Script Theory Research Articles

Clinical reasoning in emergency medical technicians and its compliance with the illness script theory: A pilot study.

Emergency medical technicians (EMTs) play a pivotal role in the management and treatment chain of emergency patients and their health outcomes. Knowing the clinical reasoning pattern in prehospital procedures is of particular importance that can help to develop a correct clinical decision-making process in this group. Therefore, this study aimed to clarify the clinical reasoning in EMTs and evaluate its compliance with the "illness script" theory. This descriptive-analytical study was conducted in 2021 at Hormozgan University of Medical Sciences (HUMS) by involving EMTs in two groups of experts and novices. To collect and analyze participants' mental script-based information, the "think aloud" method was used. In the content analysis of extracted protocols, two main steps were considered: 1) preparing a suitable map to compare the protocol with the base pattern and 2) quantifying the relationship between the protocol and the base pattern. Statistical Package for the Social Sciences (SPSS)-21 software, the Shapiro-Wilk test, and the independent t-test were used for analyzing quantitative data. After exploring the concordance of the clinical reasoning of EMTs with the base pattern, results showed that the components of Enabling condition and Management were consistent with the illness script strategy. Pathophysiology and Diagnosis components did not conform to the base pattern. Regarding Signs and Symptoms, these were significantly different from the classic pattern of illness script. A new component called Contextual insight was suggested for this pattern. Generally, on comparing the clinical script content of experts and novices, only two components of Pathophysiology and Diagnosis did not show any significant difference (P > 0.05) between these two groups. Results of evaluating the clinical reasoning of the under-study groups showed that in some components of the pattern, they practiced as in other medical groups, but in relation to some components, this was not the case. It is due to the different nature of the prehospital conditions. Also, there is a need to add new components to the base model, which should be considered in distinguishing between expert and novice EMTs.

Good servant, bad master: How eighty women perceive the influence of pornography on sexual scripts

Women are often portrayed as the victims of pornography. Their active consumption and the ways in which pornography shapes their sexuality are still under-researched. This article has three goals: to explore how and why young women watch pornography; to analyse how they perceive the influence of pornography on their sexual scripts; and to determine related positive and negative factors. Guided by sexual script theory, I thematically analysed responses from an open-ended form completed by 80 young Czech women (18-30 years old). The analysis resulted in six themes related to cultural, interpersonal and intrapsychic sexual scripts – in other words, the domains of what is societally appropriate, interpersonal relationships, and inner desires. These findings have important implications: pornography simultaneously influences several domains of sexuality. Findings show that under certain conditions, pornography may be beneficial for sexual empowerment and sexual satisfaction, but at the same time, it may also produce negative effects – providing a complex and often contradictory experience for the individual.

Taking a chance on love: scenes, scripts, and affects in Four Saints in Three Acts and Jazz-Cabaret songs and performances of the 1930s

ABSTRACT Gertrude Stein and Virgil Thomson’s opera Four Saints in Three Acts (1934) famously combined avant-garde aesthetic practices and elements of popular culture. While commentators routinely note the recurrence of folk- and hymn-tune harmonies and cadences in Thomson’s otherwise resolutely ‘modernist’ music, they have accorded virtually no attention to the jazz-cabaret song, a form of popular music that emerged and established itself artistically and commercially during the same decade that Four Saints in Three Acts was produced and performed. This article examines a dynamic point of intersection between Stein and Thomson’s avant-garde opera and the jazz-cabaret song-form of the 1930s in some of the performances of Black cabaret star Jimmie Daniels as they were experienced by Thomson and other gay-male habitués of Harlem and Paris cabarets. One of Daniels’s signature tunes, the 1932 Harold Arlen-Ted Koehler song, ‘I’ve Got the World on a String’, is analysed in relation to Freud’s account of the fort-da ‘game’ and more generally in relation to Silvan Tomkins’s script theory.

