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PubMedDate not supplied

An orthopaedic workshop and skills laboratory.

Planning and implementing care for patients with musculoskeletal disorders can be intimidating for nursing students. Moreover, changes in health care delivery often limit the opportunities students will have to learn skills and participate in the care of a patient in need of these services. This article describes the development of an orthopaedic workshop and skills laboratory which provides hands-on learning experience in a nonthreatening environment. The teaching strategy uses the collaborative resources of health care providers, allowing the student to be introduced to the care of orthopaedic patients from admission to discharge.

Attitude of Health Personnel↗

PubMed2005

It's practice, with sleep, that makes perfect: implications of sleep-dependent learning and plasticity for skill performance.

Although there is no consensus regarding the functions of sleep, one exciting hypothesis is that sleep contributes importantly to learning and memory. Over the last decade, several studies have provided substantive evidence supporting the role of sleep in memory processing. This article focuses on sleep-dependent learning and brain plasticity in humans, specifically in the development of skill performance that is the foundation of many sports actions. The different forms and stages of human memory are discussed, then evidence of sleep-dependent skill learning and associated sleep-dependent brain plasticity is described. In conclusion, a consideration of the fundamental importance of sleep in real-life skill learning is provided.

Brain↗

PubMed1989

A practical approach to creative teaching: an experiment.

The purpose of this experiment was to see if creative teaching methods would prove effective when included in a school of nursing teaching programme. This would be demonstrated by significant differences in levels of achievement in assessments and a demonstration that the knowledge gained was applied to the clinical situation. Didactic teaching methods were exchanged for a more creative approach without alteration of the course structure. The quasi experimental method was used, with four introductory courses of 20 nursing students at two separate district schools as the sample, two groups acting as the control groups and two as the experimental groups. The teaching sessions introduced medical problems associated with poor oxygenation, particularly those consequent to heart disease. The teaching was supported by appropriate care planning within the Roper et al. (1981) theoretical framework. Three distinct areas were identified; fact learning, e.g. anatomy and physiology, problem identifications and planning for nursing, intervention and skill learning. Students in the experimental groups were given work sheets and facilities for self learning whilst those in the control groups continued with a traditional lecture/demonstration format. The results of the experiment were evaluated by testing all four groups using multiple choice objective tests, essays, problem solving and nursing intervention exercises and practical assessments. The findings showed that the experimental groups did no better in the multiple choice objective tests or in the essays than the control groups but they did do significantly better in the problem identification and planning for nursing intervention exercise. In the assessment of practical skills there was no difference between the groups in skill performance but the experimental groups were able to apply the theory significantly better than the control groups.

Creativity↗

PubMed2001

Students' perception of problem-based learning in the medical curriculum of the Faculty of Medicine, University of Colombo.

INTRODUCTION: Problem-based learning (PBL) is used as an instructional method in the system-based modules of the new innovative curriculum of the Colombo Medical Faculty in Sri Lanka. This study was undertaken to assess whether objectives of having PBL to facilitate acquisition of desirable learning skills and generic skills had been achieved. The perceived advantages and disadvantages of PBL were also studied. MATERIALS AND METHODS: The study population comprised third year medical students who had completed 12 PBL sessions. A self-administered questionnaire, which measured learning outcomes and acquisition of generic skills on a 5-point Likert rating scale, was used. RESULTS: The response rate was 87.2% (n = 188). Eighty per cent of students were aware of the rationale for having PBL and of learning from recommended material. Seventy-five per cent knew the competencies that could be acquired from PBL and two-thirds knew about the importance of small group discussions. PBL had helped to improve communication skills in 57% and problem solving skills in 52%. The main disadvantage was that it was time-consuming. Only 46.6% were satisfied with the participation of colleagues in the group. Seventy-six per cent felt that PBL could be better conducted. CONCLUSION: Awareness of concepts of PBL, reasons for its inclusion in the curriculum and educational advantage was high. The main disadvantage perceived was that it was time-consuming. There is a need to improve the conduct of PBL and, provide guidance and awareness programme for students.

Attitude↗

PubMed2006

Bilateral basal ganglia activation associated with sensorimotor adaptation.

