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PubMed1994

Teaching and learning clinical skills, Part 2--Development of a teaching model and schedule of skills development.

In Part 1 of this paper the development of a multidisciplinary Skills Centre in a London teaching hospital, and the Clinical Skills Matrix, a composite list of skills required by nurses and doctors was described. Part 2 describes how a model for skills teaching, the Integrated Skills Teaching Model, was developed in order to provide a framework for teaching within the centre. This work and that of Alavi et al (1991) led to the development of a Schedule of Skills Development. This identifies the skills to be acquired and indicates the level of performance at specific stages throughout the Project 2000 programme. The schedule provides a comprehensive overview of skill development for teachers, students and clinical staff.

Clinical Competence↗
PubMed2005

Brain activation during execution and motor imagery of novel and skilled sequential hand movements.

This experiment used functional magnetic resonance imaging (fMRI) to compare functional neuroanatomy associated with executed and imagined hand movements in novel and skilled learning phases. We hypothesized that 1 week of intensive physical practice would strengthen the motor representation of a hand motor sequence and increase the similarity of functional neuroanatomy associated with executed and imagined hand movements. During fMRI scanning, a right-hand self-paced button press sequence was executed and imagined before (NOVEL) and after (SKILLED) 1 week of intensive physical practice (n = 54; right-hand dominant). The mean execution rate was significantly faster in the SKILLED (3.8 Hz) than the NOVEL condition (2.5 Hz) (P < 0.001), but there was no difference in execution errors. Activation foci associated with execution and imagery was congruent in both the NOVEL and SKILLED conditions, though activation features were more similar in the SKILLED versus NOVEL phase. In the NOVEL phase, activations were more extensive during execution than imagery in primary and secondary cortical motor volumes and the cerebellum, while during imagery activations were greater in the striatum. In the SKILLED phase, activation features within these same volumes became increasingly similar for execution and imagery, though imagery more heavily activated premotor areas, inferior parietal lobe, and medial temporal lobe, while execution more heavily activated the precentral/postcentral gyri, striatum, and cerebellum. This experiment demonstrated congruent activation of the cortical and subcortical motor system during both novel and skilled learning phases, supporting the effectiveness of motor imagery-based mental practice techniques for both the acquisition of new skills and the rehearsal of skilled movements.

Adult↗
PubMed2001

Optimal teaching environment for laparoscopic splenectomy.

BACKGROUND: Traditional surgical teaching depends on graduated acquisition of skill learned in residency. The introduction of minimal access techniques after residency training has created a new paradigm dependent on animate course experiences and limited preceptor training. The outcome of performance of a new skill "learned" in these settings has not been assessed. The purpose of this study was to test the benefit of an animate course compared with a precepted operating room experience in learning to perform a laparoscopic splenectomy. METHODS: All attending surgeons who had taken a 1-day course to learn laparoscopic splenectomy (n = 37) and those who had undergone an intraoperative preceptorship (in their hospital) by the lead author (n = 15) were polled to ascertain their previous experience with laparoscopy and with laparoscopic splenectomy since the intervention. The course included lectures, operative videos, and an animal lab. Statistical differences were measured using a t test. RESULTS: Thirty-two of the 37 (86.5%) taking the course and all 15 of the precepted surgeons responded. There was no difference between the groups regarding prior laparoscopic experience (P = 0.73), laparoscopic training during residency (P = 0.74), academic or private practice (P = 0.48), or follow-up since the intervention (P = 0.36). The participants graded the courses (1 to 5, 5 = excellent) at an average of 4.72. Fourteen of 15 precepted surgeons have performed laparoscopic splenectomy as compared with 2 of 32 taking courses (nonprecepted surgeons; P <0.0001). The number of laparoscopic splenectomies performed totaled 112 for precepted surgeons and 4 for nonprecepted surgeons (P = 0.0003). The nonprecepted surgeons performed significantly more open splenectomies than laparoscopic (95 versus 13 respectively, P = 0.02). Reasons quoted not to proceed with laparoscopic splenectomy included waiting for the perfect patient, concern of hilar management, and splenic size. CONCLUSION: Surgeons precepted in their own operating room performed a laparoscopic splenectomy more readily than those gaining experience from a course only (93% versus 6%, respectively) despite no difference in their preintervention experience and having the opportunity to do so. The expectation of the eventual performance of advanced laparoscopic techniques depends on a precepted experience.

