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PubMed2006

The interaction of implicit learning, explicit hypothesis testing learning and implicit-to-explicit knowledge extraction.

To further explore the interaction between the implicit and explicit learning processes in skill acquisition (which have been tackled before, e.g. in [Sun, R., Merrill, E., & Peterson, T. (2001). From implicit skill to explicit knowledge: A bottom-up model of skill learning. Cognitive Science, 25(2), 203-244; Sun, R., Slusarz, P., & Terry, C. (2005). The interaction of the explicit and the implicit in skill learning: A dual-process approach. Psychological Review, 112(1), 159-192]), this paper explores details of the interaction of different learning modes: implicit learning, explicit hypothesis testing learning, and implicit-to-explicit knowledge extraction. Contrary to the common tendency in the literature to study each type of learning in isolation, this paper highlights the interaction among them and various effects of the interaction on learning, including the synergy effect. This work advocates an integrated model of skill learning that takes into account both implicit and explicit learning processes; moreover, it also uniquely embodies a bottom-up (implicit-to-explicit) learning approach in addition to other types of learning. The paper shows that this model accounts for various effects in the human behavioural data from the psychological experiments with the process control task, in addition to accounting for other data in other psychological experiments (which has been reported elsewhere). The paper shows that to account for these effects, implicit learning, bottom-up implicit-to-explicit extraction and explicit hypothesis testing learning are all needed.

Algorithms↗
PubMed2006

Situated cognition and cognitive apprenticeship: a model for teaching and learning clinical skills in a technologically rich and authentic learning environment.

The acquisition of a range of diverse clinical skills is a central feature of the pre-registration nursing curriculum. Prior to exposure to clinical practice, it is essential that learners have the opportunity to practise and develop such skills in a safe and controlled environment under the direction and supervision of clinical experts. However, the competing demands of the HE nursing curriculum coupled with an increased number of learners have resulted in a reduced emphasis on traditional apprenticeship learning. This paper presents an alternative model for clinical skills teaching that draws upon the principles of cognitive apprenticeship [Collins, A., Brown, J.S., Newman, S., 1989. Cognitive Apprenticeship: teaching the crafts of reading, writing and mathematics. In: Resnick, L.B. (Ed.) Knowing. Learning and Instruction: Essays in Honor of Robert Glaser. Lawrence Erlbaum Associates, New Jersey, pp. 453-494] and situated cognition within a technologically rich and authentic learning environment. It will show how high quality DVD materials illustrating clinical skills performed by expert practitioners have been produced and used in conjunction with CCTV and digital recording technologies to support learning within a pedagogic framework appropriate to skills acquisition. It is argued that this model not only better prepares the student for the time they will spend in the practice setting, but also lays the foundation for the development of a clinically competent practitioner with the requisite physical and cognitive skills who is fit for purpose [UKCC, 1999. Fitness for Practice: The UKCC Commission for Nursing and Midwifery Education. United Kingdom Central Council for Nursing Midwifery and Health Visiting, London].

Attitude of Health Personnel↗
PubMed1997

Patients with Alzheimer's disease who cannot perform some motor skills show normal learning of other motor skills.

Previous researchers have claimed that patients with Alzheimer's disease (AD) learn new motor skills normally, although many AD patients cannot perform the tasks and must be eliminated from the analysis. Excluding them assumes that they have a deficit of motor performance (competence to perform the task), but not of motor learning (ability to improve performance). The present study administered 4 motor tasks to 20 AD patients and 20 controls. The results showed that the ability to complete 1 task (performance) did not predict the rate of improvement (learning) on another task, which indicates that AD patients do indeed have a performance deficit and not a general deficit of motor skill learning. Dementia ratings predicted the ability to perform tasks but not the ability to learn them. It is concluded that it is defensible to claim that AD patients learn a motor skill normally, even if some of the patients are unable to perform the task.

Aged↗
PubMedDate not supplied

Multiple motor learning experiences enhance motor adaptability.