Using an experiential learning model to teach clinical reasoning theory and cognitive bias: an evaluation of a first-year medical student curriculum

ABSTRACT Background Most medical students entering clerkships have limited understanding of clinical reasoning concepts. The value of teaching theories of clinical reasoning and cognitive biases to first-year medical students is unknown. This study aimed to evaluate the value of explicitly teaching clinical reasoning theory and cognitive bias to first-year medical students. Methods Using Kolb’s experiential learning model, we introduced dual process theory, script theory, and cognitive biases in teaching clinical reasoning to first-year medical students at an academic medical center in New York City between January and June 2020. Due to the COVID-19 pandemic, instruction was transitioned to a distance learning format in March 2020. The curriculum included a series of written clinical reasoning examinations with facilitated small group discussions. Written self-assessments prompted each student to reflect on the experience, draw conclusions about their clinical reasoning, and plan for future encounters involving clinical reasoning. We evaluated the value of the curriculum using mixed-methods to analyze faculty assessments, student self-assessment questionnaires, and an end-of-curriculum anonymous questionnaire eliciting student feedback. Results Among 318 total examinations of 106 students, 254 (80%) had a complete problem representation, while 199 (63%) of problem representations were considered concise. The most common cognitive biases described by students in their clinical reasoning were anchoring bias, availability bias, and premature closure. Four major themes emerged as valuable outcomes of the CREs as identified by students: (1) synthesis of medical knowledge; (2) enhanced ability to generate differential diagnoses; (3) development of self-efficacy related to clinical reasoning; (4) raised awareness of personal cognitive biases. Conclusions We found that explicitly teaching clinical reasoning theory and cognitive biases using an experiential learning model provides first-year medical students with valuable opportunities for developing knowledge, skills, and self-efficacy related to clinical reasoning.

Women, Scripts and Conditioning

Abstract Despite educational and employment advancements, research indicates that traditional and sexual scripts are nevertheless often considered and adhered to as related to gendered conditioning. This manuscript reviews the traditional sexual script and sexual script theory, provides application illustrations of the theories and discusses the implications of such conditioning, particularly for women.

Sex or Socialization? Replicating Heterosexual Couples’ Gender Differences in the Association between Orgasm and Satisfaction in Same-Gender/Sex Couples

ABSTRACT Orgasm is commonly considered an important aspect of sexual activity. The current study sought to replicate and extend prior work by examining gender/sex differences in the association between orgasm and satisfaction in a sample of same-gender/sex couples. We also examined how desire for an orgasm moderated this association. Although prior research found a curvilinear association between orgasm and satisfaction for heterosexual women (but not men), we found that orgasm curvilinearly predicted relationship and sexual satisfaction across genders/sexes, indicating more frequent orgasm was associated with higher satisfaction only to an extent for all individuals in our sample. We also found that when desire for orgasm was high, orgasm was associated with higher relationship and sexual satisfaction than when desire was low, suggesting that desire for orgasm may differentially affect how orgasm is related to satisfaction. We discuss our findings in terms of sexual scripting theory, contextualizing our results by considering the socially constructed nature of sexuality and how sexual scripts may vary across individuals with different sexual and gender identities.

Co-creation experience in travel photography service: exploring the formative mechanism of repurchase intention from the perspective of script theory

ABSTRACT This research aims to clarify the core attributes of travel photography service, and how it may be possible to cultivate tourist loyalty to this service when travelling to the next destination. A mixed method with two studies was conducted to answer these questions. Study 1 adopted semi-structured interviews and thematic analysis to identify the key variables and their potential relations. The results showed that co-creation experience in travel photography was mainly composed of sense seeking, multi-actor interaction, and active participation, which played an extremely important role in tourists’ cognitive memory, service outcome evaluation, and future travel decision-making. To further verify the relationship between variables, study 2 used a survey to explore the formative mechanism and boundary conditions of the co-creation experience on tourist repurchase intention. The results indicated the co-creation experience was positively associated with repurchase intention. Memory recollection and photo satisfaction both mediated this relationship. Inertia positively moderated the relationships between co-creation experience, memory recollection and photo satisfaction on repurchase intention. These effects were stronger when individual inertia was high. This study also provides practical insights into how it may be possible to cultivate travel service loyalty in destination marketing.

How Medical Students Apply Their Biomedical Science Knowledge to Patient Care in the Family Medicine Clerkship.

The online version contains supplementary material available at 10.1007/s40670-022-01697-5.

