Procedures in the Hybrid Operating Room

Joel A. Kaplan MD, CPE, FACC , in Kaplan's Cardiac Anesthesia , 2017

Multidisciplinary Team

Two important issues must be highlighted when evolving a TAVR program: First, it is not a solo procedure that can be done only by a group of physicians away from other team members. This team approach, which is known also as an MDT approach, is essential for a successful procedure. While the importance of full collaboration between interventional cardiologist and cardiac surgeon is obvious, it is even more critical to incorporate other key providers from other physician groups (eg, anesthesiology, radiology, noninvasive cardiology, intensive care) into the process (Fig. 27.4). Second, it is important to emphasize that TAVR therapy program is a process that starts outside the OR with patient evaluation and selection of suitability for this procedure and does not stop after the procedure, but continues in the postoperative period. 5

Considering the different personalities of each team member may help to create a high-performing MDT. To accomplish this, the Myers-Briggs Type Indicator may be useful 78 (Fig. 27.5). A balanced team should have members with comparable personalities in terms of attitude and function to ensure free communication during the procedure. Of course, there must be one in the team who is theprimus inter pares person (usually the interventionist). However, it is also important that everyone in the team feels free to communicate whenever they think that there is a problem.

Responsibilities for the different heart team members must be assigned before starting the procedure:

•

Normally, instrumentation of the patient as well as anesthetic management belongs to the anesthesiologist.

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The intervention itself is performed by cardiologists, cardiac surgeons, or (ideally) both.

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Temporary transvenous pacemaker implantation can be done by the anesthesiologist from the jugular vein or by the interventionist from the femoral vein.

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Rapid pacing can be induced by the anesthesiologist or by the interventionist. No matter who is responsible, clear communication is mandatory.

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Echocardiographic imaging is done by the anesthesiologist or an echocardiographer.

Measures of Personality across Cultures

Velichko H. Fetvadjiev , Fons J.R. van de Vijver , in Measures of Personality and Social Psychological Constructs, 2015

Myers–Briggs Type Indicator (MBTI)

(Myers et al., 1998).

The MBTI has been developed to measure the assignment of individuals into one of 16 personality types (derived from the combination of four dichotomous attitudes or functioning styles: Extraversion–Introversion, Judgment–Perception, Thinking–Feeling, and Sensing–Intuition) inspired from Jung's (1921/1971) theory. The instrument has multiple forms with different scoring formats. Rather than sum scores indicating standing on an underlying trait, the scales provide type assignments. The MBTI has been claimed to be 'the most widely used personality inventory in the world' (McCaulley & Moody, 2008, p. 408). It has been translated into more than 30 languages, of which over 10 versions are approved by the publisher. However, there are no direct examinations of cross-cultural equivalence in a factor-analytic and DIF framework. The theoretical types have nonetheless been replicated in all cultures examined, with varying distribution (McCaulley & Moody, 2008). Only (satisfactory) data from monocultural studies were reported by McCaulley and Moody (2008). References to some (hardly accessible) publications on studies in non-US populations have also been provided. A number of concerns have been raised regarding the psychometric properties of the MBTI (Boyle, 1995; McCrae & Costa, 1989). Despite the MBTI's popularity, the instrument's adequacy for cross-cultural comparisons cannot be assessed in the psychometric framework adopted in the present review.

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Personality Traits and the Inventories that Measure Them

Michael C. Ashton , in Individual Differences and Personality (Second Edition), 2013

The Myers–Briggs Type Indicator (MBTI)

The MBTI (Myers & McCaulley, 1985) is loosely based on a theory of psychological "types" developed by the Swiss psychologist Carl Jung. The MBTI consists of nearly 100 self-report items that each contain two statements; the respondent chooses which item best describes him or her. The MBTI assesses four characteristics. Unlike most other inventories, people do not obtain numerical scores for each characteristic, but instead are assigned to one pole or another of each characteristic. For example, instead of obtaining a certain score on the extraversion scale, an individual is declared as an "extravert" (E) if he or she answers most questions in the extraverted direction, or alternatively is declared as an "introvert" (I) if he or she answers most questions in the introverted direction. (Sometimes, a difference in response to one question could make the difference between being declared, say, an extravert as opposed to an introvert.) On the basis of this method of scoring, each person is assigned a "type" based on the combination of his or her scores on the four scales.