Education, Medical, Continuing↗
PubMed1994

Cognitive correlates to social cue perception in schizophrenia.

Previous research has examined social skill learning in schizophrenic patients in relation to information-processing deficits and psychiatric symptoms. Relationships were examined in the current report between social cue perception, thought to be an early and necessary component of skill learning, and various information-processing deficits and psychiatric symptoms. Twenty-six inpatients with DSM-III-R diagnoses of schizophrenia completed measures of social cue perception, cognitive functioning, and psychiatric symptoms. Results showed that cue perception was significantly related to measures of early visual processing, recognition memory, and psychiatric symptoms of withdrawal/retardation. Implications of these findings for future research into the social-perceptual deficits of schizophrenic patients are discussed.

Adult↗
PubMed2000

Plasticity and primary motor cortex.

One fundamental function of primary motor cortex (MI) is to control voluntary movements. Recent evidence suggests that this role emerges from distributed networks rather than discrete representations and that in adult mammals these networks are capable of modification. Neuronal recordings and activation patterns revealed with neuroimaging methods have shown considerable plasticity of MI representations and cell properties following pathological or traumatic changes and in relation to everyday experience, including motor-skill learning and cognitive motor actions. The intrinsic horizontal neuronal connections in MI are a strong candidate substrate for map reorganization: They interconnect large regions of MI, they show activity-dependent plasticity, and they modify in association with skill learning. These findings suggest that MI cortex is not simply a static motor control structure. It also contains a dynamic substrate that participates in motor learning and possibly in cognitive events as well.

Animals↗
PubMed2001

Students' expectations of learning key skills and knowledge.

Students' expectations of the key skills and knowledge they acquire and how their perceptions of these change during the four year period of their speech and language therapy (SLT) degree programme are explored. This is important because students are central to the teaching and learning process so their expectations of learning have to be taken into account in order to best help them to achieve the required learning outcomes. Over 100 De Montfort University (DMU) SLT under-graduate students from the four years were surveyed by questionnaire. The research findings are discussed to examine the significance of differences between and within year cohorts. The outcomes of this research will provide a basis for recommendations for DMU and other universities' SLT programmes, and for the improvement of student learning guidance.

Health Knowledge, Attitudes, Practice↗
PubMed1995

Neurobiology of skill and habit learning.

Recent evidence indicates that the basal ganglia are critical brain structures for motor-skill and habit learning, and may be important for the acquisition of some perceptual and cognitive skills. The cerebellum appears to contribute importantly only to motor-skill learning. Transitory cortical changes occur during motor-skill learning, but perceptual-skill learning may involve a semi-permanent change in neuronal sensitivity in the primary sensory cortex.

Animals↗
PubMed2001

Learning manual skills in spinal anesthesia and orotracheal intubation: is there any recommended number of cases for anesthesia residency training program?

Wide variability exists in the number of anesthetic procedures to which anesthesia residents are exposed during their training. The number of attempts at various procedures before a trainee becomes proficient at performing each anesthetic procedure is not known. To determine the learning process of 150 attempts of spinal anesthesia and 100 attempts of orotracheal intubation, the two most frequent anesthetic procedures, we evaluated 9 first-year anesthesia residents according to their rate of success or failure. The learning curves of both procedures revealed an initial rapid improvement of success during the first 20 attempts. Spinal anesthesia was more difficult to learn (p=0.0002) but the learning curves of spinal anesthesia and orotracheal intubation reached a nondifferent high success rate of 82 per cent and 88.9 per cent respectively (p=0.13). According to this study the institutional recommended number of cases for spinal anesthesia and orotracheal intubation were 112 and 27 cases respectively.

Adult↗
PubMedDate not supplied

Images of medial temporal lobe functions in human learning and memory.