Sensorimotor adaptation tasks can be classified into two types. When subjects adapt movements to visual feedback perturbations such as in prism lens adaptation, they perform kinematic adaptations. When subjects adapt movements to force field perturbations such as with robotic manipulanda, they perform kinetic adaptations. Neuroimaging studies have shown basal ganglia involvement in kinetic adaptations, but have found little evidence of basal ganglia involvement in kinematic adaptations, despite reports of deficits in patients with diseases of the basal ganglia, such as Parkinson's and Huntington's disease, in these. In an effort to resolve such apparent discrepancy, we used FMRI to focus on the first few minutes of practice during kinematic adaptation. Human subjects adapted to visuomotor rotations in the context of a joystick aiming task while lying supine in a 3.0 T MRI scanner. As demonstrated previously, early adaptive processes were associated with BOLD activation in the cerebellum and the sensory and motor cortical regions. A novel finding of this study was bilateral basal ganglia activation. This suggests that, at least for early learning, the neural correlates of kinematic adaptation parallel those of other types of skill learning. We observed activation in the right globus pallidus and putamen, along with the right prefrontal, premotor and parietal cortex, which may support spatial cognitive processes of adaptation. We also observed activation in the left globus pallidus and caudate nucleus, along with the left premotor and supplementary motor cortex, which may support the sensorimotor processes of adaptation. These results are the first to demonstrate a clear involvement of basal ganglia activation in this type of kinematic motor adaptation.

Adaptation, Physiological↗

PubMed2002

Rehearsal of task variations and contextual interference effect in a field setting.

The present study showed a consistent pattern with a typical contextual interference effect in motor skill learning (N=38 adults). Individuals trained under the high contextual interference condition may receive greater learning benefits than those under the low contextual interference condition during the rehearsal of task variations of a single motor skill in a field setting.

Adolescent↗

PubMed1987

Plasticity of cortical function related to voluntary movement motor learning and compensation following brain dysfunction.

Processes of motor learning and of compensation after localized brain dysfunction were studied in the monkey tasked with conditioned (visually-initiated, reaction-time) hand movements. Field potentials in various cortical areas of the cerebral hemisphere were recorded successively for many months with electrodes implanted on the surface and in the depth of the cortex. The potentials associated with the conditioned movement were found to change during processes of learning the movement and during courses of degradation as well as recovery after the brain dysfunction. Motor learning of the reaction-time movement can be categorized into "recognition" and "skill" learnings. The former is the process for associating the visual stimulus with the movement and accompanied mainly by increasing activities of prefrontal, premotor and prestriate cortices. The latter is attaining better performances in executing the movement, particularly with shorter and more fixed reaction time, and is accompanied by recruitment of the cerebro-cerebellar interaction. The conditioned movements which had been well established were experimentally disturbed by transient, local cooling of different cortical areas or by cerebellar hemispherectomy. Three possible mechanisms of compensation are proposed as follow: 1. Substitution: Compensation occurring immediately through substitutional neuronal circuits. On transient cooling of the forelimb motor cortex, the somatosensory cortex became predominant in motor function and replaced the disabled motor cortex in executing the reaction-time movement, although activity was weak and slow (paretic but not paralytic). Resection of the cerebellar hemisphere also induced the compensatory motor function of the somatosensory cortex so that the movement could be performed although it was weak, slow and clumsy. 2. Relearning: Compensation by relearning through normally unused neuronal circuits. Prolonged and variable reaction times after cerebellar hemispherectomy persisted when the operation included both dentate and interpositus nuclei but recovered within about three weeks when the interpositus nucleus was preserved. It is suggested that the information processing for the well accomplished reaction-time movement is mainly mediated by the cerebro-cerebellar neuronal circuit including the dentate nucleus but is gradually relearned through the normally unused circuits involving the interpositus nucleus after the dentate nucleus lesion. 3. Rebuilding: Compensation by rebuilt neuronal circuits, e.g., by sprouting and/or regeneration (see S. Kawaguchi in this book).

Action Potentials↗

PubMed1997

Teaching practical skills: a guide for preceptors.

Concern has been expressed that recently qualified nurses may be deficient in clinical skills. In this article the authors explore psychomotor skills learning and suggest strategies to support preceptors who have responsibility for developing such skills in students. The advice should prove helpful to clinical staff who are involved in teaching clinical skills to nursing students.

Clinical Competence↗

PubMed1998

Effects of Practice Conditions and Supplemental Training Method on Cognitive Learning and Interpersonal Skill Generalization.

Organizational expenditures for interpersonal-skills training have been rising. However, little is known about the translation of cognitive learning into skilled interpersonal-task performance, or about the mechanisms through which interpersonal skills in one domain generalize to other interpersonal tasks. This study used a 2 x 2 experimental design to examine the effectiveness of neutral versus stressful practice conditions and mastery-versus performance-oriented supplemental training for improving cognitive learning and interpersonal-skill transfer to a novel task. Participants who experienced stressful salary-negotiation practice conditions, followed by mastery-oriented supplemental training, showed greater skill transfer when performing a novel task (i.e., contract negotiations). Results showed that superior cognitive learning (i.e., recall, comprehension, and synthesis) and greater time on task were the mechanisms that supported interpersonal-skill transfer for trainees in the stressful practice/ mastery-oriented training condition when compared with the other experimental groups. Copyright 1998 Academic Press.

