descriptive study to explore the perspectives of multiple stakeholders involved in the implementation of CBME in two residency programs (the first cohort) to launch the Royal College's Competence by Design model at one Canadian university. Semi-structured interviews were conducted with 17 participants across six stakeholder groups including residents, department chairs, program directors, faculty, medical educators, and program administrators. Data collection and analysis were iterative and reflexive to enhance the authenticity of the results. Results: The participants' perspectives organized around three key themes including: a) contextualizing curriculum and assessment practices with educational goals of CBME, b) coordinating new administrative requirements to support implementation, and c) adaptability toward a competency-based program structure, each with sub-themes. Conclusion: By eliciting the perspectives of different stakeholder groups who experienced the implementation processes, we developed a common understanding regarding facilitators and challenges for program directors, program administrators and educational leaders across PGME. Results from our study contribute to the scholarly conversation regarding the key aspects related to CBME implementation and serve to inform its ongoing development and application in various educational contexts.

Introduction: La formation médicale axée sur les compétences (FMAC) offre des avantages et des bénéfices perçus pour les études médicales postdoctorales et la formation de médecins compétents. Le but de notre étude était d'apprendre des personnes impliquées dans l'implantation de la FMAC dans deux programmes de résidence afin d'informer les pratiques de mise en œuvre en cours. Méthodes: Nous avons réalisé une étude qualitative descriptive pour explorer les perspectives de plusieurs parties prenantes impliquées dans la mise en œuvre de la FMAC dans deux programmes de résidence (la première cohorte) visant à mettre en place le modèle Compétence par conception du Collège royal dans une université canadienne. Des entrevues semi-structurés ont été menés auprès de 17 participants issus de six groupes de parties prenantes, notamment des résidents, des chefs de département, des directeurs de programme, des membres de la faculté, des éducateurs médicaux et des administrateurs de programme. La collecte et l'analyse des données étaient itératives et réflexives afin d'enrichir l'authenticité des résultats. Résultats: Les perspectives des participants se sont organisées autour de trois thèmes clés, à savoir : a) contextualiser les pratiques de curriculum et d'évaluation avec les objectifs d'apprentissage de la FMAC, b) coordonner les nouvelles exigences administratives pour soutenir la mise en œuvre, et c) s'adapter à une structure de programme axée sur les compétences, chacun avec des sous-thèmes. Conclusion: En recueillant les perspectives des différents groupes de parties prenantes ayant vécu les processus de mise en œuvre, nous avons développé une compréhension commune des facilitateurs et des défis pour les directeurs de programme, les administrateurs de programme et les leaders éducatifs dans la formation médicale postdoctorale. Les résultats de notre étude contribuent à la conversation savante concernant les aspects clés liés à la mise en œuvre de la FMAC et servent à informer son développement et son application en cours dans différents contextes éducatifs.

What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey.

INTRODUCTION: The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests. METHODS: A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform. RESULTS: Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks. CONCLUSIONS: This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.

Residents as Medical Coaches.

OBJECTIVES: With the recent implementation of Competency-based Medical Education (CBME) and emphasis on direct observation of learners, there is an increased interest in the concept of clinical coaching. While there is considerable literature on the role of attending physicians as coaches, little data is available on the role of residents as coaches, and residents' perceptions about effective coaching. We aimed to identify distinct characteristics of residents' coaching, to examine residents' perceptions on what they valued most in clinical coaches, and to explore trainees' ideas about how to optimize this role. DESIGN: We performed an exploratory qualitative study, using 45 minutes semi-structured interviews. We did a thematic analysis of the interview transcripts using both inductive and deductive coding. PARTICIPANTS: We invited and interviewed 5 surgical and 5 nonsurgical residents, and 3 surgical and 3 nonsurgical attending staff. Residents were recruited from all post graduate levels and from a variety of programs. SETTING: Our study was done in a large tertiary teaching hospital. RESULTS: Residents perceived that they have a significant role as coaches for junior learners, different from the attending's role. The proximity between the coach and the coaches leads to a different supervisor-learner rapport. This was of benefit as learners described feeling more comfortable making mistakes and seeking feedback, which potentiates effective coaching. Residents reported feeling that it was easier to coach their recently-acquired skills as the subtleties of the tasks and the troubleshooting were fresher in memory. Residents expressed appreciating a coach who values autonomy and does not intervene except when patient safety is at risk. Strategies identified to further optimize residents' role as coaches include placing coaching as a priority, ensuring dedicated time, and offering teaching sessions on coaching. CONCLUSIONS: Residents have distinct roles as coaches, driven by their recent experience being coached and as near peers. More research is needed to evaluate concrete measures to optimize residents' role as coaches and to improve their coaching skills.

