Mental Models Research Articles

Serious Illness Communication Tool for Palliative Care Fellows: Development, Implementation, and Lessons Learned.

Introduction: Learning expert communication skills is a core educational goal within palliative care training, yet there are few communication-based educational tools specifically designed for specialty-trained palliative care providers. Objective: To develop and implement a tool to facilitate effective learning of serious illness communication for hospice and palliative medicine fellows. Methods: A novel formative assessment tool was developed within the UCLA Palliative Care Fellowship program, and utilized throughout the academic year on a weekly basis. Focus groups were held for fellows and faculty separately at the end of the academic year in order to gain insight into the experience and effectiveness of the tool. Focus group transcripts were analyzed through thematic analysis. Results: There was a 47% participation rate in the focus groups (n = 7). Qualitative analysis demonstrated positive impact of the tool in identifying learning goals, improving quality of feedback, and in standardizing language around advanced communication skills, with most value in the first half of the fellowship year. Some aspects of the tool were found to increase feedback anxiety, including the competency scoring component, frequency of use, and utilization with individual patient encounters. Conclusion: This novel communication tool provides an important addition to serious illness communication training of specialist palliative care providers, in creating a shared mental model for naming and organizing skills, as well as generating specific high quality learning goals and feedback. Preliminary feedback from our pilot implementation phase provided important information about how to refine the tool and remove components that unnecessarily added to feedback anxiety.

Cracking the code: interpreting content and phrases used in maternal-fetal medicine fellowship letters of recommendation

BackgroundLetters of recommendation for Maternal-Fetal Medicine(MFM) fellowship are a critical part of the applicant selection process. However, data regarding best practices for how to write LOR for MFM is limited. Similarly, within letters of recommendation, differences in the “code” or meaning of summative words/phrases used at the end of letters of recommendation are seen between surgery, pediatrics, and medicine. However, data regarding code MFM Letters of recommendation are quite limited. ObjectiveWe sought to describe what Maternal-Fetal Medicine program directors value in letters of recommendation for fellowship applicants and how PDs interpret commonly used summative words/phrases. Study DesignAfter IRB exemption, subject matter experts developed an e-survey querying the importance of various letters of recommendation “best practices” described by other specialties. Content and face validation were performed prior to dissemination. This cross-sectional survey was administered to MFM program directors in February 2023. The primary outcome was the relative importance of letters of recommendation content areas. Secondary outcomes included the strength of each summative “code” phrase. Descriptive analysis was performed and principal component analysis (PCA) was then used to reduce the list of phrases to their underlying dimensions. Statistical analysis was performed by SPSS 29.0. ResultsOf 104 MFM program directors sent the survey, 70 (67%) responded. MFM program directors reviewed an average of 78 applications (SD, 30) with 60% writing ≥3 letters/year. Ninety-one percent of respondents noted that letters of recommendation are important/very important in shaping impressions of an applicant. Respondents reported the depth of interaction with an applicant, the applicant's specific behavior traits, the applicant's abilities and a summative statement including strength of the recommendation as important content for MFM fellowship letters of recommendation. Letter length, use of bold/italics, and restating the applicant's curriculum vitae were considered not important. Following PCA with varimax rotation, 14 specific phrases used in letters of recommendation were reduced to 5 themes: high qualitative assessments, average qualitative assessments, objective metrics, exceeding expectations and grit. These themes accounted for 64.6% of the variance in the model (KMO 0.7, Bartlett's Test of Sphericity p<.01). Phrases that respondents considered positive included: “Top 5%,” “Want to keep,” and “highest recommendation,” (all mean score≥4.5/5), while “expected level,” “showed improvement,” and “2nd quartile” were negatively associated code words (all mean score <2.5/5). ConclusionMFM program directors reported that descriptions of an applicant's abilities, behavior traits, and depth of the writer's interactions with the applicant were all important components of an MFM fellowship letters of recommendation. Letter length, bold/italics, and highlights from the CV were not important. A clear “code” emerged regarding summative phrases included in letters of recommendation. Dissemination of these data might help less experienced letter writers send a clearer message and ensure all letter writers have a shared mental model.