Journal Article↗

PubMed1983

The efficiency of skilled performance.

The observed ease or effort of performance has traditionally been considered an integral part of any definition of skill (e.g., Guthrie, 1935). Empirical investigations of skill learning and performance have, however, largely ignored the effort or efficiency with which the movement is performed. This situation has arisen despite the fact that in many skills, particularly athletic endurance events or industrial work tasks, efficiency of performance may be essential to the goal of the task. This paper focuses on the energy demand of various skills and its relationship to issues of learning, performance, and individual differences in preferred rhythm. It is shown that across a variety of tasks the individual's freely chosen work-rate is the most efficient. The significance of preferred rhythm to theoretical perspectives on rhythmic activity is discussed.

Journal Article↗

PubMed1982

Learning a motor skill with spatial and temporal parameters.

The purpose of this study was to determine how individuals learned a motor skill having temporal and spatial parameters. For scores of 10 adult males one-way repeated-measures multivariate analysis indicated that subjects learned the skill but follow-up analysis showed acquisition occurred on accuracy only. Some processing limitations were possible with the number of trials a possible limiting factor.

Adolescent↗

PubMed2003

Registered dietitians' use of physical assessment parameters in professional practice.

OBJECTIVE: To examine how registered dietitians who have completed one of two physical assessment programs use the knowledge and skills learned in practice and whether method of instruction had an affect on use of skills in practice. SUBJECTS/SETTING: Surveys were mailed to 891 persons, all of whom completed a Dietitians in Nutrition Support dietetic practice group or University of Medicine and Dentistry of New Jersey continuing education program. Four hundred seventeen surveys were returned and 407 were usable. STATISTICAL ANALYSIS: chi(2) analysis and stepwise logistic regression was used to analyze the data. Statistical significance was P=.05. RESULTS: Sixty percent of respondents worked in a clinic setting. Four of the five most-used competencies were similar between the two programs. More registered dietitians are using physical assessment competency information in clinical assessment, but not performing the competencies independently. Respondents with the Certified Diabetic Educator credential (P=.007) and Certified Nutrition Support Dietitians credential (P=.215) were more likely to use select physical assessment competencies. Confidence was reported as enhancing use of physical assessment competencies (n=153, 45%) and time was a barrier to using physical assessment competencies (n=159, 52%). APPLICATIONS/CONCLUSIONS: There were no significant differences in use of physical assessment competencies between the University of Medicine and Dentistry of New Jersey program and the Dietitians in Nutrition Support program. Although not statistically significant, there appeared to be more use of physical assessment competencies by those who received additional training and those who completed the University of Medicine and Dentistry of New Jersey program. This study reveals that registered dietitians are using the values in clinical assessment, however they must move to actually performing physical assessment competencies in practice.

Adult↗

PubMed1988

Cholinergic 'blockade' as a model for cholinergic depletion. A comparison of the memory deficits with those of Alzheimer-type dementia and the alcoholic Korsakoff syndrome.

The effect of cholinergic 'blockade' on human memory performance as a model for the effect of cholinergic depletion in clinical disorders was investigated. A wide range of memory functions was assessed in 70 subjects, using tests which were identical or closely similar to those which have previously been employed in clinical studies of Alzheimer and Korsakoff patients. In addition, a physiological measure of the degree of central cholinergic blockade was included, as well as measures of subjective arousal and objective attention. It was found that cholinergic blockade had no significant effect on the more passive aspects of primary (or 'working') memory, namely span tests and a measure of verbal short-term forgetting; in this, it contrasts with the marked deficits seen in Alzheimer-type dementia. On the other hand, cholinergic blockade produced impairment at a visuospatial short-term forgetting test, and at a verbal test in which the distractor task was made more difficult. On tests of secondary memory, cholinergic blockade produced a pattern similar to that seen in the anterograde amnesia of Alzheimer and Korsakoff patients, namely a pronounced impairment in learning verbal and visuospatial material, a 'normal' forgetting rate once learning had been accomplished, and relative preservation of the response to priming and of skill learning (procedural memory). Cholinergic blockade, however, did not produce a retrograde amnesia, nor did it affect the recall of temporal context or of long-established semantic knowledge. This pattern of results is compared with that obtained in previous studies of Alzheimer and Korsakoff patients.

