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McIntosh T, Antes AL, Schenk E, Rolf L, DuBois JM. Addressing serious and continuing research noncompliance and integrity violations through action plans: Interviews with institutional officials. Account Res 2023:1-33. [PMID: 36896610 PMCID: PMC10493235 DOI: 10.1080/08989621.2023.2187292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
Serious and continuing research noncompliance and integrity violations undermine the quality of research and trust in science. When researchers engage in these behaviors, institutional officials (IOs) often develop corrective action plans. Ideally, such plans address the root causes so noncompliance or research integrity violations discontinue. The aim of this study was to identify what IOs perceive as causes and action plan activities typically prescribed. We conducted semi-structured in-depth interviews with 47 IOs at research institutions across the U.S. including: institutional review board and institutional animal care and use committee chairs and directors, chief research officers, research compliance and integrity officers, and institutional conflicts of interest chairs and directors. The most common root causes identified were: 1) lack of knowledge or training, 2) failure to provide research team supervision, and 3) researcher attitudes toward compliance. The most common action plan activities include: 1) retraining in compliance or research integrity, 2) follow-up and hands-on involvement with the researcher, and 3) mandated oversight or mentoring. Because the most commonly identified action plan activities fail to adequately address the majority of root causes, our findings suggest a need for IOs to rethink existing approaches to action plan development to more effectively target root causes.
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Affiliation(s)
- Tristan McIntosh
- Bioethics Research Center, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA
| | - Alison L Antes
- Bioethics Research Center, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA
| | - Emily Schenk
- Bioethics Research Center, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA
| | - Liz Rolf
- Bioethics Research Center, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA
| | - James M DuBois
- Bioethics Research Center, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA
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Solomon ED, Mozersky J, Goodman M, Parsons MV, Baldwin KA, Friedrich AB, Harris JK, DuBois JM. A randomized implementation trial to increase adoption of evidence-informed consent practices. J Clin Transl Sci 2022; 7:e28. [PMID: 36721403 PMCID: PMC9884547 DOI: 10.1017/cts.2022.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Several evidence-informed consent practices (ECPs) have been shown to improve informed consent in clinical trials but are not routinely used. These include optimizing consent formatting, using plain language, using validated instruments to assess understanding, and involving legally authorized representatives when appropriate. We hypothesized that participants receiving an implementation science toolkit and a social media push would have increased adoption of ECPs and other outcomes. Methods We conducted a 1-year trial with clinical research professionals in the USA (n = 1284) who have trials open to older adults or focus on Alzheimer's disease. We randomized participants to receive information on ECPs via receiving a toolkit with a social media push (intervention) or receiving an online learning module (active control). Participants completed a baseline survey and a follow-up survey after 1 year. A subset of participants was interviewed (n = 43). Results Participants who engaged more with the toolkit were more likely to have tried to implement an ECP during the trial than participants less engaged with the toolkit or the active control group. However, there were no significant differences in the adoption of ECPs, intention to adopt, or positive attitudes. Participants reported the toolkit and social media push were satisfactory, and participating increased their awareness of ECPs. However, they reported lacking the time needed to engage with the toolkit more fully. Conclusions Using an implementation science approach to increase the use of ECPs was only modestly successful. Data suggest that having institutional review boards recommend or require ECPs may be an effective way to increase their use.
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Affiliation(s)
- Erin D. Solomon
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jessica Mozersky
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Melody Goodman
- School of Global Public Health, New York University, New York, NY, USA
| | - Meredith V. Parsons
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Kari A. Baldwin
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Annie B. Friedrich
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jenine K. Harris
- George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - James M. DuBois
- Bioethics Research Center, Washington University School of Medicine, St. Louis, MO, USA
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Solomon ED, Mozersky J, Wroblewski M, Baldwin K, Parsons M, Goodman M, DuBois JM. Understanding the Use of Optimal Formatting and Plain Language When Presenting Key Information in Clinical Trials. J Empir Res Hum Res Ethics 2022; 17:177-192. [PMID: 34410175 PMCID: PMC8712347 DOI: 10.1177/15562646211037546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent revisions to the Common Rule require that consent documents begin with a focused presentation of the study's key information that is organized to facilitate understanding. We surveyed 1,284 researchers working with older adults or individuals with Alzheimer's disease, supplemented with 60 qualitative interviews, to understand current use and barriers to using evidence-based formatting and plain language in key information. Researchers reported using formatting in 42% of their key information sections, and plain language in 63% of their key information sections. Perceived barriers included lack of knowledge, Institutional Review Board, other members of their team, and the burden associated with implementation. Education and training are required to increase adoption of the practices.