Sexual Harassment or Just Coaching? Sport Students Making Sense of Possibly Sexualising Coach Behaviours

Research has shown that athletes are divided in their assessment of possibly sexualising behaviours from coaches towards athletes. How they arrive at their conclusions has received less attention—yet it is crucial to understand as a basis for safeguarding measures. Using video-elicitation focus group interviews with sport students, we zoomed in on different types of ‘grey area’ situations involving coaches and athletes. We drew on social script theory to highlight the cultural tools sport students use to distinguish between acceptable and unacceptable coaching behaviours. Our analyses showed that the students drew on two types of scripts in their interpretative work: (1) sport scripts, denoting templates for ‘normal’ coach–athlete interactions (typically with a performance and/or caring rationale), and (2) sexual harassment scripts, encompassing beliefs and expectations of how sexual transgressions play out and among whom. We discuss how the students evaluated concrete grey area situations by comparing and contrasting them with both scripts. In these assessments, the students relied on cues and clues from the portrayed interactions, including the gender of the coach and athlete and knowledge about the specific sport setting. Our analyses demonstrate how views about sexual harassment in sport relate to the specificities of the sport setting and the gendered social dynamics in the situation.

Fisting intimacy: The sexual scripting of intimacy in gay men’s anal fisting

ABSTRACT Anal fisting has often been caricatured as an aggressive, if not violent, mode of sexual and erotic practice between gay men, circumscribed by discourses of risk, danger, and even death. In this study, I explore how a sample of 28 South African gay men who regularly incorporate anal fisting into their preferred sexual practices construct and understand the experience of intimacy in the practices and relations of their fist-fucking. Through sexual scripting theory and a Thematic Analysis of unstructured individual interviews conducted with participants, the results highlight a scripting of intimacy with/in anal fisting that is grounded on three recurrent and interrelated themes: trust and vulnerability; connection and communication; as well as pleasure and skill. The results of this study draw attention to the ways in which anal fisting is not only experienced as a deeply intimate form of pleasure and lovemaking for its participants, but, moreover, how the construction and understanding of intimacy in fist-fucking is framed as a queer/er mode of anal sex/uality and erotics that defines and constitutes itself in contradistinction to both hetero- and homo-normative scripts.

Teaching of Clinical Reasoning Guided by Illness Script Theory.

Teaching of clinical reasoning (CR) can be facilitated by educational strategies guided by illness script theory. To evaluate the effects of an educational strategy guided by illness script theory on the diagnostic accuracy of chest pain in medical students. Experimental study in 3 phases, with 18 third-year medical students completing phase 3. Phases 1 and 2 had 27 students. In phase 1, each participant solved 8 clinical cases (6 of chest pain and 2 distractors). In phase 2, participants were divided into 2 groups, which distinctly trained 3 of the chest pain diagnoses from phase 1. In phase 3, after 1 week, each participant solved 8 new cases, with the same diagnoses as phase 1. Case resolution time and diagnostic accuracy were evaluated. The significance level adopted for statistical analysis was p < 0.05. In phase 3, both groups showed improved diagnostic accuracy and reduced case resolution time for the trained diagnoses, with no transfer of learning. For these diagnoses, the diagnostic accuracy scores in phases 1 and 3 were: group 1 = 1.00, IQR [0.00 to 1.00] versus 2.00, IQR [2.00 to 2.50], p = 0.017 and group 2 = 1.00, IQR [0.66 to 1.17] versus 3.00, IQR [1.33 to 3.00], p = 0.006. Case resolution times in seconds were: group 1: 485, IQR [450 to 583] versus 318, IQR [284 to 418], p = 0.027 and group 2: 655, IQR [543 to 740] versus 408, IQR [337 to 569], p = 0.010. The proposed strategy seems to contribute to improved diagnostic accuracy, and it may be considered for teaching CR.

The longitudinal relation between violence exposure in daily life, hostile automatic thoughts, and cyber-aggression.

Cyber-aggression is a serious social problem worldwide. Its risks have been frequently explored, and violence exposure in daily life has been regarded as an important risk factor of cyber-aggression. However, the longitudinal association between violence exposure in daily life and cyber-aggression has not yet been examined, and the mechanisms underlying the link between violence exposure and cyber-aggression remain largely unclear. Based on the General Aggression Model and Script Theory, we explored the circular relation between violence exposure in daily life, hostile automatic thoughts, and cyber-aggression. The current study adopted a longitudinal design to address these issues among 941 college students. The results indicated violence exposure in daily life predicted hostile automatic thoughts and cyber-aggression 6 months later; hostile automatic thoughts predicted violence exposure and cyber-aggression 6 months later; and cyber-aggression predicted hostile automatic thoughts and violence exposure 6 months later. Moreover, each of them plays a mediating role in the association between the other two variables. These results support and expand the General Aggression Model and Script Theory that violence exposure, aggressive cognition, and aggression facilitate each other. This also provides theoretical guidance on reducing cyber-aggression in daily life.

