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How institutions of higher education respond to campus sexual assault impacts the well-being and academic success of student survivors. Researchers at the Center for Institutional Courage developed an 11-step framework for campuses to respond to sexual assault in a manner that minimizes harm. This mixed-methods study uses the framework to understand college victim advocate perceptions of campus response to sexual assault. Results from a national survey and four focus groups found that advocates identify courageous response efforts as strong relationships across campus units, availability of trauma-informed services, and when resources were available to meet students' direct needs. The critical role of leadership throughout the framework was also identified. Implications for policy and practice are discussed., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Federal law in the United States mandates that institutions of higher education address sexual assault within their communities. Colleges and universities have increasingly hired full-time professionals to manage response efforts, including campus-based victim advocates. Campus-based advocates provide emotional support, help students access and understand report options, and ensure students receive appropriate accommodations. Very little is known about the experience or perceptions of campus-based victim advocates. In this study, 208 professional campus-based advocates from across the United States completed an anonymous online survey focused on their perceptions of campus response to sexual assault. Multiple regression analysis was applied to investigate how psychosocial factors (burnout, secondary trauma, and compassion satisfaction) and organizational factors (perceptions of leadership, organizational support, and community relational health) were associated with advocate perceptions of institutional response to sexual assault. Findings indicate that while advocates experience burnout and secondary trauma, and have lower than average compassion satisfaction scores, these psychosocial outcomes do not influence their perception of response efforts. However, all the organizational factors significantly contribute to how advocates view response. The more positively advocates viewed leadership, campus support, and relational health, the more positive they viewed the response efforts on campus. In order to improve response efforts, administrators should engage in meaningful training on sexual assault, include campus advocates in high-level discussions of campus sexual assault and ensure appropriate resources are provided to advocacy services.

Physician decisions concerning allocation of health care resources to patients are highly variable and poorly understood. Psychological androgyny theory (PAT) has been employed as a model of the interpersonal and task activities required of physicians for care of their patients. Several studies have successfully predicted physician resource utilization using measures derived from PAT. Using a sample of 97 first-year medical students, the authors explored the relationship between PAT and risk preference in loss-framed gambles in order to elucidate the process whereby variables derived from PAT predict resource utilization. As hypothesized, students selecting the certain loss had significantly higher mean androgyny scores than did students selecting uncertainty. Research involving these constructs is integrated in the context of a theoretical "causal model," which highlights issues deserving of future research.

Psychological androgyny theory (PAT) was employed as a model of the interpersonal (social) and task activities required of physicians for care of their patients. According to PAT, individuals with a large repertoire of task and social skills ("androgynous" individuals) should be optimally adaptable to contingencies reflecting varying combinations of task and social challenges. The authors examined the relationship between androgyny and preference for intubation on a patient management problem involving end-stage lung disease for 67 general internists and internal medicine housestaff from two hospitals. Results revealed a negative relationship between androgyny and preference for intubation, suggesting that androgynous and nonandrogynous physicians respond differently to complex and difficult decision-making tasks. Indirect evidence is offered to suggest that this response reflects a general tendency to utilize fewer health care resources. Discussion focuses on the need to improve the precision of measurement of these latent constructs.

One hundred thirty-seven physicians were asked to choose between a certain loss of five years of life expectancy and a 50/50 gamble of losing either ten years or zero years of life expectancy. These choices were presented as hypothetical options for a patient with cancer. The 46 who chose the certain loss ordered 23% fewer laboratory tests/patient visit in our General Medicine Clinic over an eight-week period than those who chose the gamble (p less than 0.05). This risk preference was further stratified by sequentially offering five, four, three, two, and one years of certain loss against the same 50/50 gamble of ten or zero years of loss; greater preference for the gamble correlated with greater laboratory use (p less than 0.002). To exclude physician knowledge or case mix as a cause of this result, this risk preference was correlated with total score, and with the cost of tests ordered in patient management problems, of 49 physician on the American Board of Internal Medicine Certifying Examination. Cost of tests ordered was 23% less for the 17 who chose the certain loss (p less than 0.001); total score did not vary with risk preferences. There was no association between risk preference in the face of gain and laboratory use, and none between an individual's risk preferences in the face of gain and in the face of loss. The cognitive processes that determine risk preference in the face of loss, whatever they may be, appear to have a substantial influence on physician test-ordering behavior.