An argument-based validation study of the fundamentals of laparoscopic surgery (FLS) program.

BACKGROUND: The Fundamentals of Laparoscopy Surgery (FLS) program was launched over 15 years ago. Since then, there has been an exponential rise in advancements of laparoscopy and its uses. In response, we conducted an argument-based validation study of FLS. The purpose of this paper is to exemplify this approach to validation for surgical education researchers using FLS as an illustrative case. METHODS: The argument-based approach to validation involves three key actions: (1) developing interpretation and use arguments; (2) research; and (3) building a validity argument. Drawing from the validation study of FLS each step is exemplified. RESULTS: Qualitative and quantitative data sources from the FLS validity examination study provided evidence that both supported claims, but also generated backing for rebuttals. Some of the key findings were synthesized in a validity argument to illustrate its structure. DISCUSSION: The argument-based validation approach described numerous advantages over other validation approaches: (1) it is endorsed by the foundational documents in assessment and evaluation research; (2) its specific language of claims, inferences, warrants, assumptions and rebuttals provides a systematic and unified way to communicate both the processes and outcomes of validation; and (3) the use of logic reasoning in building the validity document clearly delineates the relationship between evidence and the inferences made to support desired uses and interpretations from assessments.

Emerging concepts in the CanMEDS physician competency framework.

Background: The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies. Methods: Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted. Results: 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts. Conclusion: This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.

Contexte: Le référentiel de compétences CanMEDS pour les médecins sera mis à jour en 2025. Cette révision arrive à un moment où la société, les soins de santé et l'enseignement médical sont bouleversés et en pleine mutation à cause de la pandémie de la COVID-19. On est aussi à l'heure où l'on reconnaît de plus en plus les effets du colonialisme, de la discrimination systémique, des changements climatiques et des nouvelles technologies sur les soins de santé et la formation des médecins. Pour effectuer cette révision, nous avons avons extrait de la littérature scientifique les concepts émergents se rapportant aux compétences des médecins. Méthodes: Les concepts émergents ont été définis comme des idées ayant trait aux rôles et aux compétences des médecins qui sont débattues dans la littérature, mais qui sont absentes ou sous-représentées dans le cadre CanMEDS 2015. Nous avons réalisé une recherche documentaire, un examen des titres et des résumés, et une analyse thématique pour repérer les concepts émergents. Les métadonnées de tous les articles publiés dans cinq revues d'éducation médicale entre le 1er octobre 2018 et le 1er octobre 2021 ont été extraites. Quinze auteurs ont effectué un examen des titres et des résumés pour relever et étiqueter les concepts sous-représentés. Deux auteurs ont procédé à une analyse thématique des résultats pour dégager les concepts émergents. Une vérification a été faite par les membres de l'équipe. Résultats: Parmi les 4973 articles dépouillés, 1017 (20,5 %) abordaient un concept émergent. Les dix thèmes suivants sont ressortis de l'analyse thématique: l'équité, la diversité, l'inclusion et la justice sociale; l'antiracisme; l'humanité du médecin; la médecine fondée sur les données; les systèmes adaptatifs complexes; l'environnement de l'apprentissage clinique; les soins virtuels; le raisonnement clinique; l'expertise adaptative; et la santé planétaire. L'ensemble de ces thèmes ont été approuvés comme concepts émergents par l'équipe de rédaction. Conclusion: Cet examen de la littérature a permis de relever dix concepts émergents qui peuvent servir à éclairer la révision du référentiel de compétences CanMEDS pour les médecins qui aura lieu en 2025. La publication en libre accès de ce travail favorisera la transparence du processus de révision et le dialogue continu sur les compétences des médecins. Des groupes de rédaction ont été recrutés pour développer chacun des concepts émergents et pour examiner la façon dont ils pourraient être intégrés dans la version du référentiel CanMEDS de 2025.