The MBTI is used very widely in business settings, for example in seminars aimed at improving employees' self-understanding and understanding of each other. Moreover, some studies have shown some support for the construct validity of the MBTI (McCrae & Costa, 1989). However, one shortcoming of the MBTI is that it loses a great deal of precision by describing people in terms of only two levels of each characteristic rather than in terms of a more specific score on each characteristic. For example, consider a person who is slightly on the "extraverted" side of the boundary between extraverts and introverts: This person would actually be more similar to a slightly "introverted" person than to an extremely "extraverted" person. (In the same way, suppose that we had to describe everyone's height as being either "tall" or "short." A "tall" 5-foot-10 person would actually be much closer in height to a "short" 5-foot-6 person than to a "tall" 6-foot-6 person.)

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Resiliency Study for First and Second Year Medical Residents

David P. Armentrout PhD , ... Danny W. Stout PhD , in Practical Predictive Analytics and Decisioning Systems for Medicine, 2015

Myers & Briggs Type Indicator

Finally, the Myers & Briggs Type Indicator (Myers and McCaulley, 1985; McCaulley, 1990) comprises variables 139 to 146. McCaulley (1990) provides this description of the types.

The MBTI items are concerned with four bi-polar preferences; items force choices between two equally valuable poles of each preference to determine the relative preference of one over the other. The four preferences are as follows:

Extraversion attitude (E) or Introversion attitude (1). In the extraverted attitude (E), persons seek engagement with the environment and give weight to events in the world around them. In the introverted attitude (I), persons seek engagement with their inner world and give weight to concepts and ideas to understand events.

Sensing perception (S) or intuitive perception (N). When using sensing perception (S), persons are interested in what is real, immediate, practical, and observable by the senses. When using intuitive perception (N), persons are interested in future possibilities, implicit meanings, and symbolic or theoretical patterns suggested by insight.

Thinking judgment (T) or Feeling judgment (F). When using thinking judgment (T), persons rationally decide through a process of logical analysis of causes and effects. When using feeling judgment (F), persons rationally decide by weighing the relative importance or value of competing alternatives.

Judgment (J) or Perception (P). When the orientation toward the world uses judgment (J), persons enjoy moving quickly toward decisions and enjoy organizing, planning, and structuring. When the orientation to the world uses perception (P), persons enjoy being curious and open to changes, preferring to keep options open in case something better turns up.

(McCaulley, 1990, paras 11–15)

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Measures of Personality

Carina Coulacoglou , Donald H. Saklofske , in Psychometrics and Psychological Assessment, 2017

The Myers–Briggs Type Indicator

One of the most widely known self-report inventories is the Myers–Briggs Type Indicator (MBTI), which is based on Jungian theory. The MBTI is a four-factor model that allows people to describe themselves by four letters (e.g., ENTJ or ISFP) that represent their particular type. The scale yields eight scores (one for each type) that can be considered on four typological opposites (e.g., Introversion or Extraversion) (Paul, 2004).

According to McCrae and Costa (1989), the MBTI is unusual among personality assessment for three reasons: it is based on a sophisticated and established theory (Jungian); it purports to measure types rather than traits specified on a continuous scale; and it is widely used to explain individuals' personality characteristics not only to professionals, but also to the individuals themselves, as well as to their coworkers, friends, and families. The authors also point out its limitations: the original Jungian concepts are distorted and even contradicted; there is no bimodal distribution of preference scores; and studies using the MBTI have frequently not confirmed either the theory or the measure.

It is composed of 94 forced-choice items that yield scores on each of the eight factors, as well as the famous four dimensions: Introversion–Extraversion, Sensation–Intuition, Thinking–Feeling, and Judging–Perceiving. Respondents are classified into one of 16 personality types based on the largest score obtained for each bipolar scale (e.g., a person scoring higher on Introversion than Extraversion, Intuition than Sensation, Feeling than Thinking, and Judging than Perceiving would be classified as an Introverted Intuitive Feeling Judging type).

The MBTI-Form G (Briggs-Myers & Briggs, 1985) provides linear scores on each dimension, which are usually discussed in terms of types based on cutoff scores. Thus the Extraversion–Introversion dimension has a normal distribution, with high scores being considered Extraverted and low scores being considered Introverted. The MBTI has been the focus of extensive research, which overall supports the inventory's satisfactory concurrent and predictive validity and reliability (Furnham & Stringfield, 1993).

