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Clozapine is the only licensed medication for treatment-resistant schizophrenia, although it is underused. Healthcare professionals (medical and non-medical professionals) play a crucial role in the management of clozapine. Consultant psychiatrists are accountable for the initiation of clozapine, whereas non-medical professionals are often responsible for the monitoring, the management of side effects and patient education. It appears that healthcare professionals‘ (HCPs) competence and confidence may have an effect on clozapine underutilisation.
Aim:
To synthesise the most pertinent literature examining the factors influencing HCPs competence and confidence in the management of clozapine and how these factors influence variation in prescribing practice.
Methods:
A review of the literature focusing on these elements was conducted. The Population, Context, Outcome (PCO) framework was adopted to support the literature search. The databases Medline, Psychinfo, Scopus, Cinahl, Pubmed, Embase, British Library, Ethos e-thesis, Google Scholar, Dart Europe e-thesis were consulted; the search was completed in January 2025. Screening, selection, data extraction and quality assessment were conducted independently by two researchers. Thematic analysis was used to investigate and compare the data emerging from the studies.
Results:
Thirty-four articles were included in the review. Six themes were identified: attitude toward and knowledge about clozapine, misconceptions (regarding side effects, monitoring and co-morbidities), guidelines, education, training and experience. HCPs self-reported as competent with guidelines (local and national), yet they expressed less confidence in their ability to adhere to them and were uncertain about managing side effects. Lack of education, training and insufficient exposure to clozapine management were significant factors impacting competence and confidence, resulting in clozapine underuse and variance in prescribing practice. The review highlighted a gap in the literature, as only a few studies involving non-medical professionals were found.
Conclusions:
A general lack of education and training related to clozapine use was identified amongst all professionals.
The impact of educational programmes on improving competence and enhancing confidence was considered positive, however when integrated with clinical practice.
The studies identified in this review were lacking in the involvement of non-medical professionals. Given their crucial role in managing side effects and educating patients and carers, it is evident that their inclusion in future research is imperative.
When we think about ‘becoming’ or ‘being’ a teacher, we often reflect on experiences that positively impacted our learning, or those that reduced our enthusiasm or motivation. The Australian Institute for Teaching and School Leadership emphasises teachers’ significant role and responsibility in preparing children and young people to lead successful and productive lives. Building on Chapter 1, this chapter introduces core skills for the profession of teaching, highlighting communication, organisation, reflective practice and leadership for aspiring teachers. Acknowledging that teaching is a human endeavour, you will explore personal attributes, including confidence, resilience and self-care, and the process of managing, building and sustaining a career, while upholding professional standards.
We investigate how the selection process of a leader affects team performance with respect to social learning. We use a laboratory experiment in which an incentivized guessing task is repeated in a star network with the leader at the center. Leader selection is either based on competence, on self-confidence, or made at random. In our setting, teams with random leaders do not underperform. They even outperform teams with leaders selected on self-confidence. Hence, self-confidence can be a dangerous proxy for competence of a leader. We show that it is the declaration of the selection procedure which makes non-random leaders overly influential. To investigate the opinion dynamics, we set up a horse race between several rational and naïve models of social learning. The prevalent conservatism in updating, together with the strong influence of the team leader, imply an information loss since the other team members’ knowledge is not sufficiently integrated.
Our doxastic states are our belief-like states, and these include outright doxastic states and degreed doxastic states. The former include believing that p, having the opinion that p, thinking that p, being sure that p, being certain that p, and doubting that p. The latter include degrees of confidence, credences, and perhaps some phenomenal states. But we also have conviction (being convinced simpliciter that p) and degrees of conviction (being more or less convinced that p). This Element shows: how and why all of the outright doxastic states mentioned above can be reduced to conviction thresholds; what degrees of conviction fundamentally are (degreed reliance-dispositions); why degrees of conviction are not credences; when suspending a belief is compatible with continuing to believe; and the surprising extent to which Kant endorsed the theory of conviction that emerges in this Element.
Most research into the impacts of climate change concentrates on what would happen at low degrees of change. We know a great deal about best-case scenarios. Thanks to wilful ignorance among policymakers, and the cultural preferences of scientists, worst-case scenarios are much less considered. We know the least about what matters most.