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Affiliation(s)
| | | | | | - Kari Baldwin
- Washington University School of Medicine in St. Louis (USA)
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Donnelly DL. First Do No Harm: Legal Principles Regulating the Future of Artificial Intelligence in Health Care in South Africa. POTCHEFSTROOM ELECTRONIC LAW JOURNAL 2022; 25:10.17159/1727-3781/2022/v25ia11118. [PMID: 35634136 PMCID: PMC9142793 DOI: 10.17159/1727-3781/2022/v25ia11118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
What sets AI systems and AI-powered medical robots apart from all other forms of advanced medical technology is their ability to operate at least to some degree autonomously from the human health care practitioner and to use machine-learning to generate new, often unforeseen, analysis and predictions. This poses challenges under the current framework of laws, regulations, and ethical guidelines applicable to health care in South Africa. The article outlines these challenges and sets out guiding principles for a normative framework to regulate the use of AI in health care. The article examines three key areas for legal reform in relation to AI in health care. First, it proposes that the regulatory framework for the oversight of software as a medical device needs to be updated to develop frameworks for adequately regulating the use of such new technologies. Secondly, it argues that the present HPCSA guidelines for health care practitioners in South Africa adopt an unduly restrictive approach centred in the outmoded semantics of telemedicine. This may discourage technological innovation that could improve access to health care for all, and as such the guidelines are inconsistent with the national digital health strategy. Thirdly, it examines the common law principles of fault-based liability for medical negligence, which could prove inadequate to provide patients and users of new technologies with redress for harm where fault cannot clearly be attributed to the healthcare practitioner. It argues that consideration should be given to developing a statutory scheme for strict liability, together with mandatory insurance, and appropriate reform of product liability pertaining to technology developers and manufacturers. These legal reforms should not be undertaken without also developing a coherent, human-rights centred policy framework for the ethical use of AI, robotics, and related technologies in health care in South Africa.
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Perceived barriers to assessing understanding and appreciation of informed consent in clinical trials: A mixed-method study. J Clin Transl Sci 2021; 5:e164. [PMID: 34589234 PMCID: PMC8453455 DOI: 10.1017/cts.2021.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Participants and research professionals often overestimate how well participants understand and appreciate consent information for clinical trials, and experts often vary in their determinations of participant’s capacity to consent to research. Past research has developed and validated instruments designed to assess participant understanding and appreciation, but the frequency with which they are utilized is unknown. Methods: We administered a survey to clinical researchers working with older adults or those at risk of cognitive impairment (N = 1284), supplemented by qualitative interviews (N = 60). Results: We found that using a validated assessment of consent is relatively uncommon, being used by only 44% of researchers who had an opportunity. Factors that predicted adoption of validated assessments included not seeing the study sponsor as a barrier, positive attitudes toward assessments, and being confident that they had the resources needed to implement an assessment. The perceived barriers to adopting validated assessments of consent included lack of awareness, lack of knowledge, being unsure of how to administer such an assessment, and the burden associated with implementing this practice. Conclusions: Increasing the use of validated assessments of consent will require educating researchers on the practice and emphasizing very practical assessments, and may require Institutional Review Boards (IRBs) or study sponsors to champion the use of assessments.