Validity studies have explored the relationship between the MBTI and other measures, such as the 16PF and the NEO-PI-R. For example, Saggino and Kline (1996) looked at correlations between the MBTI and Cattell's 16PF, as well as the Eysenck Personality Questionnaire. Their factor analysis of the MBTI yielded five factors. They argued that the EI (Extraversion–Introversion) dimension is clear, but the TF (Thinking–Feeling) dimension is "not sufficiently pure" because it loads onto different factors.

There have been a number of studies that have related the Big Five personality traits to the personality disorders, suggesting significant overlap (Samuel & Widiger, 2008; Bastiaansen, Rossi, Schotte, & De Fruyt, 2011). Some studies have related the MBTI to dark-side traits (Janowsky, Morter, & Hong, 2002). It should be noted, however, that proponents of the MBTI insist that the measure was never designed to measure, nor does it measure, "pathology" or mental illness of any form (Quenk, 2009).

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Assessment in Sport Psychology

Marc-Simon Sagal , ... Geoffrey E. Miller , in Encyclopedia of Applied Psychology, 2004

6.6 Myers–Briggs Type Indicator (MBTI)

Year created: 1962

Authors: Myers & Briggs

Based on Jungian personality theory, this is the most widely used personality inventory in the world, with more than 2 million test takers annually. MBTI has a variety of applications in the worlds of personal development and management consulting. Its primary use in sport settings is for team cohesion and increasing awareness between teammates and coaches. Personality preference is measured along four dichotomies: Extraversion/Introversion, Sensing/Intuition, Thinking/Feeling, and Judging/Perceiving. Combinations of these scales produce a four-letter acronym that reflects the dominant score on each factor. These acronyms correspond to 16 different personality types that describe persons in detail according to behaviors associated with their personalities.

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Internet-based Psychological Testing and Assessment

Azy Barak , in Online Counseling (Second Edition), 2011

Key Terms

Deindividuation

A psychological process characterized by reduced individual self-evaluation and decreased inhibition in crowd situations.

Disinhibition

Abolition or reduction of psychological mechanisms that govern spontaneous behavior.

Ecological validity

The degree to which findings obtained from research in controlled situations may be generalized and found relevant under other circumstances and more natural environments.

Factor structure

The basic main dimensions or psychological constructs underlying responses to a given test.

Myers-Briggs Type Indicator (MBTI)

A well-known, widely used personality assessment test based on Jung's typology of personality.

Normative data

Statistical parameters of a comparison group by which an individual person's test results are analyzed.

Projective test

A psychological test in which people are asked to respond to ambiguous stimuli (e.g., pictures, unfinished sentences) and in which they supposedly express their individual needs and desires.

Psychological assessment

A set of various procedures, including written tests, interviews, appraisal of group behavior, and other measures, carried out in order to evaluate a person's personality and various traits.

Psychometric properties

Quality of measurement of a psychological test, assessed by several factors, such as reliability and validity.

Qualitative

Based on subjective analysis and impression rather than objective, measured assessment.

Reliability

The degree to which a test consistently measures a trait or construct.

Rorschach inkblot test

A projective test in which people are presented with symmetrical ink stains and asked to tell what they see in them.

Social desirability

The general tendency of people to do and say things so others value and like them.

Thematic Apperception Test (TAT)

A projective test that is based on creating personal stories stimulated by given standard pictures.

Validity

The degree to which a test measures the concept it is supposed to measure.

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Forensic Psychology in Contemporary Society

T.D. Crespi , L.A. O'Leary , in Encyclopedia of Human Behavior (Second Edition), 2012

Assessment

The unique role of psychological testing (i.e., psychological assessment) has remained an important area of practice for forensic psychologists. Psychological testing provides the court with both quantitative and qualitative data which can encompass intellectual abilities, cognitive reasoning, personality strengths and weaknesses, competency data, mental status information, and data pertaining to neuropsychological functioning. Although specific tests chosen for forensic practice vary greatly, selected psychological tests often used include the Minnesota Multiphasic Personality Inventory, Wechsler Intelligence Scales, California Psychological Inventory, 16 Personality Factor Questionnaire, Myers–Brigg Type Indicator, Rorschach, Thematic Apperception Test, Bender–Gestalt, and Projective Drawings. Certainly, though, there are literally hundreds of assessment instruments commonly used by forensic psychologists in order to systematically evaluate, diagnose, and gather material on clients.