Investigations of the neural basis of mammalian memory have focused more often on the medial temporal lobe (MTL) than on any other brain region. In humans, the amnesic syndrome revealed the essential importance of the multiple structures located in the MTL system for declarative memory (the remembrance of events and facts). Other neural systems mediate procedural forms of memory, including delay eyeblink conditioning, which depends on the cerebellum, and cognitive skill learning, which depends on the striatum. We review three functional imaging studies that reveal different patterns of MTL activation associated with declarative and procedural memory tasks. One study shows separate MTL activations during the encoding or retrieval of declarative memories. A second study shows MTL activation that occurs in parallel with cerebellum-dependent delay eyeblink conditioning, but does not appear to influence that form of procedural memory. A third study reveals suppression of the MTL during striatum-dependent cognitive skill learning. These studies provide images of MTL activations that are correlated with, independent from, or antagonistic to memory performance.

Amnesia↗
PubMed2003

Establishing a women's health curriculum using the Delphi Method.

CONTEXT: A Women's Health Initiative Task Force was formed with the collaboration of five primary care medical specialties at the University of Texas Medical Branch (UTMB) at Galveston to address the education of medical students about important issues related to women's health. OBJECTIVE: To identify and prioritize key concepts in issues related to women's health Methods: Literature review and three generational Delphi Method. RESULTS: The content was identified for development of a curriculum in Women's Health for medical students and resident physicians. Objectives, tasks, skills, learning opportunities, and learning materials were defined, and the curriculum is being designed to produce, within all specialties, parallel and consistent opportunities to educate students about issues important for women's health. CONCLUSION: The rankings of topics gathered though the Delphi Method will be used to develop a curriculum in Women's Health Issues that defines objectives, tasks, skills, learning opportunities, and learning materials for the purpose of educating UTMB medical students and resident physicians about the health needs of women.

Curriculum↗
PubMed2004

Computerized patient model and simulated clinical experiences: evaluation with baccalaureate nursing students.

This study evaluated student and faculty member perceptions regarding the use of a computerized universal patient simulator (Laerdal SimMan Universal Patient Simulator) in a simulated clinical scenario. Students who used SimMan in clinical simulation activities in this baccalaureate program during two consecutive semesters were surveyed using a 20-item tool scored on a 4-point Likert scale. Four faculty members were surveyed using a 17-item tool with the same response scale. The majority of the student sample consisted of Anglo women between ages 22 and 36. Survey items related to the reality of the simulations, the pace and flow of the clinical simulation, the ability to transfer skills learned to actual clinical settings, and the value of the simulated clinical experiences. Faculty members were also surveyed related to resource issues. Descriptive statistics were used to analyze survey responses. The majority of the students and faculty members identified the simulations as realistic and valuable. However, only approximately half of the students agreed that the skills learned in the clinical simulation would transfer to a real clinical setting, compared to 100% of the faculty. Faculty members reported that implementing the simulated clinical scenario required additional time and resources.

Adult↗
PubMed1999

Striatal activation during acquisition of a cognitive skill.

The striatum is thought to play an essential role in the acquisition of a wide range of motor, perceptual, and cognitive skills, but neuroimaging has not yet demonstrated striatal activation during nonmotor skill learning. Functional magnetic resonance imaging was performed while participants learned probabilistic classification, a cognitive task known to rely on procedural memory early in learning and declarative memory later in learning. Multiple brain regions were active during probabilistic classification compared with a perceptual-motor control task, including bilateral frontal cortices, occipital cortex, and the right caudate nucleus in the striatum. The left hippocampus was less active bilaterally during probabilistic classification than during the control task, and the time course of this hippocampal deactivation paralleled the expected involvement of medial temporal structures based on behavioral studies of amnesic patients. Findings provide initial evidence for the role of frontostriatal systems in normal cognitive skill learning.

Adult↗
PubMed2006

A novel amniocentesis model for learning stereotactic skills.