The entrustable professional activities of laparoscopic surgery: moving toward an integrated training model.

BACKGROUND: Entrustable Professional Activities (EPAs) provide the opportunity to integrate multiple competencies into meaningful units that facilitate curriculum development and assessment design. As part of the process of reviewing and enhancing the Fundamentals of Laparoscopic of Surgery (FLS) program, we used the concept of EPAs to create a framework of reference that articulates a contemporary definition of Laparoscopic Surgery (LS). METHODS: The framework of reference of LS was created with data gathered from a literature review and during series of educational retreats with subject matter experts (SMEs). Various activities were implemented during these retreats to develop the LS EPAs, their constitutive competencies, and related observable behaviors. RESULTS: Ten EPAs and associated competency descriptors (articulated as observable behaviors) specific to LS were identified. In addition, knowledge areas were associated to each EPA. DISCUSSION: A comprehensive list of EPAs for LS were identified. These EPAs will be used in the development and update of the FLS program. Further, they can be used to guide the development of curriculum, clinical teaching, and assessment in any surgical program with a laparoscopic training component. They are applicable to any level of training by defining the expected observable behaviors associated with a given level of expertise. These fundamental aspects of LS provide a common framework of reference across different surgical specialties.

Development of a formative feedback tool for transanal total mesorectal excision.

INTRODUCTION: Transanal total mesorectal excision (TaTME) is a novel procedure in the treatment of rectal cancer. Current training models for TaTME suggest a period of proctored cases, but no structured feedback tool exists to guide operators during the learning phase. The objective of this study therefore was to develop a formative feedback tool for the critical steps of the transanal portion of TaTME. METHODS: A two-round Delphi study by TaTME experts was conducted to determine the items to be included in the formative feedback tool. Participants rated each step from a prepared list using a Likert scale from 1 (Not relevant) to 5 (Very relevant) with the option to suggest additional steps. Responses to the first round were presented in the second round, where participants rated the revised list of steps. Consensus was defined as > 80% of participants rating the step as 4 or 5 (out of 5). Items were combined when appropriate to avoid redundancy. Rating anchors describing performance (on a 5-point scale) were then developed for each step. The final tool was recirculated and participants rated the finished product on its feasibility and usefulness. RESULTS: Twenty-six TaTME experts were contacted for participation. Fifteen experts (58%) participated in the first round of the study, and eleven (42%) participated in the second round. The majority (14, 93%) had completed fellowship training in colorectal surgery. The first round of the Delphi study contained 34 items, and 32 items met inclusion criteria after the second round. Redundant items were combined into 15 items that comprised the final tool. Out of eight respondents to the feasibility survey, all believed the feedback tool enhances the feedback of learners and would use it for training purposes if available. CONCLUSION: This work describes the development of a novel consensus-based formative feedback tool specific to TaTME.

Does Educational Handover Influence Subsequent Assessment?