For many professionals in the court system, psychological testing is truly an integral aspect of the testimony of the forensic psychologist. The expectation, generally, is that psychological test results provide objective, impartial, psychological information which can inform the testimony of the forensic psychologist. However, psychological tests provide data only about current functioning and do not accurately predict future behavior. Nonetheless, psychological testing can provide comparisons with the normative sample on which the test was developed and provide indications of psychological and psychiatric disorders which can be invaluable for court systems.

Of no surprise, the questions often asked of the forensic psychologist in a court situation, or in a referral, often relate directly to the results of the psychological evaluation. What is the intellectual level of the defendant? Is the client suicidal? Is the client dangerous? Will the client benefit from counseling and/or psychotherapy? Indeed, all the data compiled from the psychological testing ideally must be integrated into a comprehensive picture which can be presented to the court. Ultimately, in providing testimony, the forensic psychologist may be presented with additional questions, and the psychologist must present findings which can help the court system render a decision.

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Academic Managers – Heads of Departments/Schools

S. Marshall , in International Encyclopedia of Education (Third Edition), 2010

Training and Development for the Role

In response to the concern about preparing academics in a better manner for a possible future role as head of department, the notion of development centers has been introduced in the UK – a notion imported from other areas of the public sector most notably the National Health Service and State Schools, and blue-chip companies such as the Royal Bank of Scotland and Bayer. The aim of development centers is to help both organizations and individuals alike determine (further to the deployment of assessment-center technology), diagnose, and formulate an appropriate personal-development plan for prospective heads. The purpose of this plan is to assist the individual move toward the realization of his/her leadership potential. Stevenson and Howlett's (2007) account of the setting up of a development center at the University of Newcastle in the UK was further to the university's concern to develop a pool of potential heads of school. Such an initiative had the added benefit of assisting certain ambitious individuals realize, prior to putting themselves forward for the heads–of-school role, that such a role was not actually one that they were either comfortable with or capable of undertaking. As Stevenson and Howlett (2007) note, "investing early can prevent expensive mistakes in the Heads of School appointment process" (p. 125).

Many research studies explore the range of support for heads of department, suggesting various tactics that they have identified as working, in terms of better preparing and supporting heads of department. For example, Murray (1999) considered a range of training options, which included co-opting potential leaders onto various department and university committees, filling administrative roles, or directing various activities. This technique (referred to by Steinmetz in Murray's 1999 article quoted at the beginning of this section) of what constitutes an induction is used quite extensively for prospective heads of department in UK HEIs. However, for individuals to gain maximum benefit from such opportunities, it is suggested that training and development be run in parallel (Rhodes, 2007). An exploration of what research studies suggest effective training and development might look like as what follows.

Little empirical research has focused on the process of determining the training and development needs of heads of department. Two such recent studies, however, provide a useful starting point. The first, undertaken by Aziz et al. (2005) in the USA, revealed four key primarily cognitive areas: (1) budgets and funding, (2) academic staff issues, (3) legal issues, and, finally, (4) professional development. A UK study conducted by Ramsden (2006) sought to explore the benefits sought from a heads of department program, identifying six primarily affective areas: (1) self-knowledge, (2) environment knowledge, (3) style/reflection, (4) learning new techniques, (5) sharing experiences, and (6) gaining confidence.

Wolverton et al. (2005), identifying a similar set of complex needs for chairs and prospective chairs at the University of Nevada, subsequently designed a developmental program of seven 3-h sessions over 1   year, based on:

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conceptual understanding (tools and techniques to improve performance);

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skill development (communication-related issues); and

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reflective practice (journal based on Myers Briggs Type Indicator diagnostics and small group discussions).

Increasingly, leadership development for academic managers is seen as a cognitive process, moving into the affective domain, as opposed to solely a training process. As Weick (2001) notes, leadership development is partly about sense making which comes through a journey of self-discovery, understanding, and reflecting on relationships with others, and an awareness of the environment.

Few studies reveal development programs which attempt to develop both the competences as well as the competencies for the role. McLeod and Jennings (1990) have documented a course they ran for International Business Machines (IBM) (UK) which addressed the latter, suggesting effective development programs including:

Gestalt work, personal construct theory, guided affective imagery, Chinese philosophy, psychosynthesis, and using the right –hand side of the brain" (p. 69).

The incorporation of a number of these approaches is now used in the programs offered by the Leadership Foundation for Higher Education in the UK, with the program for heads of department (or those aspiring to such a role) including:

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knowledge, understanding, and skill development;

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case-study analysis;

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self-awareness diagnostics;

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personal construct theory;

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mythodrama; and

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reflective practice.

