Errors in First Aid for the USMLE (2007): Behavioral Science

The following is from an email sent to the First Aid Team concerning errors/corrections/suggestions to their 2007 edition.

1. Behavioral Science (references: HY Biostatistics and HY Behavioral Science)
   

   1. P.66, Statistical Distribution: I found the (mean>median>mode) v (mean<median<mode) labeling to be unintuitive for right and left skew. To emphasize the idea that the mean is sensitive to skew, the median is insensitive to skew, and the mode is totally uninfluenced by skew, the order should have instead been: (mode< median<mean) and (mean>median>mode). But even this falls somewhat short. The best diagram I have seen is on P.11 of Glasner’s HY Biostatistics. I have attached a quick drawing of it (bottom of page). It is intuitive and requires little (if any) explanation.

   2. P.68, Reportable Diseases: Of the 50+ reportable diseases nationwide (CDC website), I thought the absences of Chlamydia, Hep C, and Lyme disease from this list were significant. Should these be included, the mnemonic would have to change from “Be a smart chicken or you’re gone” to something more straightforward, like the following triplets:
      1. (Hep) ABC, MMR, SSS, TLC, SEX (AIDS, Gonorrhea, Chlamydia)
   3. P.70, Written Advanced Directive: This definition implies that a Living Will can only contain wishes to “withhold or withdrawal life-sustaining treatment.” This is not the case.
      1. Living Will: A document which specifies the life-prolonging measures an individual wants and does not want taken on his/her behalf in the event of a terminal illness or incapacitation.
      2. A Living Will, unlike a DNR/DNI order, can have instructions for both positive and negative measures.
   4. P.74, Sleep stages: Stage 3-4 is described as containing “bed-wetting” while in #6 it says, “Imipramine is used to treat enuresis…” Just to be consistent, I think it should say, “…to treat enuresis ( bed-wetting)…”
   5. P.75, Operant Conditioning: The following three lines are not consistent in their terms/descriptions and I found them to confuse the issue for me. My suggestions follow.
      1. Learning in which a particular action is elicited because it produces a reward.
      2. Positive Reinforcement – desired reward produces action (mouse presses button to get food).
      3. Negative Reinforcement – removal of aversive stimulus [up arrow] behavior (mouse presses button to avoid shock). Do not confuse with punishment. (a definition or example of punishment was never given)
         1. Operant Conditioning – learning in which a consequence produces a behavior.
         2. Positive Reinforcement – introduction of a positive stimulus [up arrow] the behavior (Child cleans room to earn money).
         3. Negative Reinforcement – removal of an aversive stimulus [up arrow] the behavior (Child cleans room to end mother’s complaining). Do not confuse with Punishment.
         4. Punishment – Learning in which a consequence (following the behavior) [down arrow] the behavior (Child is denied dessert for frequently interrupting others. Child now allows others to speak ).
   6. P.76, Immature Ego Defenses: This list is good but is missing a few terms. My suggestions for inclusion and a change to the definition of Isolation:
      1. Somatization - Psychic conflict manifested as physically real bodily symptoms – After hearing bad news, wanting to vomit.
      2. Intellectualism - avoiding/replacing emotion with intellectual detail – cancer patient obsesses over the workings of a CT machine instead of facing poor prognosis.
      3. Isolation (change) – separation of emotion from idea – a child describes his birthday party in a monotone.
      4. Undoing -carrying out symbolic behavior to atone for unacceptable action – A nun making the sign of the cross after cursing.
      5. Passive-Aggression – unconsciously falling short of expectation after creating the expectation – Friend leaves you at campus after promising to give you a ride home.

Right Skew – Left Skew

 

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