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The application of scientific principles in diverse science domains is widely regarded as a hallmark of expertise. However, the role of basic science knowledge and principles in clinical medicine is the subject of considerable controversy. The study examined the understanding of complex biomedical concepts related to cardiovascular physiology. Subjects at various levels of expertise were presented with questions and problems pertaining to the concepts of cardiac output and venous return. The experiment employed the combined methods of a cognitive science approach to problem-solving with a focused clinical interview approach common in science education research. / The results indicated a progression of conceptual models of the circulatory system as a function of expertise. This was evident in subjects' explanations and applications of these concepts. The study also characterized the etiology of significant misconceptions and biases, evident in subjects' reasoning at each level of expertise. / This research has implications for a theoretical model of conceptual understanding in complex science domains, as well as, implications for medical instruction. It is proposed that the development of a clinically-relevant epistemology of basic science knowledge could contribute substantially to a revised medical curriculum that could impart a more robust conceptual understanding of biomedical concepts to medical students.

This study investigated the effects of empathy training on medical students' responses to emotionally intense situations. It also explored the interaction between empathy and stress. Thirteen volunteers from a second-year medical class completed the study which utilized a two-factor crossover design. In the first of three testing situations, each subject participated in a 15-minute videotaped interview with an actor who portrayed an angry, fearful, or grieving patient. Each medical student then completed measures of empathic understanding and perceived stress regarding the encounter, as well as scales of coping and hardiness. Each simulated patient rated the medical student's level of empathic understanding. Two raters, blind to the experimental design, analyzed the tapes and rated the medical students' degree of communicated empathy. Subjects were then randomly assigned to one of two groups: training with follow-up, or control with delayed training. The first group received four 3-hour weekly sessions in empathy training while the second group served as a wait-list control. All subjects then participated in a second taped interview and completed all measures again. The subjects in group two received the training while the first group received no further treatment. All subjects were tested a third time which concluded the experimental procedure. The principal statistical analyses comprised a series of 2 x 2 ANOVAS tested at the .05 level of significance. Results revealed that, following the training, subjects learned to interact in a more empathic manner; effect sizes ranged from 1.08 to 18.32. Also, subjects' stress levels regarding the emotionally intense encounters were reduced; the effect size was -1.95. As hypothesized, these changes in empathy and stress were not observed for the wait-list control group, while training effects were maintained for subjects in the follow-up group. Changes in hardiness and coping were not statistically significant. An outline is presented which illustrates the mediating function of empathic responding in stressful interactions. Also addressed are implications for empathy training in medical education and for communication in the physician-patient relationship. / Graduate and Postdoctoral Studies / Graduate

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