The core epistemic responsibilities of universities: Results from a Delphi study.

Epistemic responsibilities (ERs) of universities concern equipping and empowering its researchers, educators and students to attain, produce, exchange and disseminate knowledge. ERs can potentially guide universities in improving education, research and in service to society. Building on earlier philosophical work, we applied empirical methods to identify core ERs of universities and their constituting elements. We used a three-round Delphi survey, alternating between closed questions to gain consensus, and open questions to let panelists motivate their answers. 46 panelists participated in our study. We reached consensus on six ERs: 1) to foster research integrity, 2) to stimulate the development of intellectual virtues, 3) to address the big questions of life, 4) to cultivate the diversity of the disciplinary fields, 5) to serve and engage with society at large, and 6) to cultivate and safeguard academic freedom. Together the six ERs contain 27 elements. Consensus rates ranged from 73%-100% for both the ERs and their elements. Participants' detailed responses led to substantial improvements in the accompanying descriptions of the ERs. Our findings can inform the debate about the roles and responsibilities of universities, and inform researchers and policy makers to emphasize epistemic tasks of universities.

[Psychotherapeutic knowledge and skills: essential in working as a psychiatrist]. / Psychotherapeutische kennis en vaardigheden: essentieel in het werk als psychiater.

Psychotherapeutic skills are essential elements in the daily work of psychiatrists. This article aims to bring attention to the psychotherapeutic competences described in the new training program for psychiatrists in the Netherlands. To illustrate the competences, two clinical cases are presented in which the psychiatrist executes psychotherapeutic skills to be effective in diagnosis and treatment. With the help of these psychotherapeutic competences, the psychiatrist manages to tolerate and understand frequently occurring demands of complex psychiatric patients, is able to make sense of behavior and, if possible, is able to reflect on this with the patient with the aim to start effective psychotherapeutic interventions and make progression in treatment. Clinical psychiatric practice cannot be seen apart from psychotherapy, because without psychotherapeutic knowledge and skills, treatment will be ineffective and can cause stagnating treatments, ineffective treatment relationships, overdiagnosis, regression in the patient or polypharmacy.

[Acute dystonia in a patient with an elevated clozapine level due to an infection]. / Acute dystonie bij een patiënte met een door infectie verhoogde clozapinespiegel.

Acute dystonia is a side-effect associated with the use of antipsychotics. We describe the case of a 75-year-old patient with late-onset schizophrenia who used clozapine. During a hospital admission due to pneumonia, she developed a form of acute dystonia consisting of a rotational torticollis, which disappeared rapidly after treatment with biperiden. Blood examination showed an increase of the clozapine level, probably due to the infection. This case report shows that acute dystonia, although very rare, can occur during treatment with clozapine; therefore awareness is needed of the circumstances that can alter clozapine levels.

[In- and out-of-hospital emergency psychiatry: what is the best approach?] / Acute psychiatrie binnen en buiten het ziekenhuis.

A range of clinical syndromes may present with psychiatric symptoms, both in and out of hospital settings. In such situations agitation, suicidality, communication difficulties and legal aspects often play a role, making diagnosis and treatment a challenge. Based on several case studies, we illustrate how the recently-published Dutch open access source 'Acute Psychiatry' (www.acutepsychiatrie.com) can be of help in acute psychiatric presentations both within and outside psychiatric hospitals.

[Publish & Perish; research on research and researchers]. / Publish & Perish; onderzoek naar onderzoek en onderzoekers.

BACKGROUND: In the last years many people have questioned the reliability of research results and the societal relevance of much of today's clinical research; they are critical too about the current publication culture in which scientists are judged according to the number of articles they have published, impact factors and citations.
AIM: To make a close study of the publication culture that now prevails in the Dutch biomedical sciences.
METHOD: Discussion of results described in the thesis entitled 'Publish and Perish; research on research and researchers'.
RESULTS: To investigate what 'pressure to publish' is, we designed the Publication Pressure Questionnaire. In addition, in a group of 437 professors, we found a relationship between 'pressure to publish' and burnout; about 25% of the professors reported having suffered from severe burnout. We used focus groups to discover the factors that scientists consider are harmful in today's publication culture. They mentioned aspects such as impact factors, problems with research funding, authorship of articles, publication bias, emphasis on quantity rather than quality and 'domineering egos'. Next, we sought the views of 400 Dutch psychiatrists on the influence of pharmaceutical sponsorship on clinical trials. The psychiatrists seem to overlook the effects that pharmaceutical sponsoring might have on research results, but were more critical of results that appeared to be 'too good to be true'. A character study of more than 500 biomedical professionals revealed a link between scientific misconduct and pressure to publish; Machiavellian characteristics seemed to be associated with this misconduct. Finally, the author of the thesis (with 'tongue in cheek') describes a new psychiatric disorder which he calls 'publiphilia impactfactorius', defined as a disorder affecting biomedical professionals characterised by narcissistic, psychopathic, manipulative and emotionally unstable traits, whose egos are focused primarily on publication and high citation scores.
CONCLUSION: The thesis demonstrates that on the one hand scientists should look critically at new research so that they can assess its value, but on the other hand they must be ready to support new research, even though most results are likely to require later revision and updating. In spite of the shortcomings of many published research results, they are after all, the best we have at a particular moment.