The Impact of Mental Models on the Transition from Communism to Capitalism. The Comparative Case Study of Azerbaijan and Poland

The purpose of the article. The breakdown of the so-called Eastern Bloc, the disintegration of the Soviet Union, and the demise of communism fueled transition processes in Central and Eastern Europe, Western Asia, and Central Asia. The great majority of transformation difficulties across different areas demonstrate that when pursuing the process of a structural change, it is important to take into account diverse sets of formal and informal institutions preserved in each country. Each country has a unique set of formal and informal institutions. These differences are easily observed between Poland and Azerbaijan. The aim of this paper is to compare and contrast the outcomes of Poland and Azerbaijan's transitions from communism to capitalism and to identify the primary factors driving these two different transformations. Methodology. The paper presents two complementary methods to compare the transitions from communism to capitalism in Poland and Azerbaijan. The first method involves secondary analysis, where existing data from reputable sources such as the European Bank for Reconstruction and Development (EBRD) database, the Bertelsmann Transformation Index (BTI), and country reports are compiled to provide insights into economic, political, and social indicators. Additionally, a comparative case study approach is employed, using Geert Hofstede's six cultural dimensions framework to explore the cultural influences on transition outcomes. By integrating these methods, the study aims to offer a comprehensive analysis of the transformation processes in Poland and Azerbaijan. Results of the research. The results of the analysis presented in the paper support the hypothesis that the historically-shaped differences in mental models and strong ties to international protectors determined the paths of transformations in Poland and Azerbaijan. The primary similarities and contrasts in the mindset are justified by the colonial or imperial history of the nations.

Difficulty and Mastery of Physics Concepts for Middle School Students in Density Material

The purpose of this research is exploring the student’s density conception as early as possible so that when heading to essential topics that involve density in physics (like statics and dynamics fluid), students can easily understand these essential topics. In general, students' concept understanding of density is already relatively high with 63,5%. There are differences between the conceptual understanding of male and female students, which the conceptual understanding of density in female students was better than male students. The notable difference between them is the understanding of the concepts relating mass, volume, and density. Some students also shown that they had not been able to understand the basic conception of the density and properties of matter. For further research, it is better to provide a short interview session and give students the opportunity to describe mental models of the properties of substances that students have understood.

Closer to Home: A Quality Improvement Initiative to Optimize Satellite Site Bed Capacity.

The coronavirus disease 2019 pandemic resulted in the underutilization of inpatient beds at our satellite location. A lack of clarity and standardized admission criteria for the satellite led to frequent transfers to the main campus, resulting in patients traveling larger distances to receive inpatient care. We sought to optimize inpatient resource use at the satellite campus and keep patients "closer to home" by admitting eligible patients to that inpatient unit (LA4). Our aim was to increase bed capacity use at the satellite from 45% to 70% within 10 months. Our process measure was to increase the proportion of patients needing hospitalization who presented to the satellite emergency department (ED) and were then admitted to LA4 from 76% to 85%. A multidisciplinary team used quality improvement methods to optimize bed capacity use. Interventions included (1) the revision and dissemination of satellite admission guidelines, (2)steps to create shared understanding of appropriate satellite admissions between ED and inpatient providers, (3) directed provider feedback on preventable main campus admissions, and (4) consistent patient and family messaging about the potential for transfer. Data were collected via chart review. Annotated run charts were used to assess the impact of interventions over time. Average LA4 bed capacity use increased from 45% to 69%, which was sustained for 1 year. The average percentage of patients admitted from the satellite ED to LA4 increased from 76% to 84%. We improved bed capacity use at our satellite campus through transparent admission criteria and shared mental models of patient care needs between ED and inpatient providers.

Perioperative care of patients with recent stroke undergoing nonemergent, nonneurological, noncardiac, nonvascular surgery: a systematic review and meta-analysis.

