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Learning by imitation: a hierarchical approach.

To explain social learning without invoking the cognitively complex concept of imitation, many learning mechanisms have been proposed. Borrowing an idea used routinely in cognitive psychology, we argue that most of these alternatives can be subsumed under a single process, priming, in which input increases the activation of stored internal representations. Imitation itself has generally been seen as a "special faculty." This has diverted much research towards the all-or-none question of whether an animal can imitate, with disappointingly inconclusive results. In the great apes, however, voluntary, learned behaviour is organized hierarchically. This means that imitation can occur at various levels, of which we single out two clearly distinct ones: the "action level," a rather detailed and linear specification of sequential acts, and the "program level," a broader description of subroutine structure and the hierarchical layout of a behavioural "program." Program level imitation is a high-level, constructive mechanism, adapted for the efficient learning of complex skills and thus not evident in the simple manipulations used to test for imitation in the laboratory. As examples, we describe the food-preparation techniques of wild mountain gorillas and the imitative behaviour of orangutans undergoing "rehabilitation" to the wild. Representing and manipulating relations between objects seems to be one basic building block in their hierarchical programs. There is evidence that great apes suffer from a stricter capacity limit than humans in the hierarchical depth of planning. We re-interpret some chimpanzee behaviour previously described as "emulation" and suggest that all great apes may be able to imitate at the program level. Action level imitation is seldom observed in great ape skill learning, and may have a largely social role, even in humans.

Animals↗

Crisis resource management training for an anaesthesia faculty: a new approach to continuing education.

BACKGROUND: Human error and system failures continue to play a substantial role in adverse outcomes in health care. Anaesthesia crisis resource management addresses many patient safety issues by teaching behavioural skills for critical events but it has not been systematically utilized to teach experienced faculty. METHODS: An anaesthesia crisis resource management course was created for the faculty of our medical school's anaesthesia teaching programmes. The course objectives were to understand and improve participants' proficiency in crisis resource management (CRM) skills and to learn skills for debriefing residents after critical events. Through surveys, measurement objectives assessed acceptance, utility and need for recurrent training immediately post-course. These were measured again approximately 1 year later along with self-perceived changes in the management of difficult or critical events. RESULTS: The highly rated course was well received in terms of overall course quality, realism, debriefings and didactic presentation. Course usefulness, CRM principles, debriefing skills and communication were highly rated immediately post-course and 1 year later. Approximately half of the faculty staff reported a difficult or critical event following the course; of nine self-reported CRM performance criteria surveyed all claimed improvement in their CRM non-technical skills. CONCLUSIONS: A unique and highly rated anaesthesia faculty course was created; participation made the faculty staff eligible for malpractice premium reductions. Self-reported CRM behaviours in participants' most significant difficult or critical events indicated an improvement in performance. These data provide indirect evidence supporting the contention that this type of training should be more widely promoted, although more definitive measures of improved outcomes are needed.

Adult↗

Skill-based conditioning games as an alternative to traditional conditioning for rugby league players.

This study investigated the effects of skill-based conditioning games and traditional conditioning for improving speed, agility, muscular power, and maximal aerobic power in rugby league players. Sixty-nine subelite rugby league players performed either a skill-based conditioning games program (N = 32) or a traditional conditioning (i.e., running activities with no skill component) program (N = 37). Each player participated in a 9-week in-season training program, performed over 2 competitive seasons. Players performed 2 organized field-training sessions each week. Players underwent measurements of speed (10-m, 20-m, and 40-m sprint), muscular power (vertical jump), agility (L run), and maximal aerobic power (multi-stage fitness test) before and after the training period. Skill-based conditioning games induced a significant improvement (p < 0.05) in 10-m, 20-m, and 40-m speed, muscular power, and maximal aerobic power, whereas traditional conditioning activities improved 10-m speed and maximal aerobic power only. No significant differences (p > 0.05) were detected between the traditional conditioning and skill-based conditioning games groups for changes in 10-m speed, agility, and maximal aerobic power. Both groups won 6 of 8 matches played within the training period, resulting in a win-loss ratio of 75%. However, on average, the skill-based conditioning games group scored more points in attack (p < 0.05) and had a greater (p < 0.05) points differential than the traditional conditioning group. The results of this study demonstrate that skill-based conditioning games offer an effective method of in-season conditioning for rugby league players. In addition, given that skills learned from skill-based conditioning games are more likely to be applied in the competitive environment, their use may provide a practical alternative to traditional conditioning for improving the physiological capacities and playing performance of rugby league players.

Adult↗

How to present a paper at a scientific meeting.

BACKGROUND AND OBJECTIVES: Presentation of a scientific work is a learned skill that requires constant improvement especially now with the use of computer aided presentation--Microsoft PowerPoint. It addresses the peculiarities of preparation for a conference in a developing country. METHODOLOGY: Description of personal experience acquired through training and practice at scientific conferences has been stated. Relevant books and articles have been cited. RESULTS: The four parts of a presentation (preparation, presentation proper, questions and answer sessions and handling stage fright) and the effects of successful presentations have been highlighted. CONCLUSION: Scientific presentations are essential to a researcher throughout life and the skills can be learned and/ or improved upon through desire to learn, determination to succeed, training and constant practice of the process.

