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PubMed2004

Experiences from psychiatric rotation for pre-registration house officers: contributions to subjective learning.

SETTING: The clinical experience and the subjective learning of pre-registration house officers who completed 4 months' psychiatric rotation are described. METHOD: The study was cross-sectional and based on self-report. The participants had responded to an anonymous questionnaire at the completion of their 4 months' psychiatric rotation in the period 1999-2001. Of those eligible (n = 137), 85 (61%) completed the questionnaire. The relationships between individual background variables, different factors of the learning environment, and good learning outcome were explored. CONCLUSIONS: The subjective learning benefit and positive learning environment were most related to the amount of practical experience, the degree of tailoring of the tasks to the house officers' competence, and to the formal intramural teaching programme. Supervision, gender, previous experience, and prior interest in psychiatry did not have significant impact on subjective learning. The findings are discussed in terms of the learning model that was developed.

Adult↗

PubMed2000

Nonverbal learning disability: adult outcomes.

There are few empirical studies of the adult outcomes of nonverbal learning disability (NLD). An overwhelming majority of NLD studies has been devoted to the nature of academic difficulties of school children, whereas the few follow-up studies have tended to be limited to college-age young adults. Herein, it is argued that the problems of adults with NLD do not fall solely in academic areas, and that early academic remediation programs might do well to include intervention in emotional and social skills enhancement.

Adult↗

PubMed2004

Exploring the self-learning experiences of patients with depression participating in a multimedia education program.

The purpose of the present study was to explore the self-learning experiences of depression patients on interactive multimedia education program. Qualitative in-depth interviews were employed. Fourteen patients with a first episode of major depression were recruited from a psychiatric outpatient department. Explanations of the purposes of the exercise and on-the-spot teaching were provided by the researcher before the study began. A tape-recorded, semi-structured interview format was employed after two weeks. Data analysis was performed in the framework of line-by-line content, contextual and thematic analysis. Eight subjects successfully completed the entire learning activities. Content analysis revealed 4 main aspects of successful self-learning experiences: the triggering of learning motivation, the enjoyment of self-paced learning, support for the effects of learning materials, and the gaining of self- awareness and changes. The factors influencing learning performance were related to: environmental impact, the degree of familiarity with traditional learning, possession or non-possession of the necessary computer operation skills, and good computer support. However, the findings provide a preliminary understanding of the application of interactive multimedia education programs in terms of self-learning outcomes and recognizing key elements of learning impediments among the study sample. A larger sample size with different clinical contexts is recommended to determine the effect and generalizability for future research. Furthermore, the creation of a computerized learning environment with different educational styles is crucial to patients' success in obtaining depression-related information and understanding effective adaptive skills.

Adaptation, Psychological↗

PubMed2004

Learning dermatology.

Students should be involved in curriculum planning and encouraged to formulate their own learning outcomes. Adult learners appreciate opportunities to learn from real or simulated experiences that are applicable to real-life situations. Contact with patients is essential to help students to develop empathy and communication skills and patients with chronic skin conditions such as psoriasis can make an active contribution to the education of students. Students learning dermatology use both pattern- recognition and analytical processes, but pattern recognition develops only with repetition and it is not realistic to expect students to acquire many diagnostic skills. Instead teachers should provide students with a framework that will enable them to analyse skin conditions, to understand the relevance of what is taught and to apply their learning in the future. All medical graduates should be able to describe the skin and record their findings each time they clerk a patient.

Clinical Competence↗

PubMed2005

Computer based safety training: an investigation of methods.

BACKGROUND: Computer based methods are increasingly being used for training workers, although our understanding of how to structure this training has not kept pace with the changing abilities of computers. Information on a computer can be presented in many different ways and the style of presentation can greatly affect learning outcomes and the effectiveness of the learning intervention. Many questions about how adults learn from different types of presentations and which methods best support learning remain unanswered. AIMS: To determine if computer based methods, which have been shown to be effective on younger students, can also be an effective method for older workers in occupational health and safety training. METHODS: Three versions of a computer based respirator training module were developed and presented to manufacturing workers: one consisting of text only; one with text, pictures, and animation; and one with narration, pictures, and animation. After instruction, participants were given two tests: a multiple choice test measuring low level, rote learning; and a transfer test measuring higher level learning. RESULTS: Participants receiving the concurrent narration with pictures and animation scored significantly higher on the transfer test than did workers receiving the other two types of instruction. There were no significant differences between groups on the multiple choice test. CONCLUSIONS: Narration with pictures and text may be a more effective method for training workers about respirator safety than other popular methods of computer based training. Further study is needed to determine the conditions for the effective use of this technology.

Adult↗

PubMed2000

Neuronal coding of prediction errors.