Traditional motor learning theory emphasizes that skill learning is specific to the context and task performed. Recent data suggest, however, that subjects exposed to a variety of motor learning paradigms may be able to acquire general, transferable knowledge about skill learning processes. I tested this idea by having subjects learn five different motor tasks, three that were similar to each other and two that were not related. A group of experimental subjects first performed a joystick-aiming task requiring adaptation to three different visuomotor rotations, with a return to the null conditions between each exposure. They then performed the same joystick-aiming task but had to adapt to a change in display gain instead of rotation. Lastly, the subjects used the joystick-aiming task to learn a repeating sequence of movements. Two groups of control subjects performed the same number of trials, but learned only the gain change or the movement sequence. Experimental subjects showed generalization of learning across the three visuomotor rotations. Experimental subjects also exhibited transfer of learning ability to the gain change and the movement sequence, resulting in faster learning than that seen in the control subjects. However, transient perturbations affected the movements of the experimental subjects to a greater extent than those of the control subjects. These data demonstrate that humans can acquire a general enhancement in motor skill learning capacity through experience, but it comes with a cost. Although movement becomes more adaptable following multiple learning experiences, it also becomes less stable to external perturbation.

Adaptation, Physiological↗
PubMedDate not supplied

Deficit in learning of a motor skill requiring strategy, but not of perceptuomotor recalibration, with aging.

We investigated the effect of aging on different aspects of motor skill learning using two computer-presented perceptuomotor tasks. The relationship between visual and proprioceptive feedback was transformed in the first task, which was open to the formation and use of strategies. This task was designed to lead to perceptuomotor adaptation that was then measured by performance on a very similar second task that was not open to the use of strategy task. Older participants showed impaired learning of the strategic task but not of the nonstrategic task. This is in line with the suggestion that the effect of aging on learning and memory may be to reduce working memory resources.

Adaptation, Physiological↗
PubMed2003

Prediction precedes control in motor learning.

Skilled motor behavior relies on the brain learning both to control the body and predict the consequences of this control. Prediction turns motor commands into expected sensory consequences, whereas control turns desired consequences into motor commands. To capture this symmetry, the neural processes underlying prediction and control are termed the forward and inverse internal models, respectively. Here, we investigate how these two fundamental processes are related during motor learning. We used an object manipulation task in which subjects learned to move a hand-held object with novel dynamic properties along a prescribed path. We independently and simultaneously measured subjects' ability to control their actions and to predict their consequences. We found different time courses for predictor and controller learning, with prediction being learned far more rapidly than control. In early stages of manipulating the object, subjects could predict the consequences of their actions, as measured by the grip force they used to grasp the object, but could not generate appropriate actions for control, as measured by their hand trajectory. As predicted by several recent theoretical models of sensorimotor control, our results indicate that people can learn to predict the consequences of their actions before they can learn to control their actions.

Biophysical Phenomena↗
PubMed2003

Fronto-parieto-cerebellar interaction associated with intermanual transfer of monkey tool-use learning.

Prior motor skill learning (original learning; OL) with one hand (original hand; OH) can affect relearning of the same skill (transfer learning; TL) with the opposite hand (transferred hand; TH). This phenomenon is known as intermanual transfer of learning. We explored specialization of brain activation underlying tool-use between hands by measuring regional cerebral blood flow in two monkeys using positron emission tomography. We found brain activation specified for TL in the bilateral prefrontal cortex, bilateral intraparietal sulcus region, and cerebellum contralateral to TH. The results suggest that those regions may be related to intermanual transfer of tool-use learning, presumably in terms of modifying a motor engram specific for OH.

Animals↗
PubMedDate not supplied

Where Canadian family physicians learn procedural skills.

BACKGROUND AND OBJECTIVES: Little is known about where family physicians learn procedural skills. In this study, we examine where Canadian family medicine graduates learned to do the procedures they perform. METHODS: In 2001, a cross-sectional postal survey was conducted of the 369 family medicine graduates from the University of Alberta and the University of Calgary between 1996 - 2000. From a list of 31 procedures, respondents identified procedures regularly performed over the past 2 years and indicated which procedures they had stopped performing. Respondents indicated whether the procedures performed were learned primarily during medical school and residency, through formal skills training following residency, or in the practice setting. RESULTS: The 282 (76.4% response rate) respondents reported performing a mean of 10.5 (SD=5.3) procedures. The vast majority reported learning procedural skills in medical school or during family medicine residency training (91.1%), followed by the clinical practice setting (12.6%), then formal skills training (6.4%). Those in rural practice learned a relatively greater proportion of procedural skills through formal skills training. CONCLUSIONS: For Canadian family physicians, procedural skill acquisition occurs across the learning continuum. Medical schools and residency training programs play a role in facilitating the learning of procedural skills and supporting self-directed learning.