Alcohol Amnestic Disorder↗

PubMed2004

The influence of sleep on auditory learning: a behavioral study.

Evidence continues to support a role for sleep in delayed learning without further practice. Here we demonstrate the beneficial influence of sleep on auditory skill learning. Fifty-six subjects were randomly assigned to two groups, trained and tested on a pitch memory task three times across 24 h. The morning group was trained at 09.00 h, retested 12 h later that same day, and again after 12 h sleep. The evening group was trained at 21.00 h, retested 12 h immediately after sleep, and again 12 h later the next day. At retesting, both groups combined showed significant delayed learning only after sleep, but not across equivalent periods of wake, regardless of which came first. These data add to the growing literature describing sleep-dependent learning throughout sensory and motor domains.

Acoustic Stimulation↗

PubMed1995

Improving patient moving and handling skills.

Training in manual handling should incorporate a problem-solving approach. The handling and moving of patients is a learned skill that needs regular revision. Assessment of patient capabilities is essential, as is the provision of a safe, ergonomically satisfactory environment. There is no single technique that works in all situations.

Back Pain↗

PubMed1993

The effects of imagery abilities and mental rehearsal on learning a nursing skill.

Nursing demands competency in numerous psychomotor skills. Using theory from Paivio (1986), Anderson (1976, 1985), and Bandura (1986), this attribute-treatment study explored the interactive effects of imagery skills and various combinations of physical and mental practice on learning a skill. The author assessed 108 nursing students for imagery abilities and randomly assigned them to a physical practice (PP), mental rehearsal (MR), or a combined mental rehearsal plus physical practice (MR + PP) group. After learning to apply and remove sterile gloves, subjects were evaluated on their performance. A 3-factor ANOVA was performed and a significant main effect for practice condition was obtained. Subjects in the MR+PP condition performed significantly better than subjects in the MR condition but not the PP condition. These findings have important implications. Incorporating the use of mental rehearsal as an adjunct to physical practice in an effort to facilitate skill acquisition was found to be beneficial.

Analysis of Variance↗

PubMed2005

Prescription audit adjunct to rational pharmacotherapy education improves prescribing skills of medical students.

OBJECTIVE: To assess the impact of a rational pharmacotherapy (RP) teaching program during clinical pharmacology clerkship by analyzing the results of prescription audits (PAs) of the medical students. Collectively, we intended to observe the possible improvement of the students in their prescribing, problem solving and self-directed learning skills. DESIGN: At the beginning and end of the clerkship, the students were presented with cases of uncomplicated osteoarthritis to assess their prescribing skills; format and rationality were scored. SETTING: A medical school in Turkey that teaches RP to the fourth-year students in clinical pharmacology clerkship. PARTICIPANTS: There were 94 students of the 2002-2003 academic year in three groups and a single group of students belonging to the previous academic year tested. Of those students from the previous academic year, 26 were also analyzed a year later to demonstrate the long-term impact of the training. MAIN OUTCOME MEASURES: Prescribing skills of medical students and their opinions about PA. RESULTS: Direct assessment via PA demonstrated that the scores for post-clerkship prescriptions were far better than those for pre-clerkship prescriptions in terms of format and rationality. Long-term assessment showed that the scores declined within a year following clerkship, but they were still higher than those of their pre-clerkship scripts. Analysis of the questionnaires revealed that the students were satisfied with PA. The majority of the students stated they had learned the general principles of RP and gained better prescribing skills, and they intended to apply most of the principles learned to their future professional lives. The script format scores of a retrospectively created PA-exempted group were significantly lower than those of the students to whom an established PA education was given. CONCLUSION: PA sessions were shown to be an easy and a useful method of both evaluating and reinforcing prescribing skills gained though problem-based RP education.

Analgesics↗

PubMed2001

Directing attention to movement effects enhances learning: a review.

Studies investigating the influence of the learner's focus of attention, induced by instructions or feedback, on motor skill learning are reviewed. In general, directing performers' attention to the effects of their movements (external focus of attention) appears to be more beneficial than directing their attention to their own movements (internal focus of attention). Preliminary evidence is presented indicating that an internal attentional focus constrains the motor system by interfering with natural control processes, whereas an external focus seems to allow automatic control processes to regulate the movements. Support for the view that actions are controlled by their anticipated effects comes from research demonstrating functional variability in motor control, as well as the benefits of purposeful activity in occupational therapy. We explain these results in terms of the ideomotor principle of human actions (James, 1890) and its more modern derivatives (Hommel, 1996; Prinz, 1990, 1997).

Attention↗