PURPOSE: Educational handover (i.e., providing information about learners' past performance) is controversial. Proponents argue handover could help tailor learning opportunities. Opponents fear it could bias subsequent assessments and lead to self-fulfilling prophecies. This study examined whether raters provided with reports describing learners' minor weaknesses would generate different assessment scores or narrative comments than those who did not receive such reports. METHOD: In this 2018 mixed-methods, randomized, controlled, experimental study, clinical supervisors from 5 postgraduate (residency) programs were randomized into 3 groups receiving no educational handover (control), educational handover describing weaknesses in medical expertise, and educational handover describing weaknesses in communication. All participants watched the same videos of 2 simulated resident-patient encounters and assessed performance using a shortened mini-clinical evaluation exercise form. The authors compared mean scores, percentages of negative comments, comments focusing on medical expertise, and comments focusing on communication across experimental groups using analyses of variance. They examined potential moderating effects of supervisor experience, gender, and mindsets (fixed vs growth). RESULTS: Seventy-two supervisors participated. There was no effect of handover report on assessment scores (F(2, 69) = 0.31, P = .74) or percentage of negative comments (F(2, 60) = 0.33, P = .72). Participants who received a report indicating weaknesses in communication generated a higher percentage of comments on communication than the control group (63% vs 50%, P = .03). Participants who received a report indicating weaknesses in medical expertise generated a similar percentage of comments on expertise compared to the controls (46% vs 47%, P = .98). CONCLUSIONS: This study provides initial empirical data about the effects of educational handover and suggests it can-in some circumstances-lead to more targeted feedback without influencing scores. Further studies are required to examine the influence of reports for a variety of performance levels, areas of weakness, and learners.

Learner handover: Perspectives and recommendations from the front-line.

INTRODUCTION: Current medical education models increasingly rely on longitudinal assessments to document learner progress over time. This longitudinal focus has re-kindled discussion regarding learner handover-where assessments are shared across supervisors, rotations, and educational phases, to support learner growth and ease transitions. The authors explored the opinions of, experiences with, and recommendations for successful implementation of learner handover among clinical supervisors. METHODS: Clinical supervisors from five postgraduate medical education programs at one institution completed an online questionnaire exploring their views regarding learner handover, specifically: potential benefits, risks, and suggestions for implementation. Survey items included open-ended and numerical responses. The authors used an inductive content analysis approach to analyze the open-ended questionnaire responses, and descriptive and correlational analyses for numerical data. RESULTS: Seventy-two participants completed the questionnaire. Their perspectives varied widely. Suggested benefits of learner handover included tailored learning, improved assessments, and enhanced patient safety. The main reported risk was the potential for learner handover to bias supervisors' perceptions of learners, thereby affecting the validity of future assessments and influencing the learner's educational opportunities and well-being. Participants' suggestions for implementation focused on who should be involved, when and for whom it should occur, and the content that should be shared. DISCUSSION: The diverse opinions of, and recommendations for, learner handover highlight the necessity for handover to maximize learning potential while minimizing potential harms. Supervisors' suggestions for handover implementation reveal tensions between assessment-of and for-learning.

Children's spirituality: Exploring spirituality in the lives of cancer survivors and a healthy comparison group.

This study found that children with a history of cancer had higher scores on certain measures of spirituality compared to their healthy peers. Health history was found to significantly moderate the relations among spirituality and outcome variables, such as depression and anxiety. Furthermore, parent-child dyadscancer had more highly correlated scores than parent-child dyadshealthy on both the Depression subscale and the Existential Well-Being subscale, whereas parent-child dyadshealthy had more highly correlated scores than parent-child dyadscancer on the Duality factor. Limitations and future directions are discussed.

The challenges of detecting progress in generic competencies in the clinical setting.

