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PubMed2006

Effects of sex and insulin/insulin-like growth factor-1 signaling on performance in an associative learning paradigm in Caenorhabditis elegans.

Learning is an adaptive change in behavior in response to environmental stimuli. In mammals, there is a distinct female bias to learn skills that is still unprecedented in other animal taxa. Here we have investigated the biological determinants of performance in an associative learning paradigm in the nematode Caenorhabditis elegans. Using an assay of chemotactic reactions associated with food deprivation, wild-type male worms show inferior learning ability relative to hermaphrodites. Sex-based learning difference is therefore an ancient evolutionary feature appearing even in relatively simple animals. C. elegans mutants with reduced insulin/IGF-1 signaling also exhibit a greatly reduced learning ability in this assay. In addition, hyperactivation of insulin/IGF-1 signaling through loss-of-function mutations in the PTEN phosphatase daf-18, a negative regulator of insulin/IGF-1 signaling, enhances learning ability beyond that of wild type. According to our epistasis analysis, the effect of DAF-2 on learning acts via phosphatidylinositol 3,4,5-trisphosphate (PIP(3)) production, but not the DAF-16 FOXO transcription factor. This implies that the signaling pathway from DAF-2 affecting this learning paradigm branches between PIP(3) production and DAF-16. However, learning capacity of nematodes is lowered by loss-of-function mutations in daf-16, suggesting involvement of noninsulin/IGF-1 signaling-dependent DAF-16 activation in learning. Potentially, sex and insulin/IGF-1 signaling affect performance in this learning assay via effects on the neurobiology of learning.

Animals↗

PubMed2001

Problem-based learning (PBL) as an approach in the teaching of biochemistry of the endocrine system at the Angeles University College of Medicine.

INTRODUCTION: Biochemistry is a basic science subject introduced in the first year of the medical curriculum. At the Angeles University College of Medicine, the approach used in teaching biochemistry has always been the conventional lecture-based strategy. This study described the factors involved in the development of modules and the use of problem-based learning (PBL) as an innovative strategy in teaching the biochemistry of the endocrine system. MATERIALS AND METHODS: Four PBL modules consisting of clinical problems, student's and facilitator's guides and a list of learning objectives were developed and used by 68 first year medical students under the supervision of a tutor during small group tutorial sessions. A 5-point Likert scale questionnaire was employed to ascertain the perceptions of the students on the influences of the components of PBL on the learning process. RESULTS: The respondents affirmed that the PBL approach motivated them to actively control the direction of their learning needs and encouraged them to acquire self-learning skills. Ninety per cent of the students found the PBL approach to have inspired them to take charge of their own learning of the biochemistry of the endocrine system. CONCLUSION: The study showed that the students found this alternative method acceptable particularly in motivating to clarify biochemical concepts that facilitated their understanding of selected endocrine problems.

Biochemistry↗

PubMed1992

[Socialization of physician's role during the clinical part of medical education. 1: Students' assessment of own skills].

The learning of clinical skills may be the most important factor in the socialization of medical students to the doctor's role. In this survey 225 students from early and late stages of the clinical curriculum at the University of Oslo were asked to assess their clinical skills. The results show that many students lack sufficient practice, and there is little development of clinical skills from early to late stages of the clinical curriculum. This can promote an uncertainty amongst the students about the doctor's role. These results should lead to changes in the clinical teaching. Each department should set clearer objectives for what the students should be taught, and should verify that this takes place. Training in communication skills should be emphasized. Students should be given greater responsibility for clinical work throughout the clinical phase of their training.

Adult↗

PubMedDate not supplied

The effects of lead exposure on learning in a multiple repeated acquisition and performance schedule.

This study sought to determine the selectivity of Pb-induced changes in learning, as distinct from non-specific or performance effects, and to explore the nature of the underlying error patterns contributing to any learning deficits. To accomplish this, rats were chronically exposed to 0, 50, or 250 ppm Pb acetate in drinking water from weaning and trained on a multiple repeated acquisition (RA) and performance (P) schedule beginning at 55 days of age. The RA component required the rat to learn a new 3-member sequence of responses during each experimental session (Center Right Left, RLC, CLR, RCL, and LRC), while the correct sequence of responses for the P component was constant across sessions (LCR). Significant decrements in accuracy on the RA component but not on the P component were found in Pb-exposed groups compared to control, effects that could not be attributed to differential rates of responding. Analyses of error patterns revealed that the effects of Pb exposure on RA accuracy levels derived from two sources. The first consisted of a perseveration of P-like sequence responding (LCR) even during the RA component. Secondly, Pb exposure increased perseverative responding on a single lever, even though the schedule itself never directly reinforced such repetitive responding. The increase in frequency of these two types of perseverative behavior was incompatible with acquisition of non P-like sequences during the RA component. Adding a 5 sec tone to the light stimuli signalling the transition between RA and P components of the multiple schedule failed to attenuate these effects of Pb, suggesting that deficits in stimulus control were not the sole behavioral mechanism of these impairments. Examination of individual data revealed the presence of both 'learners' and 'non-learners' in each group, with the prevalence of the latter being suggestively higher in Pb-exposed groups than in controls. These findings may be relevant to the classroom setting, where periods requiring learning may frequently be interspersed with periods of performance of learned skills.