Time for Tea: Factors of Service Quality, Memorable Tourism Experience and Loyalty in Sustainable Tea Tourism Destination

Underpinned by Script Theory and the S-O-R model, this research enhances the green tourism consumption literature to identify how destination service quality contributes to visitors’ memorable experiences and loyalty towards a place-based food tourism attraction. A total of 202 tourists who visited the Best of Highlands tea plantation in Malaysia were surveyed using an online questionnaire. Using PLS-SEM, this study has several notable findings: (i) destination service quality factors: activities, cleanliness, language, and security emerged as predictors of memorable tourism experiences; (ii) memorable tourism experiences strongly predicted destination loyalty; and (iii) memorable tourism experiences mediate the path between destination service quality and destination loyalty. This study therefore provides new insights into both sustainable tea tourism and script theory with respect to how memories guide future decision making. These results also provide insights for tea tourism providers in designing an unforgettable destination that stimulates the tourist’s intention to revisit the destination and to communicate it to others.

Conceptual Overview (Portrayals of Sexuality in Pornography)

Conceptual Overview (Portrayals of Sexuality in Pornography)

“I’ve Learned to Convert My Sensations into Sounds”: Understanding During-Sex Sexual Communication

ABSTRACT Research generally supports the idea that sexual communication is beneficial to partners in committed relationships. However, much existing sexual communication research has a verbal communication bias and has examined sexual communication in non-sexual contexts, neglecting a wide variability of other forms of communication that occur during sex. Thus, from a sexual scripts theoretical framework, the purpose of the present study was to: (1) explore how individuals communicate needs, desires, pleasure, and displeasure to their partners during sex; (2) investigate perceptions of during-sex sexual communication’s purposes; and (3) document individuals’ perceived barriers and facilitators to during-sex sexual communication. Data from 27 interviews conducted among individuals in committed different-gender relationships (15 women, 11 men, 1 queer person; 21–68 years old), were analyzed using thematic analysis. Participants reported communicating using a combination of verbal, vocal, and bodily forms of communication. Most participants indicated that communicating during sex increased sexual pleasure and emotional intimacy and was useful for clarifying doubts and reducing insecurities. Many individuals nonetheless reported avoiding verbal communication during sex to preserve the mood, protect a partner’s feelings, and avoid experiencing negative emotions and a partner’s judgment. Sexual communication was also described as a skill that is developed over time and through the development of sexual subjectivity. Implications for sexual script theory and future sexual communication research are discussed.

How do youth, parents, and educators use discursive sexual scripts to make sense of youth engagement with internet pornography?

ABSTRACT In this article, we explore how culturally available sexual scripts are drawn on to make meaning of young people’s engagement with internet pornography (IP). We draw on a version of sexual scripting theory developed by feminist discursive scholars to perform a critical thematic analysis of 24 interviews with parents, educators, and young people. We identify three main scripts commonly drawn on by participants to make sense of youth engagement with IP, namely: a script of harm, a heterosexual script, and a developmentalist script. These scripts, often interweaving with one another, were deployed in various ways, firstly, as ‘risk talk’ and, secondly, as ‘resistant talk’. While both adults and youth engaged with dominant (‘risk’) and alternative (‘resistant’) talk, adults primarily positioned youth within ‘risk talk’. We show how alternative ‘resistant talk’ disrupts common, scripted ways of accounting for youth engagement with IP in a way that demonstrates more nuanced sexual subjectivities – particularly among youth – than the traditional media effects paradigm acknowledges. Importantly, our findings show how, within discursive restraints, essentialized gender constructions can be resisted to position youth as agentic sexual subjects.

The Role of Sexual Scripts in the Relationship Between Pornography Use and Sexual Coercion.