CONTEXT: Competency-based medical education has spurred the implementation of longitudinal workplace-based assessment (WBA) programmes to track learners' development of competencies. These hinge on the appropriate use of assessment instruments by assessors. This study aimed to validate our assessment programme and specifically to explore whether assessors' beliefs and behaviours rendered the detection of progress possible. METHODS: We implemented a longitudinal WBA programme in the third year of a primarily rotation-based clerkship. The programme used the professionalism mini-evaluation exercise (P-MEX) to detect progress in generic competencies. We used mixed methods: a retrospective psychometric examination of student assessment data in one academic year, and a prospective focus group and interview study of assessors' beliefs and reported behaviours related to the assessment. RESULTS: We analysed 1662 assessment forms for 186 students. We conducted interviews and focus groups with 21 assessors from different professions and disciplines. Scores were excellent from the outset (3.5-3.7/4), with no meaningful increase across blocks (average overall scores: 3.6 in block 1 versus 3.7 in blocks 2 and 3; F = 8.310, d.f. 2, p < 0.001). The main source of variance was the forms (47%) and only 1% of variance was attributable to students, which led to low generalisability across forms (Eρ2  = 0.18). Assessors reported using multiple observations to produce their assessments and were reluctant to harm students by consigning anything negative to writing. They justified the use of a consistent benchmark across time by citing the basic nature of the form or a belief that the 'competencies' assessed were in fact fixed attributes that were unlikely to change. CONCLUSIONS: Assessors may purposefully deviate from instructions in order to meet their ethical standards of good assessment. Furthermore, generic competencies may be viewed as intrinsic and fixed rather than as learnable. Implementing a longitudinal WBA programme is complex and requires careful consideration of assessors' beliefs and values.

Emotions and assessment: considerations for rater-based judgements of entrustment.

CONTEXT: Assessment is subject to increasing scrutiny as medical education transitions towards a competency-based medical education (CBME) model. Traditional perspectives on the roles of assessment emphasise high-stakes, summative assessment, whereas CBME argues for formative assessment. Revisiting conceptualisations about the roles and formats of assessment in medical education provides opportunities to examine understandings and expectations of the assessment of learners. The act of the rater generating scores might be considered as an exclusively cognitive exercise; however, current literature has drawn attention to the notion of raters as measurement instruments, thereby attributing additional factors to their decision-making processes, such as social considerations and intuition. However, the literature has not comprehensively examined the influence of raters' emotions during assessment. In this narrative review, we explore the influence of raters' emotions in the assessment of learners. METHODS: We summarise existing literature that describes the role of emotions in assessment broadly, and rater-based assessment specifically, across a variety of fields. The literature related to emotions and assessment is examined from different perspectives, including those of educational context, decision making and rater cognition. We use the concept of entrustable professional activities (EPAs) to contextualise a discussion of the ways in which raters' emotions may have meaningful impacts on the decisions they make in clinical settings. This review summarises findings from different perspectives and identifies areas for consideration for the role of emotion in rater-based assessment, and areas for future research. CONCLUSIONS: We identify and discuss three different interpretations of the influence of raters' emotions during assessments: (i) emotions lead to biased decision making; (ii) emotions contribute random noise to assessment, and (iii) emotions constitute legitimate sources of information that contribute to assessment decisions. We discuss these three interpretations in terms of areas for future research and implications for assessment.

Influence of social factors on the relation between lie-telling and children's cognitive abilities.

Lie-telling may be part of a normative developmental process for children. However, little is known about the complex interaction of social and cognitive factors related to this developmental behavior. The current study examined parenting style, maternal exposure to stressors, and children's cognitive abilities in relation to children's antisocial lie-telling behavior in an experimental setting. Children (3-6years, N=157) participated in a modified temptation resistance paradigm to elicit spontaneous lies. Results indicate that high authoritative parenting and high inhibitory control interact to predict a lower propensity to lie, but those who did lie had better semantic leakage control. This suggests that although children's lie-telling may be normative during early development, the relation to children's cognitive abilities can be moderated by responsive parenting behaviors that discourage lying.

The contributions of mental state understanding and executive functioning to preschool-aged children's lie-telling.