[Power in the PhD programme]. / Macht tijdens het promotietraject.

This article describes the role of power in the world of biomedical research. On the basis of some examples, I intend to demonstrate the influence of power, or its misuse, on PhD students and supervisors, and how this may have a negative effect on the research of PhD students. I will then outline how the biomedical research field can prevent these practices, and how it can create a better and more inspiring atmosphere for young, enthusiastic and talented researchers.

How do scientists perceive the current publication culture? A qualitative focus group interview study among Dutch biomedical researchers.

OBJECTIVE: To investigate the biomedical scientist's perception of the prevailing publication culture. DESIGN: Qualitative focus group interview study. SETTING: Four university medical centres in the Netherlands. PARTICIPANTS: Three randomly selected groups of biomedical scientists (PhD, postdoctoral staff members and full professors). MAIN OUTCOME MEASURES: Main themes for discussion were selected by participants. RESULTS: Frequently perceived detrimental effects of contemporary publication culture were the strong focus on citation measures (like the Journal Impact Factor and the H-index), gift and ghost authorships and the order of authors, the peer review process, competition, the funding system and publication bias. These themes were generally associated with detrimental and undesirable effects on publication practices and on the validity of reported results. Furthermore, senior scientists tended to display a more cynical perception of the publication culture than their junior colleagues. However, even among the PhD students and the postdoctoral fellows, the sentiment was quite negative. Positive perceptions of specific features of contemporary scientific and publication culture were rare. CONCLUSIONS: Our findings suggest that the current publication culture leads to negative sentiments, counterproductive stress levels and, most importantly, to questionable research practices among junior and senior biomedical scientists.

The assessment of publication pressure in medical science; validity and reliability of a Publication Pressure Questionnaire (PPQ).

PURPOSE: To determine content validity, structural validity, construct validity and reliability of an internet-based questionnaire designed for assessment of publication pressure experienced by medical scientists. METHODS: The Publication Pressure Questionnaire (PPQ) was designed to assess psychological pressure to publish scientific papers. Content validity was evaluated by collecting independent comments from external experts (n = 7) on the construct, comprehensiveness and relevance of the PPQ. Structural validity was assessed by factor analysis and item response theory (IRT) using the generalized partial credit model. Pearson's correlation coefficients were calculated to assess potential correlations with the emotional exhaustion and depersonalization subscales of the Maslach Burnout Inventory (MBI). Single test reliability (lambda2) was obtained from the IRT analysis. RESULTS: Content validity was satisfactory. Confirmatory factor analysis did not support the presence of three initially assumed separate domains of publication pressure (i.e., personally experienced publication pressure, publication pressure in general, pressure on position of scientist). After exclusion of the third domain (six items), we performed exploratory factor analysis and IRT. The goodness-of-fit statistics for the IRT assuming a single dimension were satisfactory when four items were removed, resulting in 14 items of the final PPQ. Correlations with the emotional exhaustion and depersonalization scales of the MBI were 0.34 and 0.31, respectively, supporting construct validity. Single test administration reliability lambda2 was 0.69 and 0.90 on the test scores and expected a posteriori scores, respectively. CONCLUSION: The PPQ seems a valid and reliable instrument to measure publication pressure among medical scientists.

[The interest shown by medical students and recently qualified doctors in a career in psychiatry]. / De belangstelling voor het beroep van psychiater bij studenten geneeskunde en basisartsen.

BACKGROUND: In view of the current shortage of psychiatrists in the Netherlands it is important to find out what attracts medical students and recently qualified doctors to a career in psychiatry. AIM: To discover what aspects of psychiatry are of interest to medical students and recently qualified doctors and to determine what interest profile is suited to the practice of psychiatry. METHOD: Medical students and recently qualified doctors from the Free University medical school in Amsterdam and from Utrecht University medical school completed a questionnaire which investigated why certain specialisms, including psychiatry, were chosen as future careers, and which also examined the appeal of 47 aspects of a career in medicine. RESULTS: About 30% of the students expressed an interest in becoming psychiatrist. The interest was slightly greater among first-year students but decreased in the course of their medical training. About 6% of recently qualified doctors actually work in psychiatry and a larger percentage want to become psychiatrist in five years' time. The interest profile of persons interested in psychiatry differs from that of persons not interested in psychiatry and is different for men and women. CONCLUSION: The interest of students in a career in psychiatry decreases in the course of their medical training. This is in keeping with the general decrease in interest in any other career in medicine and probably reflects the current increasing focus on only one single medical specialism. The interest profile of persons interested in a career in psychiatry lies more in the communicative and psychosocial sphere and is focused in relationships that develop during long-term treatment rather than on medical-technical aspects. After qualifying as doctors, women with an interest in psychiatry often develop an interest in improvisation, diagnostics and pharmacotherapy.