To systematically review and perform a meta-analysis of published literature regarding postoperative stroke and mortality in patients with a history of stroke and to provide a framework for preoperative, intraoperative, and postoperative care in an elective setting. Patients with nonneurological, noncardiac, and nonvascular surgery within three months after stroke have a 153-fold risk, those within 6 months have a 50-fold risk, and those within 12 months have a 20-fold risk of postoperative stroke. There is a 12-fold risk of in-hospital mortality within three months and a three-to-four-fold risk of mortality for more than 12 months after stroke. The risk of stroke and mortality continues to persist years after stroke. Recurrent stroke is common in patients in whom anticoagulation/antiplatelet therapy is discontinued. Stroke and time elapsed after stroke should be included in the preoperative assessment questionnaire, and a stroke-specific risk assessment should be performed before surgical planning is pursued. In patients with a history of a recent stroke, anesthesiology, surgery, and neurology experts should create a shared mental model in which the patient/surrogate decision-maker is informed about the risks and benefits of the proposed surgical procedure; secondary-stroke-prevention medications are reviewed; plans are made for interruptions and resumption; and intraoperative care is individualized to reduce the likelihood of postoperative stroke or death.

Exclusive Disjunctions With Three Disjuncts from First-Order Predicate Calculus

First-order predicate logic seems to be incompatible with the way people understand embedded exclusive disjunctions with three disjuncts. In classical logic, an exclusive disjunction with three disjuncts holds when the three disjuncts hold. However, it is hard to note that for people. The theory of mental models can explain this fact. According to that theory, individuals tend to process embedded exclusive disjunctions with three disjuncts intuitively. Thus, they only consider possible situations in which just one of the disjuncts is the case. The present paper tries to explain this problem within first-order predicate logic. The main point is that, in the latter logic, in inferences having, as its first premise, an embedded exclusive disjunction with three disjuncts, and, as its second premise, the first disjunct of that very exclusive disjunction, it is possible to infer none of the other two disjuncts.

Neural mechanisms of the continued influence effect of misinformation: Analysis based on fMRI causal connectivity

The continued influence effect of misinformation (CIEM) can negatively affect individuals’ reasoning and judgment processes. This research aims to enhance the correction of misinformation and foster rational judgement by investigating the internal brain mechanisms involved in the processing of the CIEM through the use of task-based functional magnetic resonance imaging combined with Granger causality analysis. Our findings demonstrate notable effective interactions in varying directions between the left inferior frontal gyrus and middle temporal gyrus during the encoding phase, and between the right anterior cingulate gyrus and left inferior occipital gyrus in the retrieval phase. These insights elucidate the roles of mental model updating and retrieval failure in the processing of CIEM, offering more granular evidence to support the differentiation in processing phases.

A multimodal pedagogical approach to teaching electromagnetics

AbstractElectromagnetics is a core course in the undergraduate electrical engineering curriculum that entails the study of electric and magnetic fields. Students, usually, perceive it as a challenging course since it requires them to build mental models of the spatial and time‐varying electric and magnetic fields that cannot be seen by the naked eye. Moreover, the mathematics used in this subject is quite complex and abstract and can further compound the students' difficulties in connecting abstract math with real‐life industry applications. To address these challenges, the author designed an undergraduate electromagentics course, which utilized certain pedagogical techniques to enhance the learning experience of the students. These pedagogies include extensive usage of MATLAB simulations, animations, and videos during the course that helps students visualize and conceptualize abstract concepts, usage of a comprehensive course‐wide equation sheet, and highlighting the connection of the theory with real‐life applications and industry jobs. This paper presents some of the simulations designed by the author as part of this course. Moreover, the equation sheet is also reproduced and access to its source is provided for the benefit of other instructors and students. The paper also presents results from the end‐of‐semester students' survey to measure the efficacy of these pedagogical techniques.

Mental models for inclusive, socially-just disaster planning: a multi-community study in Saint Martin after Hurricane Irma.