Adult↗
PubMed2004

Skilled motor learning does not enhance long-term depression in the motor cortex in vivo.

Learning of motor skills may occur as a consequence of changes in the efficacy of synaptic connections in the primary motor cortex. We investigated if learning in a reaching task affects the excitability, short-term plasticity, and long-term plasticity of horizontal connections in layers II-III of the motor cortex. Because training in this task requires animals to be food-deprived, we compared the trained animals with similarly food-deprived untrained animals and normal controls. The results show that the excitability, short-term plasticity, and long-term plasticity of the studied horizontal connections were unaffected by motor learning. However, stress-related effects produced by food deprivation and handling significantly enhanced the expression of long-term depression in these pathways. These results are compatible with the hypothesis that the acquisition of a complex motor skill produces bi-directional changes in synaptic strength that are distributed throughout the complex neural networks of motor cortex, which remains synaptically balanced during learning. The results are incompatible with the idea that learning causes large unidirectional changes in the population response of these neural networks, which may occur instead during certain behavioral states, such as stress.

6-Cyano-7-nitroquinoxaline-2,3-dione↗
PubMed2004

Deficits in long-term retention of learned motor skills in patients with cortical or subcortical degeneration.

We investigated the acquisition and long-term retention of new skills in patients with cortical (Alzheimer's disease, AD) and subcortical (progressive supranuclear palsy, PSP; Parkinson's disease, PD) degeneration. The motor skill task performance of the PD and PSP patients improved with training, but the improvement disappeared within a few months, whereas AD patients retained learned skills for 3-18 months. The results of our experiments show that subcortical dysfunction induces a retention deficit for newly learned motor skills. Our present study suggests that a normal striatum is necessary for the formation of long-lasting motor skills, and that the striatum plays an important role as a motor skill consolidation system.

Alzheimer Disease↗
PubMed1997

Learning perceptual skills: behavioral probes into adult cortical plasticity.

Recent studies of the improvement of perceptual performance as a function of training - perceptual learning - have provided new insights into the neuronal substrates of this type of skill learning in the adult brain. Issues such as where in the brain, when and under what conditions practice-related changes occur are under investigation. The results of these studies suggest that a behaviorally relevant degree of plasticity is retained in the adult cortex, even within early, low-level representations in sensory and motor processing streams. The acquisition and retention of skills may share many characteristics with the functional plasticity subserving early-life learning and development. While the specificity of learning provides localization constraints, an important clue to the nature of the underlying neuronal changes is the time course of learning.

Adult↗
PubMed1978

Transcendental meditation and mirror-tracing skill.

Learning, performance and patterns of inter- and intra-individual variability of 32 experienced Transcendental Meditators were compared to those of 32 non-meditators. The data indicated that certain effects attributed to the practice of Transcendental Meditation (such as increased alertness and maintenance of attention, greater consistency and less anxiety) are not manifested in terms of learning and performance of a novel perceptual-motor skill.

Adult↗
PubMed1994

Teaching and learning clinical skills, Part 1--Development of a multidisciplinary skills centre.

A critical review of current nursing, midwifery and medical education programmes in the context of a changing health service, had led staff at the nursing and medical colleges at St Bartholomew's Hospital in London to conclude that radical approaches to teaching and learning are needed. This is particularly the case for the teaching and assessment of competence in clinical skills. Increased emphasis on community care, day care and outpatient teaching with the concomitant increase in dependency and throughput of inpatients, makes it increasingly difficult for students to observe and practice communication and clinical skills. To meet this major challenge, a joint initiative between the College of Nursing & Midwifery, the Medical College and the St Bartholomew's NHS Group to develop a clinical skills learning facility has been established. The Skills Centre will provide a focus for the learning and assessment of clinical and communication skills in a multidisciplinary environment. In a series of two papers the aims and development of the joint initiative will be explored together with four key outcomes, a Clinical Skills Matrix, a staged approach to skills teaching, a schedule for teaching and assessing clinical skills and the Integrated Skills Teaching Model.