Over the last decades, modeling and simulation have become central methods in engineering design. Today’s technologies enable previously unachievable levels of sophistication and accuracy. However, if decision-makers are unaware of the confidence they can place in models and simulations (M&S), they either fail to leverage their potential by not involving them in processes or make judgments based on unreliable results. Assessments to evaluate M&S exist, but factors that enable decision-makers to have confidence and improve acceptance of using M&S need to be researched in more detail. Therefore, a literature review analyzing design requirements and an online survey to measure factors associated with confidence were conducted. As a result, the survey identified nine predictors of confidence: (1) capability, (2) history, (3) validity, (4) reliability and (5) accessibility of the model. Further, (6) integrity and (7) competence of the modeler, as well as (8) trusting nature and (9) risk awareness of the stakeholder were identified. Having confidence in M&S results significantly increases the reliance on them and leads to better-informed decision-making. Therefore, based on the findings, a framework and an initial application model were developed. The results were initially evaluated and are described.
Persistence in physician-scientist careers has been suboptimal, particularly among women. There is a gender gap in self-confidence in medicine. We measured the impact of our physician-scientist training programs on trainee’s confidence in professional, personal, and scientific competencies, using a survey measuring self-rated confidence in 36 competencies across two timepoints.
Methods:
Results were analyzed for the full survey and for thematic subscales identified through exploratory factor analysis (EFA). A mixed effects linear model and a difference in differences (DID) design were used to assess the differential impact of the programing by gender and career level.
Results:
Analysis included 100 MD-PhD or MD-only medical student or resident/fellow trainees enrolled between 2020 and 2023. Five subscales were identified through EFA; career sustainability, science productivity, grant management, goal setting, and goal alignment (Cronbach’s alpha 0.85–0.94). Overall, mean scores increased significantly for all five subscales. Women significantly increased their confidence levels in all five areas, whereas men increased only in science productivity and grant management. Mixed effects models showed significant increases over time for women compared to men in career sustainability and goal alignment. Residents and fellows had greater increases than medical students across all subscales.
Conclusion:
Physician-scientist trainees fellows increased their confidence in personal, professional, and scientific skills during training. Training had a greater impact on women than men in building confidence in sustaining careers and aligning their goals with professional and institutional priorities. The magnitude of increased confidence among residents and fellows exceeded that in medical students.
This chapter discusses decisions that police should make about how to collect eyewitness identification evidence to ensure that they elicit the most accurate identification decisions from eyewitnesses. Eyewitness decisions include whether to select someone out of a lineup and whom to pick, as well as confidence in the accuracy of that choice. Although witnessing conditions – including (among others) whether the perpetrator and witnesses belong to the same racial/ethnic groups, weapon presence, and poor viewing conditions – can influence the accuracy of identification decisions, the chapter will focus primarily on how decisions made by the police about which identification procedures to use affect the accuracy of identification decisions. The chapter discusses many of these decisions in the context of the best practices that are recommended based on the available literature. Of special interest is when there is an interaction between the witness conditioning the decisions made by law enforcement. The chapter concludes with recommendations for future research on these topics.
The Skidegate dialect of the Haida, an Indigenous Nation on the West Coast of Canada, has a phrase for “staying curious.” Gina gii Giixan aanagung means “to look around with curiosity and intent.” This Haida concept holds more than curiosity; it conveys the idea of staying observant with the world on purpose. It suggests an active stance. Staying curious by asking questions, paying attention, and learning new things takes energy and action.
The Stay Curious and Adjust Decision-Maker Move is about decision makers being in a learning relationship with their choices, actively seeking to uncover and learn from new information based on their own lives and experiences as well as the conversations they have with others. It’s a recognition that many choices are repeated (with minor changes), so there are ample opportunities for self-learning and making adjustments.
Chapter 10 provides an overview of the main ideas presented in the rest of the book. The framework proposed in this book argues that the cause of dyslexia is related to an inefficiency of the phonological processing system. However, the framework also argues for cognitive and behavioural factors associated with dyslexia to lead to different consequences and outcomes. These will develop based on individual differences associated with the past experiences of the dyslexic adult. The mix of underlying skills, past experiences and current circumstances will mean that some dyslexic people succeed in their chosen area, whereas others may be less successful. The reasons for these variations in success can be highly complex and very individual, and therefore a range of ideas and strategies will be needed to support as many individuals as possible. Hence, the coverage in the book. The aim is for this to provide a basis for individuals to develop their own personalised set of strategies that can meet the challenges faced by an individual in their chosen field of work. These should provide the basis for developing resilient self-efficacy, confidence, self-understanding and expertise.