Local perspectives provide different insights into disaster planning and response as compared to those of experts. Eliciting them, however, can be challenging, particularly for marginalised groups whose viewpoints have historically been excluded from planning processes. Fuzzy cognitive mapping (FCM) provides a semi-quantitative approach to representing the collective understanding or 'mental models' of diverse individuals and communities. This study involved 23 FCM interviews across three neighbourhoods of Saint Martin to comprehend: (i) how individuals' mental models of Hurricane Irma (2017) differ based on their context; (ii) how aligned mental models are with policy and planning documents; and (iii) the implications for the inclusiveness and representativeness of disaster response policies. It found that the residents of different neighbourhoods provided unique insights into the factors driving the social-ecological system, and that official policies aligned closely with priorities. The paper argues that the inclusion of the perspectives of different groups in disaster recovery is essential for an equitable process.

Supporting stakeholder dialogue on ecosystem service tradeoffs with a simulation tool for land use configuration effects

Various approaches are available to assist stakeholders in identifying and resolving ecosystem service tradeoffs. However, existing tools fall short in simulating land use configuration effects on ecosystem services and subsequently making these effects accessible to users with varying levels of expertise. To address this gap, we introduce PLACES, a tool that estimates land use impacts on multiple ecosystem services by incorporating landscape-level processes. Tool results are provided in real-time and visualized to support a dialogue between different stakeholders. This study presents the tool development and application during a mixed stakeholder workshop, after which mental models, questionnaires, and videos were analyzed to evaluate PLACES. The tool increased the participants’ understanding of insights of spatial processes and sparked discussions on the societal goals for sustainable landscapes. For future applications of PLACES, we encourage careful tailoring of the landscape representation and land use impact simulations to match the knowledge of the respective users.

Exploratory analysis on payment mechanisms to Community Mental Health Centers in Chile using mixed grounded theory.

Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile's National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Seven payment mechanisms implemented heterogeneously in the country's CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.

PSYCHIATRIC DEINSTITUTIONALIZATION IN BRAZIL

The Brazilian Psychiatric Reform is a movement that seeks to transform the mental health care model, promoting the deinstitutionalization and social inclusion of people with mental disorders. In this context, Therapeutic Residences represent an alternative to psychiatric institutionalization, offering residential support for individuals who face these disorders and need family or community support, aiming for their social reintegration. This experience report seeks, therefore, to share the experience of a team from the Family Health Strategy in the city of Rio de Janeiro-RJ after one year of monitoring residents of a Therapeutic Residence.

Enhancing knowledge construction in emerging technologies: the role of imagination training in immersive virtual reality environments

In the rapidly evolving landscape of educational technologies, Immersive Virtual Reality (iVR) stands out as a transformative tool for teaching and learning. The learner must actively engage, particularly when visual and auditory knowledge information is presented simultaneously. Generative learning strategies support learners in processing and integrating the information provided effectively and help them select, organize, and integrate information into a coherent mental model. Yet, learners often do not use such strategies spontaneously, so pre-training of the learning strategy is recommendable. IVR provides a spatial context for learning, where an essential strategy for promoting learning is to integrate auditory knowledge information into visually perceived space. We hypothesize that this can be done effectively through imagination, i.e., learners mentally visualize auditory information. This study investigated an imaginative pre-training strategy that targets integrating visual-spatial and auditory knowledge information. In a pre-post between-subjects design, we tested the effects of imaginative strategy pre-training. Students received either a pre-training (EG = 30) or no training (CG = 30) before exploring an iVR learning environment. Against our expectations, the EG did not outperform the CG on semantic and spatial knowledge. These findings may be explained by the demands on learners to process sensory input, and focus directed attention in a spatial iVR environment, suggesting that imagination strategies need to be anchored and complemented by other selection and organization strategies. This study contributes to a critical understanding of the possibilities and limitations of iVR in education, shedding light on the learners' processes and needs.

Stand in surgeon's shoes: virtual reality cross-training to enhance teamwork in surgery.