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DuBois JM. Collective Apathy and Racial Health Disparities in the USA: the Need for Empathy-Building and Examples of Positive Change. J Gen Intern Med 2021; 36:2123-2124. [PMID: 33655383 PMCID: PMC8298661 DOI: 10.1007/s11606-021-06673-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- James M DuBois
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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McIntosh T, Antes AL, DuBois JM. Navigating Complex, Ethical Problems in Professional Life: a Guide to Teaching SMART Strategies for Decision-Making. JOURNAL OF ACADEMIC ETHICS 2021; 19:139-156. [PMID: 34177401 PMCID: PMC8221192 DOI: 10.1007/s10805-020-09369-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article demonstrates how instructors of professionalism and ethics training programs can integrate a professional decision-making tool in training curricula. This tool can help trainees understand how to apply professional decision-making strategies to address the threats posed by a variety of psychological and environmental factors when they are faced with complex professional and ethical situations. We begin by highlighting key decision-making frameworks and discussing factors that may undermine the use of professional decision-making strategies. Then, drawing upon findings from past research, we present the "SMART" professional decision-making framework: seeking help, managing emotions, anticipating consequences, recognizing rules and context, and testing assumptions and motives. Next, we present a vignette that poses a complex ethical and professional challenge and illustrate how each professional decision-making strategy could or should be used by characters in the case. To conclude, we review a series of educational practices and pedagogical tools intended to help trainers facilitate trainee learning, retention, and application of "SMART" decision-making strategies.
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Affiliation(s)
- Tristan McIntosh
- Bioethics Research Center, Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Alison L. Antes
- Bioethics Research Center, Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - James M. DuBois
- Bioethics Research Center, Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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DuBois JM, Antes AL. Five Dimensions of Research Ethics: A Stakeholder Framework for Creating a Climate of Research Integrity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:550-555. [PMID: 29068823 PMCID: PMC5916747 DOI: 10.1097/acm.0000000000001966] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The authors explore five dimensions of research ethics: (1) normative ethics, which includes meta-ethical questions; (2) compliance with regulations, statutes, and institutional policies; (3) the rigor and reproducibility of science; (4) social value; and (5) workplace relationships. Each of the five dimensions is important not only because it addresses an aspect of good research done in a good manner but also because it addresses the concerns of key stakeholders in the research enterprise. The five-dimension framework can guide institutions as they answer three questions central to any research ethics program: (1) Who should champion research ethics? (2) What should interventions look like? and (3) Who should participate in the interventions? The framework is valuable because the answers to these three questions are radically different depending on the dimension under consideration. An expanded vision of research ethics does not entail that institutions should require additional online training or approvals from institutional review boards. However, without acknowledging all five dimensions, programs risk missing an important aspect of research ethics or ignoring the interests of important stakeholders.
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Affiliation(s)
- James M DuBois
- J.M. DuBois is Steven J. Bander Professor of Medical Ethics and Professionalism and director, Center for Clinical and Research Ethics, Washington University School of Medicine, St. Louis, Missouri. A.L. Antes is assistant professor of medicine and assistant director, Center for Clinical and Research Ethics, Washington University School of Medicine, St. Louis, Missouri
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McIntosh T, Higgs C, Mumford M, Connelly S, DuBois J. Continuous Evaluation in Ethics Education: A Case Study. SCIENCE AND ENGINEERING ETHICS 2018; 24:727-754. [PMID: 28616839 DOI: 10.1007/s11948-017-9927-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/23/2017] [Indexed: 05/26/2023]
Abstract
A great need for systematic evaluation of ethics training programs exists. Those tasked with developing an ethics training program may be quick to dismiss the value of training evaluation in continuous process improvement. In the present effort, we use a case study approach to delineate how to leverage formative and summative evaluation measures to create a high-quality ethics education program. With regard to formative evaluation, information bearing on trainee reactions, qualitative data from the comments of trainees, in addition to empirical findings, can ensure that the training program operates smoothly. Regarding summative evaluation, measures examining trainee cognition, behavior, and organization-level results provide information about how much trainees have changed as a result of taking the ethics training. The implications of effective training program evaluation are discussed.
