PSYC4121 Lecture 1

Pregunta	Respuesta
What is the Scientist-Practitioner Model?	An integrative approach to science and practice wherein each must continually inform the other. This is used in both experimental and applied psychology.
Who coined the term 'Clinical Psychology'?	Witmer in 1907 - he was the editor of "The Psychological Clinic"
When did Clinical Psychology become a part of the APA and what was the context behind this?	1919 - Clinical Psych was originally fairly separate because Psychology was trying to be more scientific and clinical psychology was rejected for this reason.
When was Clinical Psych finally accepted by the APA?	1944
When did S-P model become fully integrated into practice and training by the APA?	1949 - when the 'Boulder Committee' was assigned the task of designing the curriculum.
What were the four major recommendations of the Boulder Committee and when were these published?	1. Improve accuracy and reliability of diagnostic procedures (assessment). 2. Develop a better understanding of human behaviour (etiology, formulation, theory). 3. Develop more efficient methods of treatment (intervention). 4. Include research training in preparation of all clinical psychologists. These were published in 1950 by Remy - "Training in Clinical Psychology".
What did Eysenck argue was the issue with Psychoanalysis and Psychotherapy?	The problem with the therapy process The spontaneous remission rate: “…in order to evaluate the effectiveness of any form of therapy, data from a control group of non-treated patients would be required in order to compare the effects of therapy with the spontaneous remission rate”.
What value does training practitioners as scientists have?	- Critical thinking skills - Understand research and best practice so clients get the 'best' available treatment - Practitioners can justify their chosen treatments/interventions on empirical grounds - Avoid harm, reduce unnecessary treatment and increase likelihood of efficacy of treatment.
Name an alternative model to the S-P model and the scholars responsible for it	The Practitioner-Scholar Model (Vespia and Sauer, 2006)
Describe the scholar-practitioner model	- Places a greater emphasis on service delivery - Practitioners taught to be producers of small-scale clinical research rather than traditional research science (McFall, 2006)
Based on the scholar-practitioner model, describe the model used by a practitioner working scientifically	- Works as an applied scientist who uses theory and validated principles of assessment and validated treatments when they exist. - Where the above don't exist, they generate and test hypotheses. - Uphold a duty to pursue ideas derived from psychological science and apply this to practice in the clinic - This ensures that money is spent on procedures justified by the current state of knowledge.
What is the definition of evidence-based practice?	Defined by Dr David Sackett in the 1990s. More recently... “Integrating the best available research evidence with clinical expertise and the patients unique values and circumstances (Straus, Glasziou, Richarson & Haynes, 2011)" Requires taking into account the practice context.
What are the four key constructs of evidence-based practice?	1. Use the best research evidence 2. Use Clinical expertise 3. Consider the patient's preferences 4. Consider the practice context
What are five reasons for using EBP?	- Health care and applied knowledge grows rapidly. - The health care and applied knowledge base is vast. - Skills to integrate the best available information with clinical expertise, patient values, and your health care environment. - Avoids uncritical acceptance of ‘usual practice’. - Skills for lifelong learning and up to date practice.
What is a barrier between research and practice?	There's a vast amount of research (869,000+ articles in Medline in 2015, 5,235 journals as of April 2018) and 95% research cannot appropriately guide clinical research.
What are the 5 A's of EBP?	1. Ask the question 2. Access the evidence 3. Appraise the evidence 4. Apply the evidence 5. Assess its effectiveness
What is the PICO framework?	A useful tool to help guide and construct clinical questions. P - Population/patient/problem I - Intervention or E - exposure C - Comparison (or control) O - Outcome
What is the difference between PICO and PECO?	I = intervention E = exposure - usually naturally occurring
What does the hierarchy of evidence refer to?	The hierarchy of evidence refers to a core principle in EBP. The hierarchy assesses research quality based on the rigour of the research - strength and precision - based on methodology. The higher in the hierarchy, the less bias there is in research results.
Describe the order of the hierarchy of evidence	1. Systematic reviews 2. Critically-appraised topics 3. Critically appraised individual articles (all above are "filtered information") 4. RCTs 5. Cohort studies 6. Case-controlled studies, case series/reports (all above are "unfiltered information") 7. Background information/expert opinion
What is a weakness of the hierarchy of evidence?	1. Whilst positioned at the top, it should be noted that meta-analyses and systematic reviews take a long time to complete, and therefore may be superseded by more recent information. 2. A well-controlled, large RCT may provide better evidence than a systematic review of many smaller studies.
What is the purpose of an RCT?	- Eliminate bias in treatment assignment - Facilitates blinding (masking) of treatments to investigators, participants and assessors (including possible use of a placebo) - Single-blind study: participant in the dark - Double blind study: participant and experimenter in the dark
What are some disadvantages of using an RCT?	- Requires rigorous control of the allocation process - Can be long and/or expensive - May not be ideal for rare conditions or problems with a long latency - Generalisability (often screens out vulnerable groups) - Ethics: Is it ethical to withhold treatment?
Describe the nature of a case control study	By definition, is always retrospective because it starts with an outcome then traces back to exposure. Allows you to determine whether exposure to something is linked to an outcome. Using existing records to identify people with a problem/condition. e.g., Comparing people with condition (e.g., lung cancer) to people without, to see if they differ on a risk factor, such as smoking. Useful to investigate outbreaks of a disease and rare diseases. This is useful because they are quick, simple and inexpensive.
What is a disadvantage of a case-control study?	Proves an association only, not causality, biased & weaker because it is retrospective.
What is a cohort study?	Cohort is any group of people who are linked in some way and followed over time. Researchers observe what’s happened to the group exposed to some variable. Also trying to determine whether there is a relationship between a certain factor and disease/outcome. Compared to similar groups who were not exposed to the factor of interest. Useful because they can either be retrospective or prospective studies.
Describe the advantages and disadvantages of case-control studies and cohort studies relative to each other. Include descriptions of measures, cost, study-term, sample size, exposure, disease, causal, generalisability.	See Slides
What are the two main aim differences between different kinds of studies?	1. Aims to describe a study population (descriptive PO studies) 2. Aims to quantify the relationship between factors (analytic PICO studies)
What is the difference between an observational and an experimental/RCT study?	Within analytic studies, if a study randomly allocates participants to an intervention or condition, it is an experimental or RCT study. If not, it is an observational study.
Describe how you would determine the difference between a case-control study, a cohort study, and a cross-sectional study	Assess when the outcome measures were determined. After intervention/exposure = cohort (prospective) study At the same time as intervention/exposure = cross-sectional/survey study Before exposure was determined = Case-control study (retrospective)

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