Associative learning enables animals to anticipate the occurrence of important outcomes. Learning occurs when the actual outcome differs from the predicted outcome, resulting in a prediction error. Neurons in several brain structures appear to code prediction errors in relation to rewards, punishments, external stimuli, and behavioral reactions. In one form, dopamine neurons, norepinephrine neurons, and nucleus basalis neurons broadcast prediction errors as global reinforcement or teaching signals to large postsynaptic structures. In other cases, error signals are coded by selected neurons in the cerebellum, superior colliculus, frontal eye fields, parietal cortex, striatum, and visual system, where they influence specific subgroups of neurons. Prediction errors can be used in postsynaptic structures for the immediate selection of behavior or for synaptic changes underlying behavioral learning. The coding of prediction errors may represent a basic mode of brain function that may also contribute to the processing of sensory information and the short-term control of behavior.

Animals↗

PubMed1993

Early experience with directional coronary atherectomy: documentation of the learning curve.

OBJECTIVE: To evaluate evolving selection criteria and angiographic outcome ('learning curve') for directional coronary atherectomy. SETTING: Tertiary referral, university-based hospital. PATIENTS: Initial 50 subjects undergoing directional coronary atherectomy of de novo left anterior descending stenoses at The Toronto Hospital from July 1990 to April 1991. INTERVENTIONS: Directional coronary atherectomy according to standard interventional techniques, with pre- and post procedure qualitative evaluation and quantitative coronary arteriography (Cardiac Measurement System; Leiden, The Netherlands) to define angiographic outcome. RESULTS: Comparing 'early' (group 1) versus 'late' (group 2) subjects, baseline demographics and clinical parameters were similar. Later subjects demonstrated increased coronary tortuosity (group 1, 1.40 versus group 2, 1.64, P < 0.01) and major side branch involvement within the stenosis (group 1, seven of 25 [28%] versus group 2, 18 of 25 [72%], P < 0.01). Regardless of experience, post procedure residual minimum stenotic diameters were equal (group 1, 2.75 +/- 0.55 versus group 2, 2.49 +/- 0.42 mm) in progressively longer lesions (group 1, 11.4 +/- 4.9 versus group 2, 13.3 +/- 5.5 mm, P < 0.1), with increased symmetry (group 1, 0.60 +/- 0.28 versus group 2, 0.73 +/- 0.19, P < 0.05). Analysis of consecutive pentiles (10 subjects per group) indicated gradual increases in post procedure residual lumen during early experience (the first 30 subjects), with an abrupt deterioration in outcome (fourth pentile), secondary to qualitative changes in coronary anatomy, before a return to satisfactory residual minimum stenotic diameters (fifth pentile). CONCLUSIONS: This study defines a distinct 'learning curve' during the initial 30 patients undergoing directional coronary atherectomy, with subtle changes in case selection, predominantly reflected by qualitative indices (eg, tortuosity, dystrophic calcification), resulting in a transient deterioration in final outcomes (patient 31 to 40). Subsequently, optimal results were re-established after defining appropriate case selection criteria, in conjunction with progressive expertise.

Adult↗

PubMed2005

The outcome specificity of learned predictiveness effects: parallels between human causal learning and animal conditioning.

Two experiments examined the outcome specificity of a learned predictiveness effect in human causal learning. Experiment 1 indicated that prior experience of a cue-outcome relation modulates learning about that cue with respect to a different outcome from the same affective class but not with respect to an outcome from a different affective class. Experiment 2 ruled out an interpretation of this effect in terms of context specificity. These results indicate that learned predictiveness effects in human causal learning index an associability that is specific to a particular class of outcomes. Moreover, they mirror demonstrations of the reinforcer specificity of analogous effects in animal conditioning, supporting the suggestion that, under some circumstances, human causal learning and animal conditioning reflect the operation of common associative mechanisms.

Adolescent↗

PubMed2006

Twenty-first century learning in schools: A case study of New Technology High School in Napa, California.

The most pertinent question concerning teaching and learning in the twenty-first century is not what knowledge and skills students need--that laundry list was identified over a decade ago--but rather how to foster twenty-first century learning. What curricula, experiences, assessments, environments, and technology best support twenty-first century learning? New Technology High School (NTHS) in Napa, California, is one example of a successful twenty-first century school. In this chapter, the author describes the components of this exemplary high school, illustrating an environment that will cultivate twenty-first century student learning. New Technology High School began by defining eight learning outcomes, aligned with the standards of the Partnership for 21st Century Skills; to graduate, students demonstrate mastery of these outcomes through an online portfolio. To help students achieve the outcomes, NTHS employs project- and problem-based learning. Whereas in traditional classrooms students work alone on short-term assignments that do not lend themselves to deep understanding, the project-based learning approach has students working in teams on long-term, in-depth, rigorous projects. Students' work is supported by the school's workplace-like environment and effectiv use of technology. Meaningful assessment is essential to project-based learning; students receive continuous feedback, helping them become self-directed learners. In fact, NTHS uses outcome-based grading through which students constantly know how they are performing on the twenty-first century outcomes. Research has shown that NTHS graduates are better prepared for postsecondary education, careers, and citizenship than their peers from other schools. To facilitate twenty-first century learning, all schools need to rethink their approach to teaching and learning. New Technology High School is one way to do so.