Teamwork in surgery depends on a shared mental model of success, i.e., a common understanding of objectives in the operating room. A shared model leads to increased engagement among team members and is associated with fewer complications and overall better outcomes for patients. However, clinical training typically focuses on role-specific skills, leaving individuals to acquire a shared model indirectly through on-the-job experience. We investigate whether virtual reality (VR) cross-training, i.elet@tokeneonedotexposure to other roles, can enhance a shared mental model for non-surgeons more directly. Our study focuses on X-ray guided pelvic trauma surgery, a procedure where successful communication depends on the shared model between the surgeon and a C-arm technologist. We present a VR environment supporting both roles and evaluate a cross-training curriculum in which non-surgeons swap roles with the surgeon. Exposure to the surgical task resulted in higher engagement with the C-arm technologist role in VR, as measured by the mental demand and effort expended by participants ( ). It also has a significant effect on non-surgeon's mental model of the overall task; novice participants' estimation of the mental demand and effort required for the surgeon's task increases after training, while their perception of overall performance decreases ( ), indicating a gap in understanding based solely on observation. This phenomenon was also present for a professional C-arm technologist. Until now, VR applications for clinical training have focused on virtualizing existing curricula. We demonstrate how novel approaches which are not possible outside of a virtual environment, such as role swapping, may enhance the shared mental model of surgical teams by contextualizing each individual's role within the overall task in a time- and cost-efficient manner. As workflows grow increasingly sophisticated, we see VR curricula as being able to directly foster a shared model for success, ultimately benefiting patient outcomes through more effective teamwork in surgery.

Perceptions of Responsibilities by Primary Care Staff in a Patient-Centered Medical Home.

To examine the extent to which Veterans Health Administration (VHA) Patient-Aligned Care Team (PACT) members have a shared understanding/ agreement upon and enact responsibilities within the team. The PACT model focuses on team-based care management. However, lack of a shared understanding of team-based care management roles and responsibilities makes system-wide implementation a challenge. Quantitative and qualitative analysis of national survey data collected in 2022 from primary care personnel working in a VHA-affiliated primary care facility. Significant discrepancies exist in responses about what core team members say they do and what others perceive they should be doing, indicating either a lack of agreement, knowledge, or training about what core team members should do. Successful implementation of a team-based model requires adequate support and training for teamwork including shared mental models to work according to their clinical competency. Clear guidance and communication of expectations are critical for role clarity.

From light polarization to quantum physics: Supporting lower secondary school students’ transition from gestalt to functional thinking

In this paper, we present a new minimal mathematical conceptual approach to quantum mechanics using light polarization for lower secondary school students with the aim of bringing students closer to the so-called quantum mechanical way of thinking. We investigated how students think about some of the basic concepts and fundamental laws and we found that certain concepts are quite well-understandable in younger grades too. We studied the introduction of the so-called state circle, which can faithfully represent quantum mechanical formalism without involving students in abstract algebraic calculations. We then categorized and analyzed students’ thoughts on the superposition principle and the lack of trajectory, finding that the concept of measurement and the lack of trajectory were problematic. We explored that younger students tend to hold gestalt-like mental models of quantum concepts, while at the same time being able to use visualizations correctly for reasoning in the quantum realm. Overall, this paper provides evidence in favor of introducing basic features of quantum mechanics as early as in lower secondary school.

Attachment and Political Personality are Heritable and Distinct Systems, and Both Share Genetics with Interpersonal Trust and Altruism

The attachment and caregiving domains maintain proximity and care-giving behavior between parents and offspring, in a way that has been argued to shape people’s mental models of how relationships work, resulting in secure, anxious or avoidant interpersonal styles in adulthood. Several theorists have suggested that the attachment system is closely connected to orientations and behaviors in social and political domains, which should be grounded in the same set of familial experiences as are the different attachment styles. We use a sample of Norwegian twins (N = 1987) to assess the genetic and environmental relationship between attachment, trust, altruism, right-wing authoritarianism (RWA), and social dominance orientation (SDO). Results indicate no shared environmental overlap between attachment and ideology, nor even between the attachment styles or between the ideological traits, challenging conventional wisdom in developmental, social, and political psychology. Rather, evidence supports two functionally distinct systems, one for navigating intimate relationships (attachment) and one for navigating social hierarchies (RWA/SDO), with genetic overlap between traits within each system, and two distinct genetic linkages to trust and altruism. This is counter-posed to theoretical perspectives that link attachment, ideology, and interpersonal orientations through early relational experiences.