Clinical Competence↗
PubMed2004

Medical students' views and experiences of methods of teaching and learning communication skills.

This study aims to explore undergraduate medical students' views and experiences of methods of teaching and learning communication skills. Five focus groups were conducted with 32 students, with representatives from each of the 5 years of the medical degree, at the University of Nottingham, UK. The audiotapes were transcribed in full and the transcripts were theme analysed independently by two analysts. Two themes relating to methods of teaching and learning communication skills emerged from the analysis. Students had mixed views about instructional methods of teaching and learning communication skills such as lectures. Students seemed to prefer experiential methods of learning communication skills such as role-playing with simulated patients and communicating with real patients in a clinical context. These findings have a number of educational and research implications and these are discussed in this paper.

Adult↗
PubMed2003

Teaching and learning about skills in minor surgery.

The aim of this study was to assess the feasibility of a scenario-based approach to learning minor surgery skills. After learning component technical skills for ellipse excision and wound closure, nurses were provided with an opportunity to integrate these skills with communication skills and contextual factors in a quasi-clinical environment. Feasibility was assessed using observation of procedures and a group interview with participants, simulated patients and tutors. The scenario-based approach to teaching and learning about technical and communication skills proved feasible and was valued by participants in this course on minor surgery. Although all participants expressed anxiety about integrating skills in the quasi-clinical setting, they valued the opportunity to undergo a formative assessment prior to working in supervised settings with real patients. Learners valued highly the opportunity to reflect on their performance and to receive feedback on technical and communication skills. Future courses should include focused teaching on communication skills prior to the scenario-based exercise. Limitations of the study centre on the small numbers of participants and the novelty of the course. Repeating the evaluations on a subsequent course will provide insight into the ways in which nurses acquire and integrate new skills.

Clinical Competence↗
PubMed1989

Functional role of the sensory cortex in learning motor skills in cats.

The functional role of corticocortical input projecting to the motor cortex in learning motor skills was investigated by training 3 cats with and without the projection area. After unilateral removal of areas 1, 2, 2 praeinsularis and a part of 5, the cat was placed in a box and trained to pick up a small piece of food from a beaker in front of the box. Since the beaker and the edge of the box had a space in between, the cat had to develop a new motor skill to being the food back to the box across the space. This skill consisted of combined supination and flexion of the paw to hold the food over the gap. In all 3 cats, the training period necessary for acquisition of the motor skill for the forelimb contralateral to the lesioned brain was significantly longer than the period necessary for the forelimb ipsilateral to the lesioned cortex. Ablation of the remaining projection area after completion of the training did not impair the learned motor skill. The results suggest that the input from the lesioned area to the motor cortex participates in learning motor skills.

Animals↗
PubMed2005

Evaluating clinical simulations for learning procedural skills: a theory-based approach.

Simulation-based learning is becoming widely established within medical education. It offers obvious benefits to novices learning invasive procedural skills, especially in a climate of decreasing clinical exposure. However, simulations are often accepted uncritically, with undue emphasis being placed on technological sophistication at the expense of theory-based design. The author proposes four key areas that underpin simulation-based learning, and summarizes the theoretical grounding for each. These are (1) gaining technical proficiency (psychomotor skills and learning theory, the importance of repeated practice and regular reinforcement), (2) the place of expert assistance (a Vygotskian interpretation of tutor support, where assistance is tailored to each learner's needs), (3) learning within a professional context (situated learning and contemporary apprenticeship theory), and (4) the affective component of learning (the effect of emotion on learning). The author then offers four criteria for critically evaluating new or existing simulations, based on the theoretical framework outlined above. These are: (1) Simulations should allow for sustained, deliberate practice within a safe environment, ensuring that recently-acquired skills are consolidated within a defined curriculum which assures regular reinforcement; (2) simulations should provide access to expert tutors when appropriate, ensuring that such support fades when no longer needed; (3) simulations should map onto real-life clinical experience, ensuring that learning supports the experience gained within communities of actual practice; and (4) simulation-based learning environments should provide a supportive, motivational, and learner-centered milieu which is conducive to learning.

Computer Simulation↗