Interpersonal and communication skills training for radiology trainees using a rotating peer supervision model (microteaching).
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Clinical Competence↗
Biomedical subjects
Elizabeth Armstrong
Publications and source records attributed to Elizabeth Armstrong.
How can physicians' learning styles drive educational planning?
As changes in health care delivery systems and in the global burden of disease call for a reassessment of how tomorrow's physicians should be educated--indeed, for a reconsideration of the diversity of roles the physician should play--there is an immediate need to produce continuing medical education (CME) programs with real impact. Curriculum planners are questioning both the content of medical education and the methods of instruction and training. The product, or content, and the mechanism for its delivery have been defined and discussed, but a significant body of literature has shown that new knowledge does not necessarily lead to new behavior. Ample evidence exists in the CME literature to support the implementation of more active and self-directed learning strategies to promote the desired change in behaviors. The question, then, that is the focus of this article is how educational planning might be better guided by an understanding of how physicians learn within the continuing medical education domain. Revisiting the principles of David Kolb's Learning Styles Inventory, the authors propose applying his experiential learning model to overall curriculum design work. The authors argue that promoting the application of all learning styles in sequence in an educational encounter is a most desirable approach, and that this approach to learning could extend far beyond individual learners to influence how every component of medical education is designed, from the individual lecture or class activity to entire courses or programs.
Adult↗
Cholecystokinin and leptin: their influence upon the eating behaviour and nutrient intake of dialysis patients.
BACKGROUND: We have used serial visual analogue scores to demonstrate disturbances of the appetite profile in dialysis patients. This is potentially important as dialysis patients are prone to malnutrition yet have a lower nutrient intake than controls. Appetite disturbance may be influenced by accumulation of appetite inhibitors such as leptin and cholecystokinin (CCK) in dialysis patients. METHODS: Fasting blood samples were drawn from 43 controls, 50 haemodialysis (HD) and 39 peritoneal dialysis (PD) patients to measure leptin and CCK. Hunger and fullness scores were derived from profiles compiled using hourly visual analogue scores. Nutrient intake was derived from 3 day dietary records. RESULTS: Fasting CCK was elevated for PD (6.73 +/- 4.42 ng/l vs control 4.99 +/- 2.23 ng/l, P < 0.05; vs HD 4.43 +/- 2.15 ng/l, P < 0.01). Fasting CCK correlated with the variability of the hunger (r = 0.426, P = 0.01) and fullness (r = 0.52, P = 0.002) scores for PD. There was a notable relationship with the increase in fullness after lunch for PD (r = 0.455, P = 0.006). When well nourished PD patients were compared with their malnourished counterparts, CCK was higher in the malnourished group (P = 0.004). Leptin levels were higher for the dialysis patients than controls (HD and PD, P < 0.001) with pronounced hyperleptinaemia evident in some PD patients. Control leptin levels demonstrated correlation with fullness scores (e.g. peak fullness, r = 0.45, P = 0.007) but the dialysis patients did not. PD nutrient intake (energy and protein intake, r = -0.56, P < 0.0001) demonstrated significant negative correlation with leptin. CONCLUSION: Increased CCK levels appear to influence fullness and hunger perception in PD patients and thus may contribute to malnutrition. Leptin does not appear to affect perceived appetite in dialysis patients but it may influence nutrient intake in PD patients via central feeding centres.
Adult↗
Questioning the "big assumptions". Part I: addressing personal contradictions that impede professional development.
BACKGROUND: The ultimate success of recent medical curriculum reforms is, in large part, dependent upon the faculty's ability to adopt and sustain new attitudes and behaviors. However, like many New Year's resolutions, sincere intent to change may be short lived and followed by a discouraging return to old behaviors. Failure to sustain the initial resolve to change can be misinterpreted as a lack of commitment to one's original goals and eventually lead to greater effort expended in rationalizing the status quo rather than changing it. OBJECTIVE: The present article outlines how a transformative process that has proven to be effective in managing personal change, Questioning the Big Assumptions, was successfully used in an international faculty development program for medical educators to enhance individual personal satisfaction and professional effectiveness. This process systematically encouraged participants to explore and proactively address currently operative mechanisms that could stall their attempts to change at the professional level. CONCLUSIONS: The applications of the Big Assumptions process in faculty development helped individuals to recognize and subsequently utilize unchallenged and deep rooted personal beliefs to overcome unconscious resistance to change. This approach systematically led participants away from circular griping about what was not right in their current situation to identifying the actions that they needed to take to realize their individual goals. By thoughtful testing of personal Big Assumptions, participants designed behavioral changes that could be broadly supported and, most importantly, sustained.
Attitude↗
Questioning the "big assumptions". Part II: recognizing organizational contradictions that impede institutional change.
BACKGROUND: Well-designed medical curriculum reforms can fall short of their primary objectives during implementation when unanticipated or unaddressed organizational resistance surfaces. This typically occurs if the agents for change ignore faculty concerns during the planning stage or when the provision of essential institutional safeguards to support new behaviors are neglected. Disappointing outcomes in curriculum reforms then result in the perpetuation of or reversion to the status quo despite the loftiest of goals. Institutional resistance to change, much like that observed during personal development, does not necessarily indicate a communal lack of commitment to the organization's newly stated goals. It may reflect the existence of competing organizational objectives that must be addressed before substantive advances in a new direction can be accomplished. OBJECTIVE: The authors describe how the Big Assumptions process (see previous article) was adapted and applied at the institutional level during a school of medicine's curriculum reform. Reform leaders encouraged faculty participants to articulate their reservations about considered changes to provided insights into the organization's competing commitments. The line of discussion provided an opportunity for faculty to appreciate the gridlock that existed until appropriate test of the school's long held Big Assumptions could be conducted. CONCLUSIONS: The Big Assumptions process proved useful in moving faculty groups to recognize and questions the validity of unchallenged institutional beliefs that were likely to undermine efforts toward change. The process also allowed the organization to put essential institutional safeguards in place that ultimately insured that substantive reforms could be sustained.
Attitude↗
Linguistic resources of individuals with Asperger syndrome.
In this paper the available literature on the communication skills of individuals with Asperger Syndrome (AS) is reviewed. Current issues regarding diagnosing and understanding disorders with a core social deficit are examined as well as the potential application of sociolinguistic analyses to the study of Asperger Syndrome, such as that provided from within a Systemic Functional Linguistic framework. The need for investigations that address a broader view of "language" and its use in social situations by individuals with AS as opposed to their mastery of syntactic aspects of language, will be discussed.
Asperger Syndrome↗
Reflections on speech-language therapists' talk: implications for clinical practice and education.
BACKGROUND: Research into the practices of speech-language therapists in clinical sessions is beginning to identify the way communication in clinical interactions both facilitates and potentially impedes the achievement of therapy goals. AIMS: This target article aims to raise the issues that arise from critical reflections on the communication of speech-language therapists for both clinical practice and clinical education of future speech-language therapists. METHODS & PROCEDURES: The paper reviews the past and current literature into the communication of speech-language therapists with their clients and provide examples drawn from the authors' own empirical research. OUTCOMES & RESULTS: It is argued that one cannot assume that the current rhetoric regarding collaborative practice matches what is currently done in clinical work. CONCLUSIONS: This paper calls attention to the need to evaluate critically the processes and nature of acculturation that occurs during the first stages of professional development as a student speech-language therapist through to the ongoing development of professional practice.
Acculturation↗