Combining experts’ subjective probability estimates is a fundamental task with broad applicability in domains ranging from finance to public health. However, it is still an open question how to combine such estimates optimally. Since the beta distribution is a common choice for modeling uncertainty about probabilities, here we propose a family of normative Bayesian models for aggregating probability estimates based on beta distributions. We systematically derive and compare different variants, including hierarchical and non-hierarchical as well as asymmetric and symmetric beta fusion models. Using these models, we show how the beta calibration function naturally arises in this normative framework and how it is related to the widely used Linear-in-Log-Odds calibration function. For evaluation, we provide the new Knowledge Test Confidence data set consisting of subjective probability estimates of 85 forecasters on 180 queries. On this and another data set, we show that the hierarchical symmetric beta fusion model performs best of all beta fusion models and outperforms related Bayesian fusion models in terms of mean absolute error.
Based on a reading of Joseph O'Neill's 2008 novel Netherland, this article discusses the relationship between cricket and finance capitalism from the perspective of time and temporality. Despite its function as a global commodity, cricket inserts a flow of postcolonial time into the temporal streams of transnational market culture, neoliberalism, and the increasing financialization of the world. Set in the aftermath of 9/11 and before the financial crisis of 2008, Netherland juxtaposes the deviant temporal power of cricket with the time structures of finance capitalism to illustrate how the conduct of Wall Street before the crisis can be understood as a colonial appropriation. In O'Neill's novel, this conflict is embodied in the precarious friendship of a cosmopolitan Dutch financial analyst and a Trinidadian version of Jay Gatsby.
Chapter 8 shows that the idea that words are social tools particularly suits abstract concepts. I first review studies on conceptual acquisition in infants and children, highlighting the crucial role social and linguistic experiences play, particularly for abstract concepts. I then review studies showing that contexts referring to social situations are more effective for processing abstract than concrete concepts. The importance of social and linguistic experiences makes it necessary to adopt new methods for studying abstract concepts. These methods, which consider language a form of participatory sense-making, focus on online dialogic interactions. The final section outlines the proposal that abstract concepts have an essential social function, enhancing social cohesion. One of the possible reasons why they are so common might be linked to our need to share and co-construct our world with others. This need is particularly evident with words, like abstract ones, the meaning of which is less anchored to perceptual stimuli and more debatable and flexible.
Our confidence, a form of metacognition, guides our behavior. Confidence abnormalities have been found in obsessive–compulsive disorder (OCD). A first notion based on clinical case–control studies suggests lower confidence in OCD patients compared to healthy controls. Contrarily, studies in highly compulsive individuals from general population samples showed that obsessive–compulsive symptoms related positively or not at all to confidence. A second notion suggests that an impairment in confidence estimation and usage is related to compulsive behavior, which is more often supported by studies in general population samples. These opposite findings call into question whether findings from highly compulsive individuals from the general population are generalizable to OCD patient populations.
Methods
To test this, we investigated confidence at three hierarchical levels: local confidence in single decisions, global confidence in task performance and higher-order self-beliefs in 40 OCD patients (medication-free, no comorbid diagnoses), 40 controls, and 40 matched highly compulsive individuals from the general population (HComp).
Results
In line with the first notion we found that OCD patients exhibited relative underconfidence at all three hierarchical levels. In contrast, HComp individuals showed local and global overconfidence and worsened metacognitive sensitivity compared with OCD patients, in line with the second notion.
Conclusions
Metacognitive functioning observed in a general highly compulsive population, often used as an analog for OCD, is distinct from that in a clinical OCD population, suggesting that OC symptoms in these two groups relate differently to (meta)cognitive processes. These findings call for caution in generalizing (meta)cognitive findings from general population to clinical samples.