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Affiliation(s)
- Tristan McIntosh
- Department of Psychology, Center for Applied Social Research, The University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA.
| | - Cory Higgs
- Department of Psychology, Center for Applied Social Research, The University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Michael Mumford
- Department of Psychology, Center for Applied Social Research, The University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Shane Connelly
- Department of Psychology, Center for Applied Social Research, The University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - James DuBois
- Washington University School of Medicine in St. Louis, 4523 Clayton Ave., CB 8005, St. Louis, MO, 63110, USA
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DuBois JM, Chibnall JT, Tait R, Vander Wal JS. The Professionalism and Integrity in Research Program: Description and Preliminary Outcomes. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:586-592. [PMID: 28640035 PMCID: PMC5738297 DOI: 10.1097/acm.0000000000001804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Violations of rules and regulations in research can cause significant problems for human participants, animal subjects, data integrity, institutions, and investigators. The Professionalism and Integrity in Research Program (PI Program) provides remediation training that addresses the root causes of violations of rules and regulations in research. Through assessments, a three-day workshop, and follow-up coaching calls, the PI Program teaches evidence-based decision-making strategies designed to help researchers to compensate for bias, uncertainty, and work-related stress, and foster the skills needed to oversee research projects in today's complex regulatory environments. Across its first three years (2013-2015), the program trained 39 researchers from 24 different institutions in the United States. Participant evaluations of the program's faculty and workshop content were highly positive (4.7-4.8 and 4.5-4.6, respectively, on a 5-point scale). Preliminary program outcome assessment using validated measures of professional decision making and cognitive distortions in a pre- and postworkshop design indicated significant improvements. A follow-up survey of participants found statistically significant increases in a variety of target behaviors, including training research staff members to foster compliance and research quality, using standard operating procedures to support compliance and research integrity, performing self-audits of research operations, reducing job stressors, actively overseeing the work of the research team, and seeking help when experiencing uncertainty. Assessment of the PI Program was conducted with modest sample sizes, yet evaluation, outcome assessment, and self-reported survey data provided statistically significant evidence of effectiveness in achieving program goals.
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Affiliation(s)
- James M. DuBois
- 1J.M. DuBois is Steven J. Bander Professor of Medical Ethics and Professionalism and director, Center for Clinical and Research Ethics, Washington University School of Medicine, St. Louis, Missouri
| | - John T. Chibnall
- 2J.T. Chibnall is professor of psychiatry and behavioral neuroscience and director, Statistics & Design Section, Grants Development Office, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Raymond Tait
- 3R. Tait is professor of psychiatry and interim director of research, Cancer Center at Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jillon S. Vander Wal
- 4J.S. Vander Wal is professor of psychology and director, Clinical Psychology Graduate Program, Saint Louis University, St. Louis, Missouri
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Holm S, Hofmann B. Investigating the Reliability and Factor Structure of Kalichman’s “Survey 2: Research Misconduct” Questionnaire: A Post Hoc Analysis Among Biomedical Doctoral Students in Scandinavia. J Empir Res Hum Res Ethics 2017; 12:199-205. [DOI: 10.1177/1556264617714658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Søren Holm
- University of Oslo, Norway
- The University of Manchester, UK
- Aalborg University, Denmark
| | - Bjørn Hofmann
- University of Oslo, Norway
- Norwegian University of Science and Technology, Gjøvik, Norway
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Antes AL, Chibnall JT, Baldwin KA, Tait RC, Vander Wal JS, DuBois JM. Making Professional Decisions in Research: Measurement and Key Predictors. Account Res 2017; 23:288-308. [PMID: 27093003 DOI: 10.1080/08989621.2016.1171149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The professional decision-making in research (PDR) measure was administered to 400 National Institutes of Health (NIH)-funded and industry-funded investigators, along with measures of cynicism, moral disengagement, compliance disengagement, impulsivity, work stressors, knowledge of responsible conduct of research (RCR), and socially desirable response tendencies. Negative associations were found for the PDR and measures of cynicism, moral disengagement, and compliance disengagement, while positive associations were found for the PDR and RCR knowledge and positive urgency, an impulsivity subscale. PDR scores were not related to socially desirable responding, or to measures of work stressors and the remaining impulsivity subscales. In a multivariate logistic regression analysis, lower moral disengagement scores, higher RCR knowledge, and identifying the United States as one's nation of origin emerged as key predictors of stronger performance on the PDR. The implications of these findings for understanding the measurement of decision-making in research and future directions for research and RCR education are discussed.