OBJECTIVE: This study developed a lifelike amniocentesis model to allow effective acquisition of the stereotactic skills necessary and comfort level with this procedure. STUDY DESIGN: An amniocentesis model is constructed using a formalin preserved gravid pig uterus. A large Ziploc freezer bag (Dow, Indianapolis, Ind) filled with ultrasound gel is placed on the uterus to simulate the skin and subcutaneous layer. RESULTS: Amniocentesis can be performed in the usual fashion using this lifelike model. No leak was observed in the Ziploc bag (Dow) or gravid uterus despite more than 50 needle insertions. The cost of 4 to 5 learning stations is approximately $50.00. This model enjoys the advantages of being changeable to reproduce a variety of real-life situations, including poly/oligo/anhydramnios, varied fetal positions and different thickness of subcutaneous tissue. CONCLUSION: This low-cost novel model provides realistic tissue resistance and yields a sonographically accurate amniocentesis-training tool. The use of this model permits resident instruction in a nonthreatening environment.

Amniocentesis↗
PubMed1991

Behavioral training for mothers of mentally handicapped children: teaching of self-help skills.

Deficits in self help skills are an inevitable problem with the mentally handicapped. The acquisition of self-help skills, learned effortlessly by more intelligent children, is a crucial aspect of the overall development of the mentally handicapped child. In the present study, thirty seven mothers of mentally handicapped children aged between 3 1/2 and 8 years, with an IQ of less than 70, were trained in behavioral techniques such as shaping, task analysis, prompting, and modelling, to develop independent self-help functioning in their children. The self-help areas were toileting, feeding, bathing, washing, and dressing. Thirty two per cent of mothers reported complete skill learning. The problems encountered in the course of training and the subsequent evaluation of its efficacy are discussed.

Adult↗
PubMed1999

The adult learner: a mythical species.

Adult learning theory, first described by Malcolm Knowles in the early 1970s, is based on a number of apparently self-evident axioms about how adults learn. The fundamental assumptions remain largely untested, and a critical analysis suggests that they may be largely a product of the environment in which adults find themselves rather than of any innate differences between adults and children. What evidence does exist suggests that one critical component of adult learning, self-assessment, is not easy. Further, while students can learn the skills to learn on their own (i.e., can acquire self-directed learning skills), this does not translate into greater competence, in either the short or long term. Uncritical reliance on the principles of adult learning may have detrimental consequences, particularly in the domain of maintenance of competence.

Adult↗
PubMed1998

Regional cerebral blood flow changes in human brain related to ipsilateral and contralateral complex hand movements--a PET study.

The purpose of this study was to investigate the cortical motor areas activated in relation to unilateral complex hand movements of either hand, and the motor area related to motor skill learning. Regional cerebral blood flow (rCBF) was measured in eight right-handed healthy male volunteers using positron emission tomography during a two-ball-rotation task using the right hand, the same task using the left hand and two control tasks. In the two-ball-rotation tasks, subjects were required to rotate the same two iron balls either with the right or left hand. In the control task, they were required to hold two balls in each hand without movement. The primary motor area, premotor area and cerebellum were activated bilaterally with each unilateral hand movement. In contrast, the supplementary motor area proper was activated only by contralateral hand movements. In addition, we found a positive correlation between the rCBF to the premotor area and the degree of improvement in skill during motor task training. The results indicate that complex hand movements are organized bilaterally in the primary motor areas, premotor areas and cerebellum, that functional asymmetry in the motor cortices is not evident during complex finger movements, and that the premotor area may play an important role in motor skill learning.

Adult↗
PubMed2005

Electrophysiological evidence for cortical plasticity with movement repetition.

The role of movement repetition and practice has been extensively studied as an aspect of motor skill learning but has rarely been investigated in its own right. As practice is considered a prerequisite for motor learning we expected that even the repetitive execution of a simple movement would rapidly induce changes in neural activations without changing performance. We used 64-channel event-related potential mapping to investigate these effects of movement repetition on corresponding brain activity in humans. Ten healthy right-handed young adults performed a power grip task under visual force control to ensure constant behaviour during the experimental session. The session consisted of two parts intersected by a break. For analysis each part was subdivided into two runs to control for potential attention or fatigue effects, which would be expected to disappear during the break. Microstate analysis revealed that distinct topographies and source configurations during movement preparation, movement execution and feedback integration are responsive to repetition. The observed patterns of changes differed for the three microstates, suggesting that different, repetition-sensitive neural mechanisms are involved. Moreover, this study clearly confirms that movement repetition, in the absence of skill learning, is capable of inducing changes in neural networks.

Adult↗