Adolescent↗

PubMed2005

The research we still are not doing: an agenda for the study of computer-based learning.

Media-comparative research-that is, the comparison of computer-based learning (CBL) to noncomputer instruction-is logically impossible because there are no valid comparison groups. Results from media-comparative studies are thus confounded and difficult to meaningfully interpret. In 1994, Friedman proposed that such research be supplanted by investigations into CBL designs, usage patterns, assessment methods, and integration. His proposal appears to have largely been ignored. In this article, the author updates the agenda for research in CBL (including Web-based learning). While media-comparative studies are confounded, CBL-CBL comparisons are often not. CBL instructional designs vary in configuration (e.g., discussion board or tutorial), instructional method (e.g., case-based learning, personalized feedback, or simulation), and presentation (e.g., screen layout, hyperlinks, or multimedia). Comparisons within one level (for example, comparing two instructional methods) facilitate evidence-based improvements, but comparisons between levels are confounded. Additional research questions within the CBL-CBL framework might include: Does adaptation of CBL in response to individual differences such as prior knowledge, computer experience, or learning style improve learning outcomes? Will integrating CBL with everyday clinical practice facilitate learning? How can simulations augment clinical training? And, how can CBL be integrated within and between institutions? In addressing these questions it is important to remember the most important outcome-effect on patients and practice-and outcomes specific to CBL including costs, cognitive structuring, and learning unique to the computer-based environment. CBL is not a panacea, but holds great promise. Realization of this potential requires that media-comparative studies be replaced by rigorous, theory-guided comparisons of CBL interventions.

Computer-Assisted Instruction↗

PubMed2005

A new vision for distance learning and continuing medical education.

Increasing demands on continuing medical education (CME) are taking place at a time of significant developments in educational thinking and new learning technologies. Such developments allow today's CME providers to better meet the CRISIS criteria for effective continuing education: convenience, relevance, individualization, self-assessment, independent learning, and a systematic approach. The International Virtual Medical School (IVIMEDS) provides a case study that illustrates how rapid growth of the Internet and e-learning can alter undergraduate education and has the potential to alter the nature of CME. Key components are a bank of reusable learning objects, a virtual practice with virtual patients, a learning-outcomes framework, and self-assessment instruments. Learning is facilitated by a curriculum map, guided-learning resources, "ask-the-expert" opportunities, and collaborative or peer-to-peer learning. The educational philosophy is "just-for-you" learning (learning customized to the content, educational strategy, and distribution needs of the individual physician) and "just-in-time" learning (learning resources available to physicians when they are required). Implications of the new learning technologies are profound. E-learning provides a bridge between the cutting edge of education and training and outdated procedures embedded in institutions and professional organizations. There are important implications, too, for globalization in medical education, for multiprofessional education, and for the continuum of education from undergraduate to postgraduate and continuing education.

Education, Distance↗

PubMed2005

Early learning failure impairs adult learning in rats.

Early life experiences may affect adult learning ability. In two experiments we tested the effect of early learning failure on adult performance in Wistar rats. In the first experiment 17-day-old rats (PN17), but not 25-day-old rats (PN25), trained in a hidden platform water maze task showed deficits in tone-shock avoidance learning when they were 3-months-old. The second experiment, which included random-platform and non-platform control groups, confirmed the effect of early (PN18) spatial learning failure on adult avoidance learning. However, post-weaning training (PN25) without platform also tended to induce adult learning deficits as long as the adult task difficulty was increased. The older non-platform group did not differ from the impaired group which received early training in a fixed hidden platform task. The results are discussed in terms of the relevance of early learning outcome and developmental stage on adult general learning deficits which may be related to the learned helplessness phenomenon and developmental neural plasticity.

Age Factors↗

PubMedDate not supplied

The challenge of outcomes assessment.

While many programs undertake formal assessment of student learning outcomes to satisfy accreditation standards, the ultimate goal of outcomes assessment is program improvement and increased student achievement. Properly designed and executed, outcomes assessment should tell the program how well it is operating and the extent to which it is contributing to the growth and development of its students. It enables programs to determine if they are effective in producing graduates with the necessary knowledge, skills and values to function as valuable members of the health care team, thus contributing to improved quality of patient care.

Humans↗

PubMed2004

The role of evaluation in web-based education.