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Affiliation(s)
- Alison L Antes
- a Division of General Medical Sciences , Washington University School of Medicine , St. Louis , Missouri , USA
| | - John T Chibnall
- b Department of Psychiatry , Saint Louis University School of Medicine , St. Louis , Missouri , USA.,c Department of Psychology , Saint Louis University , St. Louis , Missouri , USA
| | - Kari A Baldwin
- a Division of General Medical Sciences , Washington University School of Medicine , St. Louis , Missouri , USA
| | - Raymond C Tait
- b Department of Psychiatry , Saint Louis University School of Medicine , St. Louis , Missouri , USA
| | - Jillon S Vander Wal
- c Department of Psychology , Saint Louis University , St. Louis , Missouri , USA
| | - James M DuBois
- a Division of General Medical Sciences , Washington University School of Medicine , St. Louis , Missouri , USA
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Master Z, McDonald M, Paciulli D, Longstaff H. A Primer on Ethics Education for Stem Cell and Biomedical Scientists. CURRENT STEM CELL REPORTS 2016. [DOI: 10.1007/s40778-016-0064-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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DuBois JM, Chibnall JT, Tait RC, Vander Wal JS, Baldwin KA, Antes AL, Mumford MD. Professional Decision-Making in Research (PDR): The Validity of a New Measure. SCIENCE AND ENGINEERING ETHICS 2016; 22:391-416. [PMID: 26071940 PMCID: PMC4819725 DOI: 10.1007/s11948-015-9667-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/03/2015] [Indexed: 05/06/2023]
Abstract
In this paper, we report on the development and validity of the Professional Decision-Making in Research (PDR) measure, a vignette-based test that examines decision-making strategies used by investigators when confronted with challenging situations in the context of empirical research. The PDR was administered online with a battery of validity measures to a group of NIH-funded researchers and research trainees who were diverse in terms of age, years of experience, types of research, and race. The PDR demonstrated adequate reliability (alpha = .84) and parallel form correlation (r = .70). As hypothesized, the PDR was significantly negatively correlated with narcissism, cynicism, moral disengagement, and compliance disengagement; it was not correlated with socially desirable responding. In regression analysis, the strongest predictors of higher PDR scores were low compliance disengagement, speaking English as a native language, conducting clinical research with human subjects, and low levels of narcissism. Given that the PDR was written at an eighth grade reading level to be suitable for use with English as a second language participants and that only one-fourth of items focused on clinical research, further research into the possible roles of culture and research ethics training across specialties is warranted. This initial validity study demonstrates the potential usefulness of the PDR as an educational outcome assessment measure and a research instrument for studies on professionalism and integrity in research.
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Affiliation(s)
- James M DuBois
- Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO, 63110, USA.
| | - John T Chibnall
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, Monteleone Hall, 1438 S. Grand Boulevard, St. Louis, MO, 63104, USA
- Department of Psychology, Saint Louis University, 3700 Lindell Boulevard, Morrissey Hall, St. Louis, MO, 63108, USA
| | - Raymond C Tait
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, Monteleone Hall, 1438 S. Grand Boulevard, St. Louis, MO, 63104, USA
| | - Jillon S Vander Wal
- Department of Psychology, Saint Louis University, 3700 Lindell Boulevard, Morrissey Hall, St. Louis, MO, 63108, USA
| | - Kari A Baldwin
- Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO, 63110, USA
| | - Alison L Antes
- Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO, 63110, USA
| | - Michael D Mumford
- Department of Psychology, University of Oklahoma, 455 W. Lindsey Street, Dale Hall Tower, Norman, OK, 73019, USA
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