This article presents self-validation theory (SVT) as a framework predicting when mental contents guide performance. First, we illustrate how confidence can validate people’s thoughts (goals, beliefs, identity) increasing and decreasing performance, depending on what thoughts are validated. This first section reviews examples of validation processes in guiding intellectual performance in academic settings, sport performance in athletes, as well as performance on diverse social tasks. SVT specifies moderating conditions for validation processes to operate. Therefore, in the second section of this review, we identify unique and testable moderators for metacognitive processes demonstrating when and for whom validation processes are more likely to occur. A third section calls for future research identifying new validating variables (e.g., preparation, courage) capable of increasing usage of unexplored thoughts relevant to performance (e.g., expectations). This final section examines new domains for validation (e.g., group performance, cheating in performance), discusses to what extent people can use self-validation strategies deliberatively to improve their performance and addresses when performance can be impaired by invalidation (e.g., due to identity threat).
Most research into the impacts of climate change concentrates on what would happen at low degrees of change. We know a great deal about best-case scenarios. Thanks to wilful ignorance among policymakers, and the cultural preferences of scientists, worst-case scenarios are much less considered. We know the least about what matters most.
The legitimacy of welfare state institutions is a key question in public policy research. In this study we examine population’s confidence in child protection systems, the role of institutional context and moral alignment. Analysing representative samples of survey data (N=6,043) of citizens in six European countries (Czechia, England, Finland, Norway, Poland and Romania), we find that overall people express confidence in their child protection system. Differences between populations are correlated with institutional context, i.e. the type of child protection system in place – that is, if people live in a country with a risk-oriented system or a family service-oriented system. People’s view on their moral alignment with the system (or not) only shows minor differences in support of interventions. However, a tendency towards polarisation is detected in Finland and Norway with clear differences in support of interventions that restrict parental rights: individuals who state they are in alignment with the system favour stronger interventions than those who say they are not.
Cebes’ challenge leads to what is typically called Socrates’ four “immortality arguments,” which structure the core of the dialogue. Despite this common label, Cebes’ challenge does not ask Socrates to show that the soul is immortal, and Socrates’ first three arguments do not claim to show immortality. Instead, Cebes challenges Socrates to address people’s fear that the soul disperses and so is destroyed when someone dies; not being destroyed upon death is, I argue, different from being immortal. After discussing Cebes’ challenge, the chapter turns to the cyclical argument, providing a new account of its basic structure. It is based on an agreement that does not require Socrates to say anything here about the nature of the soul. Nonetheless, the argument is important for aiming to show that a Pythagorean view is correct – reincarnation – by understanding death and rebirth as part of a much larger phenomenon: the coming to be and passing away of opposite things.
Six experiments investigated how the distance between one’s initial opinion and advice relates to advice utilization. Going beyond previous research, we relate advice distance to both relative adjustments and absolute adjustments towards the advice, and we also investigate a second mode of advice utilization, namely confidence shifts due to social validation.Whereas previous research suggests that advice is weighted less the more it differs from one’s initial opinion, we consistently find evidence of a curvilinear pattern. Advice is weighted less when advice distance is low and when it is high. This is in particular because individuals are much more likely to retain their initial opinions in the light of near advice. Also, absolute opinion adjustments towards the advice increases in a monotone fashion as advice distance increases. This finding is in contrast to the predictions of the theoretical framework previous studies on advice distance are based on, social judgment theory. Instead, they data are more in line with a simple stimulus-response model suggesting that absolute adjustments towards the advice increase with advice distance but—potentially—with diminished sensitivity. Finally, our data show that advice can be utilized even when it receives zero weight during belief revision. The closer advice was to the initial opinions, the more it served as a means for social validation, increasing decision-makers’ confidence in the accuracy of their final opinions. Thus, our findings suggest that advice utilization is a more complex function of advice distance than previously assumed.
Glöckner and Bröder (2011) have shown that for 77.5% of their participants’ decision making behavior in decisions involving recognition information and explicitly provided additional cues could be better described by weighted-compensatory Parallel Constraint Satisfaction (PCS) Models than by non-compensatory strategies such as recognition heuristic (RH) or Take the Best (TTB). We investigate whether this predominance of PCS models also holds in memory-based decisions in which information retrieval is effortful and cognitively demanding. Decision strategies were analyzed using a maximum-likelihood strategy classification method, taking into account choices, response times and confidence ratings simultaneously. In contrast to the memory-based-RH hypothesis, results show that also in memory-based decisions for 62% of the participants behavior is best explained by a compensatory PCS model. There is, however, a slight increase in participants classified as users of the non-compensatory strategies RH and TTB (32%) compared to the previous study, mirroring other studies suggesting effects of costly retrieval.