Rhodes (2007), writing about developing leaders at the University of Chester in the UK, refers to the view that the most effective learning for managers takes place in the workplace. He developed a three-phase in-house program (see Table 7 ) at the University of Chester which moved from the concrete to the abstract conceptualization of the requirements of the role. The third phase:

Table 7. The University of Chester management development program

Phase 1 Generic management development: e.g., strategic management, organizational effectiveness
Phase 2 Action learning sets: to promote the alignment of individuals in support of corporate objectives
Phase 3 Role modeling effective leadership: an emphasis on leadership behaviors

From Rhodes, M. (2007). Developing leaders: A structured approach to the enhancement of organisational and individual performance. In Marshall, S. (ed.) Strategic Leadership of Change in HE: What's New? pp 66–78. London: Routledge/Taylor & Francis.

developed and adapted to take account of the rapidly growing trend towards more personal forms of learning support: mentoring, coaching, 360 degree feedback, secondments, and directed learning relevant to the working context" (p. 69) ( Table 8 ).

Table 8. Leadership Development Programme

From Rhodes, M. (2007). Developing leaders: A structured approach to organisational and individual performance. In Marshall, S. (ed.) Strategic Leadership of Change in HE: What's New? pp 72. London: Routledge/Taylor & Francis.

Despite all the support that can be offered to heads of department in the form of training and development, the stress of the job remains a major concern (Sarros et al., 1997: 284). Juggling the constant stream of administrative work with that of leading, teaching, and research and scholarship, flags up a growing problem with prioritization and time management. Despite the growth in complexity, and the constant juggling act to ensure attendance to the range of areas requiring an input (e.g., strategic visioning and planning, teaching, curriculum development, research leadership, monitoring resources, and supporting staff), a significant number of committed academics view the role of head of department as offering an opportunity to make a difference. So, what further research remains to be done to better prepare and support heads of department of the future?

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Openness to Experience

Robert R. McCrae , in Encyclopedia of Applied Psychology, 2004

1 Conceptualizations of Openness

Openness to Experience is the broadest of the five basic factors that comprise the Five-Factor Model (FFM), covering a wide range of loosely related traits. Among the relevant traits are tolerance of ambiguity, low dogmatism, need for variety, aesthetic sensitivity, absorption, unconventionality, intellectual curiosity, and intuition as measured by the Myers–Briggs Type Indicator. Perhaps because the links among such traits are not obvious, Openness is the least well understood of the five factors.

In studies of trait-descriptive adjectives, the fifth factor is usually called Intellect and is defined by terms such as perceptive, analytical, and reflective. Such words suggest intellectual ability, and Openness is sometimes confused with intelligence. In fact, intelligence (as measured by ability tests such as the Wechsler Adult Intelligence Scale) shows small correlations with Openness but forms a separate factor. Years of education is also modestly related to Openness; however, it is not clear whether education promotes Openness or whether open individuals pursue more education.

Perhaps the most widely used measure of this factor is the Openness scale of the Revised NEO Personality Inventory. In that instrument, Costa and McCrae provided subscales for six aspects of life to which individuals may be relatively more open or closed: fantasy, aesthetics, feelings, actions, ideas, and values. Thus, high scorers on the overall scale are imaginative, responsive to art and beauty, attentive to their own feelings, willing to try new activities, intellectually curious, and unconventional. These traits appear to have both a motivational and a structural component. Motivationally, open people are receptive to new experience and to a deeper examination of their own thoughts, feelings, and values. Structurally, they have a permeable style of consciousness in which remote associations are easily made. In contrast, closed people are more comfortable with the world they know and tend to compartmentalize their ideas and feelings.

Although Openness appears to be an experiential style, it has pervasive social consequences. Open individuals tend to join liberal political parties and religious denominations. They seek friends who share their interests in the arts and tend to marry spouses who have similar open interests and values. Openness is also related to vocational interests and occupational behavior. Because Openness is so clearly expressed in attitudes and behaviors, there is generally strong agreement between self-reports and observer ratings on this factor.

In general, psychologists tend to be more open than closed, and many assume that Openness is a desirable trait. However, closed individuals prefer their own conservative and down-to-earth approach to life and would rate the desirability of Openness differently. Openness is associated with some negative outcomes, including nightmares, depression, and drug experimentation. Closedness is associated with authoritarianism and difficulty in adapting to change.

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