Audiovisual Aids↗

Teaching preventive medicine and health maintenance.

Preventive health care is an important part of the practice of internal medicine but is poorly taught and practiced in most residencies. A successful curriculum would impart knowledge of the preventive health care guidelines recommended by expert groups; provide opportunities for residents to understand the conceptual basis of preventive care; expose residents to clinical faculty with positive attitudes toward prevention; help residents to learn skills in physical examination, screening tests, and counseling in behavioral modification relevant to prevention; and provide a practice environment in which high-quality preventive health care is possible. All of the skills can be learned as other aspects of medicine are now learned--under the guidance of capable and respected faculty teaching at the bedside, in the clinics, and during ward rounds and conferences.

Attitude of Health Personnel↗

Impaired motor learning and diffuse axonal damage in motor and visual systems of the rat following traumatic brain injury.

Cognitive-motor functioning or motor skill learning is impaired in humans following traumatic brain injury. A more complete understanding of the mechanisms involved in disorders of motor skill learning is essential for any effective rehabilitation. The specific goals of this study were to examine motor learning disorders, and their relationship to pathological changes in adult rats with mild to moderate closed head injury. Motor learning deficits were determined by comparing the ability to complete a series of complex motor learning tasks with simple motor activity. The extent of neuronal damage was determined using silver impregnation. At all post-injury time points (day 1 to day 14), statistically significant deficits were observed in parallel bar traversing, foot placing, ladder climbing, and rope climbing. Performance improved with time, but never reached control levels. In contrast, no deficits were found in simple motor activity skills tested with beam balance and runway traverse. Histologically, axonal degeneration was widely distributed in several brain areas that relate to motor learning, including the white matter of sensorimotor cortex, corpus callosum, striatum, thalamus and cerebellum. Additionally, severely damaged axons were observed in the primary visual pathway, including the optic chiasm, optic tract, lateral geniculate nuclei, and superior colliculus. These findings suggest that motor learning deficits could be detected in mild or moderate brain injury, and this deficit could be attributed to a diffuse axonal injury distributed both in the motor and the visual systems.

Animals↗

Lifelong learning. Why professionals must have the desire for and the capacity to continue learning throughout life.

This paper will outline the theoretical constructs pertaining to lifelong learning, adult education, continuing professional development and the learning society. The need for all professionals to have highly developed learning skills in a society racing with change is evident. Pressures placed on health information managers to continue their learning beyond graduation are many and varied. Continuing professional education is one avenue that enables health information managers to continue their learning beyond graduation. Attributes of a typical lifelong learner are included in this paper to enable readers to self-assess their capacity for continued learning and their desire to undertake it. The paper concludes with a list of strategies for learners to enhance their lifelong learning skills. The role that educators can play in developing lifelong learning competence in students and graduates is also outlined.

Adult↗

All preregistration students should develop skills in learning disabilities.

In the light of ongoing service developments and government legislation it is important that preregistration nurses from all branches have the opportunity to develop their confidence and skills in the care of people who have learning disabilities. This article outlines the development of strategies employed by one institute of higher education in order to reflect the principles of "Valuing People" from a health perspective in non-learning disability nursing programmes. The particular challenges that have been encountered in the implementation of these strategies over the last 3 years are discussed, as are issues faced in the evaluation of the effectiveness of such strategies.

Clinical Competence↗

Practice-related improvement in information processing with novel antipsychotic treatment.

BACKGROUND: Attentional deficits are prominent in schizophrenia, and skill learning is impaired. Novel antipsychotic treatment has been reported to improve certain cognitive skills in schizophrenic patients, but no information is yet available about the effect of newer medications on skill learning. METHODS: Clinically stable patients with schizophrenia (n=16) and chronically hospitalized inpatients (n=8) were recruited while receiving conventional antipsychotic treatment. Subjects were tested at baseline on a visual continuous performance test (CPT), performed alone and simultaneously with an auditory CPT. Normal controls (n=8) were also tested at baseline. The inpatients and half of the outpatients were switched to treatment with risperidone. All patients then performed the visual CPT on a daily basis and performed the dual tasks once per week, for 4weeks. RESULTS: Patients who remained on conventional medications did not improve in their performance despite the extensive practice on the test. Both chronic and stable patients receiving risperidone treatment manifested a statistically significant (P<0.05) improvement from baseline on both single and dual-task visual CPT. Stable outpatients performed significantly better at the end of the protocol than the normal controls performance at baseline (P<0.05). IMPLICATIONS: These results suggest that practice-related improvements in the performance of information processing tests are enhanced by novel antipsychotic medications. Although the specific biological mechanism of this effect is not yet known, the results may suggest that use of newer medications will enhance skill development and perhaps facilitate rehabilitation of patients with schizophrenia.

Adult↗

Dream self-reflectiveness as a learned cognitive skill.

