OBJECTIVES We reviewed papers describing the development of instruments for assessing clinical communication in undergraduate medical students. The instruments had important limitations: most lacked a theoretical basis, and their psychometric properties were often poor or inadequately investigated and reported. We therefore describe the development of a new instrument, the Liverpool Undergraduate Communication Assessment Scale (LUCAS), which is intended to overcome some of these limitations. We designed LUCAS to reflect the theory that communication is contextually dependent, inherently creative and cannot be fully described within a conceptual framework of discrete skills.METHODS We investigated the preliminary psychometric properties of LUCAS in two studies. To assess construct and external validity, we examined correlations between examiners' LUCAS ratings and simulated patients' ratings of their relationships with students in Year 1 formative (n = 384) and summative (n = 347) objective structured clinical examination (OSCE) samples. Item-total correlations and item difficulty analyses were also performed. The dimensionality of LUCAS was examined by confirmatory factor analysis. We also assessed interrater reliability; four raters used LUCAS to rate 40 video-recorded encounters between Year 1 students and simulated patients.RESULTS Simulated patient ratings correlated with examiner ratings across two OSCE datasets. All items correlated with the total score. Item difficulty showed LUCAS was able to discriminate between student performances. LUCAS had a two-dimensional factor structure: we labelled Factor 1 creative communication and Factor 2 procedural communication. The intraclass correlation coefficient was 0.73 (95% confidence interval 0.54-0.85), indicating acceptable reliability.CONCLUSIONS We designed LUCAS to move the primary focus of examiners away from an assessment of students' enactment of behavioural skills to a judgement of how well students' communication met patients' needs. LUCAS demonstrated adequate reliability and validity. The instrument can be administered easily and efficiently and is therefore suitable for use in medical school examinations.communication skills

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Recent research suggests people typically “give up” pursuing their New Year resolutions within the first month. The present study investigated goal features proposed to be implicated in promoting both mental wellbeing and sustained New Year resolution pursuit. Australian and UK participants (n = 182) took part in an online longitudinal study, including four timepoints over a two-month period. At baseline, participants listed the New Year resolution to which they were most committed, and completed self-report measures to assess mental wellbeing, goal flexibility and tenacity. At the follow-up surveys, participants completed the wellbeing measure and their New Year resolution commitment, effort and stickability. As predicted, flexibility predicted wellbeing across time, however, tenacity did not. Counter to prediction, neither flexibility nor tenacity reported at baseline predicted “sticking” with one’s New Year resolution. The predicted interaction between flexibility and tenacity was not significant. New Year resolutions focused predominantly on “diet” and “exercise” were predominantly the same resolutions previously pursued and tended to be relatively abstract. Although goal flexibility predicted greater wellbeing, the findings overall tend to support the view that people are not particularly good at sticking with their New Year resolutions. Implications of the findings are discussed.

Many psychological models have been developed to explain the development and maintenance of depression. The most widely evaluated model is the cognitive model of depression, and it is against this model that emerging models should be compared. Accordingly, this cross-sectional study examined whether metacognitive beliefs, as specified in the metacognitive model of depression, would explain additional variance in depressive symptoms over dysfunctional attitudes; the core feature of the cognitive model. Moreover, mediational relationships between metacognitive beliefs, rumination, and depressive symptoms, predicted by the metacognitive model were also explored, whilst controlling for dysfunctional attitudes. A sample of 715 students completed self-report questionnaires measuring depressive symptoms, rumination, dysfunctional attitudes, and metacognitive beliefs. Regression analyses showed that metacognitive beliefs made a significant statistical contribution to depressive symptoms, after controlling for age, gender, rumination and dysfunctional attitudes. Furthermore, as predicted by the metacognitive model, the relationship between positive metacognitive beliefs and depressive symptoms was fully mediated by rumination, whilst the relationship between negative metacognitive beliefs about uncontrollability and danger and depressive symptoms was partially mediated by rumination. The results provide further empirical support for the metacognitive model of depression and indicate that positive and negative metacognitive beliefs play an integral role in the maintenance of depressive symptoms.

Research has implicated motivation and goal regulation in susceptibility to mood disorders. We studied for the first time key facets of motivation and goal regulation concurrently in relation to affective symptoms. The cross-national sample comprised 510 university students from the United States (n = 279) and United Kingdom (n = 231). Participants completed self-report measures of motivation, conditional goal setting, urgency, depression, anxiety, and mania risk. Structural Equation Modeling results found that behavioral activation system scores correlated negatively with depression and positively with mania risk, but were unrelated to anxiety. High conditional goal setting correlated uniquely with higher depression but not to anxiety or mania risk. Urgency correlated with higher anxiety, depression, and mania risk. Behavioral inhibition system scores correlated negatively with mania risk but unexpectedly did not correlate with anxiety in the multivariate model. The behavioral activation, behavioral inhibition, conditional goal setting, and urgency results showed shared and distinct patterns of relationships with depression, anxiety and mania risk. Our findings indicate unique and common risk vulnerabilities in depressive, anxious, and manic syndromes and extend an integrative knowledge of these syndromes in relation to goal regulation.

ObjectiveThere has been growing interest in the use of cognitive analytic therapy (CAT) with those facing experiences of psychosis. However, there is little research on how CAT is best applied to working with psychosis. This study aimed to identify what the key aspects of CAT for psychosis are or whether this approach requires adaptation when applied to those with experiences of psychosis, drawing on expert opinion.MethodAn adapted Delphi methodology was used. Items were generated during an initial workshop (N = 24) and then rated for agreement or importance via an online survey by a sample of experts with experience of CAT and working clinically with psychosis (N = 14).ResultsFollowing two rounds of ratings, consensus was reached on most items. Additional comments emphasized the need to be flexible with regard to the varying needs of individual clients.ConclusionsResults highlight the specific relational understanding of psychosis provided by CAT as one of the key elements of this approach. Responses emphasized the need for some level of adaptation to work with psychosis, including greater flexibility with regard to the treatment frame.Practitioner Points When working with experiences of psychosis, aspects of the CAT model, such as session length, pacing, and duration of therapy, are open to change and may require modification.When working with experiences of psychosis, narrative reformulation letters and sequential diagrammatic reformulation (SDR) remain essential to the therapy.This Delphi methodology study essentially relies on opinion. Further empirical research could test assumptions about the most important or therapeutically effective components of CAT in psychosis.CAT is still not widely used in the context of psychosis limiting the pool of experts available for the current sample.

Actual-ideal and actual-ought self-discrepancies have been theorised to be independently associated with depressive and anxious symptoms respectively. This study tested this prediction and extended it to consider whether rumination mediates these relationships. One hundred and thirty-eight students (48 males, 90 females) listed four adjectives describing how they would ideally hope to be and four adjectives describing how they ought to be.Participants then rated how distant they perceived themselves to be from each of their ideal and ought selves, as well as the importance of each ideal and ought self. Finally, participants self-reported levels of negative rumination, anxious and depressive symptoms. Actual-ideal self-discrepancy was independently associated with both anxious and depressive symptoms, whereas actual-ought self-discrepancy was independently associated with anxious symptoms only. Rumination mediated the independent relationships between actual-ideal selfdiscrepancy and anxious and depressive symptoms. Actual-ought self-discrepancy retained an independent association with anxious symptoms that was not mediated through rumination.Anxious and depressive symptoms both have independent associations with actual-ideal selfdiscrepancies, whereas anxious symptoms are uniquely associated with actual-ought selfdiscrepancies. We reveal further evidence for rumination as a cognitive-motivational transdiagnostic process linking self-regulatory difficulties with anxious and depressive symptoms.