DISCOURSE: KNOWLEDGE, NEWS, AND FAKE INTERTWINED

Discourse has been a focal point for linguists over an extended period. The multidisciplinary character of the term ‘discourse’ has resulted in diverse approaches aiming to define and explore this phenomenon. The study of various facets of discourse significantly enhances its comprehension. For our understanding, discourse encompasses the following pertinent characteristics: it is a communicative process, a dialogue, an interaction between communicators; it is a structure, a system, a distinct way of representing and perceiving the world, a special language and world, an expression and manifestation of national identity. Discourse implies knowledge, as it includes various types of it. Knowledge and news are closely linked. They are processed in discourse and with the help of it. Any explicit or implicit knowledge and news influence discourse production and comprehension. True and fake information can alter existing types of knowledge and create new ones, influence mental processes, and shape new mental models. The aim of the article is to describe discourse in its close connection with its main constituents – knowledge, news and fake. ‘Fake’ becomes a linguistic and discursive matter. It is associated with the concepts of ‘lie’, ‘deception’, and ‘manipulation’. Corpus data about ‘fake’ and ‘fake news’ give a bigger picture of the overall context of their representation, changes and dynamics in the usage. The widespread influence of fake is provided with the help of mass media. Strategic control of knowledge in the interaction process is achieved through the use of knowledge itself, accordingly, it becomes possible to control knowledge by means of deception and fake. Fake news is a genre of news information and news discourse, it is an integrative type of media text. The main goal of fake news is to deceive and manipulate consciousness of a wide audience. Manipulation entails language to subtly influence recipients, encouraging them covertly to undertake particular actions. Fake news can be studied within news discourse, media discourse, television discourse, manipulative discourse, political discourse, discourse of fake, and other types. Thus, knowledge, news and fake presented in discourse and with the help of it allow to create ‘new knowledge’, shape the audience’s understanding of discourse, make and generate mental models, control and restrict access to certain information, manipulate consciousness of the audience, transform traditional mental attitudes associated with the pursuit of truth.

Implementation and adaptation of a hub-based psychiatric and primary care program: A qualitative descriptive analysis of The Seamless Care Optimizing the Patient Experience (SCOPE) Mental Health program.

The Seamless Care Optimizing the Patient Experience (SCOPE)-Mental Health program is a comprehensive case management and psychiatric care initiative that supports primary care physicians in independent medical practices. This program offers a range of services that aims to enhance primary care capacity for mental health and provide accessible clinical care for patients. With its flexible hub-based approach, this program allows participating sites to tailor their implementation based on their available resources and specific needs within their community. The aim of this quality improvement initiative was to investigate the evolution of this collaborative mental health model, focusing on specific site adaptations, local implementation challenges, and opportunities for ongoing development and sustainability across SCOPE sites in the Greater Toronto Area. This evaluation employed a qualitative descriptive design where semi-structured interviews, guided by the Reach Effectiveness Adoption, Implementation, and Maintenance framework were conducted with staff from all 8 SCOPE-Mental Health sites. Site representatives were interviewed virtually between March and July 2023 and data were analyzed using qualitative content analysis. The SCOPE-Mental Health model permits flexibility through specific local adaptations led by community need that leverage existing assets either at the site or within the individual community. Adoption by primary care physicians was crucial to program success and facilitated efficiency and interprofessional collaboration. Maintenance efforts included pathway refinement, and marketing and funding considerations. Challenges to program development included continuity of staff, physician compensation issues, and electronic health record interoperability. The SCOPE-Mental Health program fosters linkages among unaffiliated primary care offices, hospitals, and community-based resources to improve mental health care. Key recommendations include advocating for sustainable funding and facilitated mechanisms for psychiatric consultations. This initiative offers valuable insights for healthcare organizations seeking to develop similar programs, emphasizing the need for tailored approaches and ongoing evaluation to ensure a lasting impact in underserved communities.