In this study, preschool-aged children's lie-telling behaviour was examined in relation to mental state understanding and executive functioning. Sixty-seven children aged between 25 and 43 months (Mage in months  = 34.80, SD = 4.39) participated in a temptation resistance paradigm (TRP). Children completed emerging ToM tasks measuring the following mental states: (1) diverse beliefs, (2) diverse desires, and (3) knowledge access. Children also completed measures of inhibitory control and working memory. In total, 63 of the 67 children peeked at the toy during the TRP, and a total of 26 of those children denied their transgression to the research assistant. Inhibitory control and understanding of knowledge access predicted lie-telling behaviour. Results are discussed in relation to a developmental model of children's lie-telling behaviour. Statement of contribution What is already known on this subject? The relationship between lie-telling, executive functioning, and ToM has been established in older children (aged 4 and above). Inhibitory control plays a role in young children's lie-telling (aged 2-4). Children above 3 years of age have some understanding of mental states. What does this study add? Very young children (2-3-year-olds) also possess an understanding of mental states. Mental state understanding is related to 2-3-year-old children's lie-telling behaviours and may be more predictive than inhibitory control. While the results were not significant, this study is the first to look at the unique role of working memory in very young children's lie-telling.

The Role of Self-Compassion in Buffering Symptoms of Depression in the General Population.

Self-compassion, typically operationalized as the total score of the Self-Compassion Scale (SCS; Neff, 2003b), has been shown to be related to increased psychological well-being and lower depression in students of the social sciences, users of psychology websites and psychotherapy patients. The current study builds on the existing literature by examining the link between self-compassion and depressive symptomatology in a sample representative of the German general population (n = 2,404). The SCS subscales of self-judgment, isolation, and over-identification, and the "self-coldness", composite score, which encompass these three negative subscales, consistently differed between subsamples of individuals without any depressive symptoms, with any depressive syndromes, and with major depressive disorder. The contribution of the positive SCS subscales of self-kindness, common humanity, and mindfulness to the variance in depressive symptomatology was almost negligible. However, when combined to a "self-compassion composite", the positive SCS subscales significantly moderated the relationship between "self-coldness" and depressive symptoms in the general population. This speaks for self-compassion having the potential to buffer self-coldness related to depression--providing an argument for interventions that foster self-caring, kind, and forgiving attitudes towards oneself.

Agresión relacional en preescolar: variables cognoscitivas y emocionales asociadas / Relational Aggression in Preschool: cognitive and emotional variables associated

Cuando una persona usa la agresión relacional busca dañar las relaciones de otros a través de manipulaciones y exclusión de grupo. Existe muy poca investigación sobre este tipo de agresión en el preescolar. De igual forma, tampoco se han establecido con claridad qué variables psicológicas se asocian con esta. La presente investigación se centró en la agresión relacional y la agresión física en una muestra de 77 niños y niñas de preescolar. Se midieron variables cognoscitivas (creencias favorables hacia la agresión y teoría de la mente) y variables emocionales (control de la ira) en los niños. No se encontraron diferencias significativas entre niños y niñas en los niveles de agresión física o de agresión relacional. Sin embargo, cuando se incluyó agresión física como covariada, se encontró más agresión relacional en niñas que en niños y cuando agresión relacional fue usada como covariada, se encontró más agresión física en niños que en niñas. El control de la ira apareció como un importante factor en la predicción de la agresión relacional.

When somebody uses relational aggression seeks damage relations of others through manipulation and exclusion group. There is little research on this aggression type in preschool. Similarly, not been established clearly what psychological variables are associated with this. This research focused both relational and physical aggressions in a sample of 77 preschool children. Were measured cognitive variables (beliefs favorable toward aggression and theory of mind) and emotional variables (anger) in children. Do not significant differences between boys and girls were found in levels physical aggression or relational aggression. However, when included physical aggression as a covariate, more relational aggression was found in girls than children, and when relational aggression was used as a covariate, was found more physical aggression in boys than in girls. The anger came as an important factor in predicting relational aggression.