Decades of research have examined the association between pornography use and sexual coercion, with the most significant relationships found between more deviant genres of pornography use and sexual violence. However, researchers have yet to provide a comparable body of research examining the theoretical mechanism of this association. One theory that has shown promise in explaining the association between certain variables of pornography use and sexual coercion is the sexual script theory. In this theory, scripts can best be understood as a mechanism through which society defines and disseminates what is acceptable, desirable, and pleasurable sexual conduct. Studies examining the application of the sexual script theory to the association between pornography use and sexual coercion have found that pornography use has a significant indirect effect on sexual coercion and correlates of sexual coercion through sexual scripts. The current study sought to extend this line of inquiry by examining the relationship between pornography use, sexual scripts, and sexual coercion. A structural equation model examining direct and indirect effects of sexual scripts and pornography use on sexually coercive behaviors was run using a sample of 390 college-aged males. Results of the study indicated there were significant direct and indirect effects in the model. Specifically, pornography use, while not directly related to sexually coercive behaviors, had a significant indirect effect on sexual coercion through sexual scripts. These results further support the use of the sexual scripts theory to help explain the relationship between pornography use and sexual coercion.

Women Selling Sex in Russia: Analyzing Women’s Appraisal of Exploitation and Mistreatment Using Cognitive Dissonance and Cultural Sex Script Frameworks

Globally, over a third of women have experienced physical or sexual violence in their lifetime. In Russia, human trafficking, sexual exploitation, and physical abuse of women are amongst the world’s highest. Applying cognitive dissonance theory and sexual script theory, this study explores whether women (n = 654) trading sex in Russia appraise their experiences of entering the commercial sex trade as voluntary or forced. Contributing client factors were also analyzed, including beatings (66%), rape (66%), and humiliation (86%) by clients. Multiple logistic regression assessed whether women who reported voluntarily entering the commercial sex trade were more likely to experience physical abuse but less likely to experience rape (AOR:1.37); were more likely to perceive men using them as decent/caring (AOR = 2.54); were more likely to sell sadistic/masochistic services (AOR: 2.31); and less likely to stop selling sex (AOR: 5.84). Implications of this study reveal the importance of intervention strategies that account for a woman’s unawareness of her own exploitation and mistreatment as well as the psychological barriers that prevent her from seeking help. The necessity of recognizing women selling sex as sufferers of coercion and abuse is also emphasized.

A Theory-Based Intervention to Reduce Risk and Vulnerability Factors of Sexual Aggression Perpetration and Victimization in German University Students

ABSTRACT The current study evaluated an intervention program, designed by the authors and based on the theory of sexual scripts and social learning theory, to reduce empirically established risk and vulnerability factors of sexual aggression. A sample of 1,181 university students in Germany (762 female) were randomly assigned to an intervention and a no-intervention control group. The intervention group completed six modules addressing established antecedents of sexual aggression perpetration and victimization: risky sexual scripts, risky sexual behavior, low sexual self-esteem, low sexual assertiveness, acceptance of sexual coercion, and perceived realism of pornography. After baseline (T1), intervention effects were measured one week after the last module (T2), nine months later (T3), and another 12 months later (T4). The intervention group showed significantly less risky sexual scripts and higher sexual self-esteem at T2, T3, and T4. The intervention indirectly reduced risky sexual behavior at T3 and T4 via less risky sexual scripts at T2 and increased sexual assertiveness at T3 and T4 via higher sexual self-esteem at T2. No intervention effects were found on the acceptance of sexual coercion and pornography realism. The implications of the findings for reducing the prevalence of sexual aggression perpetration and victimization are discussed.

Pornography Use and Sexual Scripts Among Men Who Have Committed Sexual Offenses

Drawing from sexual scripting theory, the present study employed semi-structured interviews with 101 individuals incarcerated for sexual offenses in a Midwestern minimum-security prison to explore: (1) Do individuals who have committed sexual offenses report that porn scripts influenced or informed their sexual behavior? and (2) How do participants understand the norms and values inherent in porn? Through a qualitative analysis, several themes were identified which included living the porn, transforming sex, porn as grooming and offending, and porn as risk. For some individuals, porn serves as a salient factor in how they navigate their sexual behaviors and relationships, however, most did not report relying on these scripts in their offenses. We discuss treatment and supervision implications related to pornography use.