The use of web-based education has increased significantly. As a result there is a need to focus on methods, employed to evaluate teaching and learning outcomes, when technology is used to enhance learning. This chapter provides an overview of what, how, and why to assess, test and measure learning. The use of technology facilitates a combination of different perspectives within an evaluation process. Not only the knowledge and skills of students but also the learning arrangements are the focus of assessment. Evaluation generates information which can be used for different purposes e.g. planning, implementing and guiding teaching and learning processes timely and for the future as well. Based on experiences of teaching health informatics, an evaluation model for web-based courses is described. The risks of dishonesty and misbehavior related to web-based education are recognized.

Education, Distance↗

PubMed2006

Education and training of health information systems--a literature review.

This review concerned the content of education and training in health information systems targeted for healthcare professionals. The publications selected for the review were explored as to their educational content, theoretical approaches, available options, learning outcomes and the respective impact on organisational learning. A total of 1772 abstracts were screened and up to 423 abstracts studied in more detail. Two reviewers independently assessed the extracted data and decided to include 21 articles for the final review. The studies were analysed in relation to health informatics competence level, previous knowledge of information system usage, learning environment, teaching methods, pedagogical approaches, goals of training and assessment of learning. The review revealed that any level of competence in health informatics contributes to the learning process. The review suggested that more attention should be paid to setting up goals for training and measuring the preferable competence level of learning. It also clearly indicated the need for further research on teaching health informatics to healthcare professionals.

Curriculum↗

PubMed2000

Distance education. Part 6. Evaluation of a core subject within the Graduate Diploma/Masters in Family Medicine. Principles of general practice.

AIM: To evaluate 'Principles of General Practice' (formerly known as the Academic Basis of General Practice), a core unit of the Graduate Diploma/Masters in Family Medicine. METHOD: Content analysis of feedback sheets and transcripts from teleconferences were analysed to facilitate the process evaluation of this core unit. Content analysis of qualitative responses to the question: 'What did you learn?' at the end of the course formed the impact evaluation. RESULTS: GPs who participated in the evaluation of the Principles of General Practice highlighted four learning outcomes in response to the question: 'What did you learn?' Categories included discipline specific and patient specific. Personal and professional outcomes were further divided into the following subcategories: affirmation of current practice; confidence in dealing with uncertainty; engaging in reflective practice; overcoming professional isolation; and providing opportunities for career change. CONCLUSIONS: The most cited reasons for participating in this course were the professional and personal. Students found that the course clarified their roles, raised self-esteem and confidence, and provided them with a sense of pride in their profession. The reflective learning style resulted in students gaining insight into themselves and their therapeutic roles, with reported changes in clinical practice, including more confidence in dealing with uncertainty. In addition to meeting course objectives there were a number of unanticipated outcomes identified. The most surprising was the recognition that general practice was a medical specialty, supported by a body of literature. For some, this assisted them to overcome feelings of professional isolation and alienation. A number of students saw this course as a stimulus to blending their clinical work with a teaching role to enhance professional growth and satisfaction.

Clinical Competence↗

PubMed2006

Educating dental students about oral health care access disparities.

Dental educators provide learning experiences for dental students that help them develop the belief that universal access to oral health care is a social justice imperative that will compel them to provide care to underserved patients after they graduate. To accomplish these learning outcomes, dental schools first recruit underrepresented minority students and students with previous volunteerism experiences. Dental educators then expose dental students to learning experiences in the classroom and in the community, dental school-based clinics, and community health clinics, to help them to develop the requisite knowledge, values, and competencies for serving underserved populations. The long-term, educational outcomes of these learning experiences have not been assessed to date. Systematic surveys should be conducted of dentists who have had these educational experiences to measure the number who actually care for the underserved in private dental offices, community health "safety net" clinics, and the Indian and Public Health Services.

Community Dentistry↗

PubMed2005

Developing an outcome-focused core curriculum.

BACKGROUND: Many UK medical schools have modified their curricula to meet the requirements of the General Medical Council and other external agencies. In particular, efforts have been focused on increasing integration and reducing factual overload through the definition of a core curriculum. Various approaches to curriculum change have been adopted in an attempt to meet such demands. PURPOSE: This paper describes a curriculum development process, which commences with a clear vision, adopts an outcome-based approach and identifies clear statements of learning outcomes. The process led to the development of an outcome-focused core curriculum structured around clinical problems, which is available to all students and staff. CONCLUSION: A model of curriculum development has evolved which is relatively simple in concept, and appears to be easy to comprehend by students, teaching staff and visitors from other institutions. It provides a practical framework for managing the difficult problems of integration and factual overload. It should be of general interest and applicability to other schools with health professional programmes looking for a realistic and acceptable way of defining a core curriculum.

Clinical Competence↗