This research was directed toward the contradiction sustained by cognitive dream psychology, which on the one hand regards dreaming as higher symbolic activity and, on the other, sees its organizational and functional characteristics as derivative and/or inferior to those of waking consciousness. Study 1 evaluates the degree of self-reflective meta-cognition in dreams from different sleep stages. Subjects were 24 college students selected such that half were self-reported high-frequency dream recallers and half were low-frequency recallers. Both groups were composed equally of men and women. Greater self-reflectiveness (SR) was found in REM dreams as compared with those from stages 2 and 4, which did not differ. High-frequency recallers showed more dream SR than did low-frequency recallers. Study 2 assessed the extent to which self-reflective and lucid dreaming can be learned as a cognitive skill by varying levels of intention and attention paid to dreaming. After 3 weeks of home dream collection, results showed that four experimental groups had greater dream SR than did a baseline group. The most effective treatment was the mnemonic, wherein attention patterning schemas learned in waking resulted in more self-reflective and lucid dreaming than did either baseline or attention-control conditions. These results provide evidence that dreaming is not single-minded but variable along a self-reflective process continuum, and suggest functional and organizational levels that are consistent with the conception of dreaming as higher order cognitive activity.

Adult↗

Effects of hippocampal lesions on patterned motor learning in the rat.

Motor skill learning in rats has been linked to cerebellar function as well as to cortical and striatal influences. The present study evaluated the contribution of the hippocampus to motor learning. Adult male rats received electrolytic lesions designed to selectively destroy the hippocampus; a sham-lesioned group of animals served as a control. The animals with hippocampal lesions acquired a patterned motor learning task as well as sham controls. In contrast, rats with hippocampal lesions were impaired in spatial, but not cued, learning in the Morris water maze. In addition, lesioned rats showed profound impairment in the novel object recognition memory task, when a 1-h delay was used between training and testing. Taken together, these results suggest that the hippocampus is not necessary during acquisition of the motor learning task.

Animals↗

Translating learning principles into practice: a new strategy for learning clinical skills.

AIM: There are data to suggest that medical school may not adequately prepare doctors for practice and that there are deficiencies in undergraduate teaching of skills in history taking, physical examination, diagnosis and management (clinical skills). There is a need to re-evaluate methods by which we can teach clinical skills effectively. This aim of this review was to describe the literature concerning the important principles underpinning effective clinical learning. Subsequently a structured learning tool and teaching process was developed in order to support these principles. METHOD: The principles of effective clinical learning were derived after a search of the medical education and relevant behavioural science literature. Consequently, a structured learning tool and teaching process was developed in order to potentiate the translation of these principles into practice for medical school training in clinical skills. RESULTS: Ten principles were derived from the 68 articles referred to in this review. These were: making active decisions, an individual focus to learning, gaining experience, feedback to the learner, reciprocal learning, holistic care, relevant learning, feasibility, cost efficiency and mentoring. A process for history taking, physical examination and management plan was developed for medical students which incorporated these principles. CONCLUSION: Relevant literature can provide the foundations for teaching and learning methods in medical education. We plan to trial this method and evaluate the impact on student learning outcomes.

Clinical Competence↗

Can anticipatory skills be learned through implicit video-based perceptual training?

The aim of this experiment was to determine the effectiveness of two video-based perceptual training approaches designed to improve the anticipatory skills of junior tennis players. Players were assigned equally to an explicit learning group, an implicit learning group, a placebo group or a control group. A progressive temporal occlusion paradigm was used to examine, before and after training, the ability of the players to predict the direction of an opponent's service in an in-vivo on-court setting. The players responded either through hitting a return stroke or making a verbal prediction of stroke direction. Results revealed that the implicit learning group, whose training required them to predict serve speed direction while viewing temporally occluded video footage of the return-of-serve scenario, significantly improved their prediction accuracy after the training intervention. However, this training effect dissipated after a 32 day unfilled retention interval. The explicit learning group, who received instructions about the specific aspects of the pre-contact service kinematics that are informative with respect to service direction, did not demonstrate any significant performance improvements after the intervention. This, together with the absence of any significant improvements for the placebo and control groups, demonstrated that the improvement observed for the implicit learning group was not a consequence of either expectancy or familiarity effects.

Adolescent↗

Learning clinical skills: an interprofessional approach.

The professions of nursing and medicine are committed to interprofessional education, in the belief that through this, patient care and satisfaction will be improved. Most initiatives involving nurses have been at post-qualification level, in primary health care, and concerning interpersonal or information management skills. Much of this collaboration has been with professions allied to medicine or social services. This paper discusses an innovative programme of shared learning in acute care, involving final year medical students and newly qualified staff nurses. The programme, developed in response to the blurring of professional roles between nurses and junior doctors, took place in our interprofessional Clinical Skills Centre. It was based around a developing patient scenario which was pertinent to the participants' area of practice. Each session was led by an experienced nurse lecturer and doctor, supported by specialist contributors. The style of learning was participative, with small interprofessional groups addressing a range of patient management issues. In this way, relevant clinical and communication skills were integrated within the context of holistic patient care. The course was well evaluated by both professional groups of participants and their managers. Subsequent research and curriculum development are leading to the expansion of this successful initiative.

Clinical Competence↗