Animals↗

PubMed1998

The acquisition of skilled motor performance: fast and slow experience-driven changes in primary motor cortex.

Behavioral and neurophysiological studies suggest that skill learning can be mediated by discrete, experience-driven changes within specific neural representations subserving the performance of the trained task. We have shown that a few minutes of daily practice on a sequential finger opposition task induced large, incremental performance gains over a few weeks of training. These gains did not generalize to the contralateral hand nor to a matched sequence of identical component movements, suggesting that a lateralized representation of the learned sequence of movements evolved through practice. This interpretation was supported by functional MRI data showing that a more extensive representation of the trained sequence emerged in primary motor cortex after 3 weeks of training. The imaging data, however, also indicated important changes occurring in primary motor cortex during the initial scanning sessions, which we proposed may reflect the setting up of a task-specific motor processing routine. Here we provide behavioral and functional MRI data on experience-dependent changes induced by a limited amount of repetitions within the first imaging session. We show that this limited training experience can be sufficient to trigger performance gains that require time to become evident. We propose that skilled motor performance is acquired in several stages: "fast" learning, an initial, within-session improvement phase, followed by a period of consolidation of several hours duration, and then "slow" learning, consisting of delayed, incremental gains in performance emerging after continued practice. This time course may reflect basic mechanisms of neuronal plasticity in the adult brain that subserve the acquisition and retention of many different skills.

Adult↗

PubMed2004

The effectiveness of video feedback in the acquisition of orthopedic technical skills.

BACKGROUND: The addition of video feedback to bench model training offers residents the opportunity to see themselves perform a surgical task. Videotaped feedback therefore promotes self-evaluation, a critical learning skill, and also has the potential to influence how a resident executes a skill once they have had the opportunity to see themselves perform the task. METHODS: Twenty-nine surgical residents were video recorded while performing three technical skills. They then were randomly assigned to receive either no feedback, video feedback alone, or video feedback with the help of an expert, an orthopedic surgeon. The surgical task was then repeated. Orthopedic surgeons evaluated the videotapes using the global rating scale and technical checklist form. RESULTS: One-way between-subject analysis of variance comparing the pretest and post-test difference scores on three different measures for each of the three tasks revealed no statistically significant differences. After controlling for rater variance, the global rating scores across the three surgical tasks did not reveal any statistically significant differences. CONCLUSIONS: This study failed to demonstrate an improvement in technical skills based on utilization of video feedback.

Analysis of Variance↗

PubMed2005

Implicit perceptual training: how, when, and why?

The perceptual skills underlying anticipatory movement in sport have been the focus of much research over the past 20 years. Methods for training such skills have tended to emphasise explicit specification of discriminative cues and the rules linking changes in the perceptual field with required responses. Recently, researchers have begun to examine less prescriptive methods of training. In the present paper, we examine conceptual, methodological, and practical issues associated with whether such skills can or indeed should be trained implicitly. The implications of two ways of conceptualising the explicit-implicit distinction for the methods used to promote implicit learning and the tests used to assess the nature of learning are considered. Finally, potential advantages of implicitly learned skills relating to task complexity and robustness under stress are discussed.

Attention↗

PubMed2005

Time-sensitive enhancement of motor learning with the less-affected forelimb after unilateral sensorimotor cortex lesions in rats.

Unilateral damage to the forelimb region of the sensorimotor cortex (FLsmc) results in time-dependent changes in neuronal activity, structure and connectivity in the contralateral motor cortex of adult rats. These changes have been linked to facilitation of motor skill learning in the less-affected/ipsilesional forelimb, which is likely to promote its use in the development of behavioral compensation. The goal of this study was to determine whether an early post-lesion-sensitive time period exists for this enhanced learning and whether it is linked to synaptogenesis in the contralesional motor cortex. Rats were trained for 21 days on a skilled reaching task with the ipsilesional forelimb beginning 4 or 25 days after unilateral ischemic (endothelin-1-induced) FLsmc lesions or sham operations. As found previously, reaching performance was significantly enhanced in rats trained early post-lesion compared with sham-operates. In rats trained later post-lesion, performance was neither significantly different from time-matched sham-operates nor strikingly different from animals trained earlier post-lesion. In layer V of the contralesional motor cortex, stereological methods for light and electron microscopy revealed significantly more total, multisynaptic bouton and perforated synapses per neuron compared with sham-operates, but there were no significant differences between early- and late-trained lesion groups. Thus, there appears to be a sensitive time window for the maximal expression of the enhanced learning capacity of the less-affected forelimb but this window is broadly, rather than sharply, defined. These results indicate that relatively long-lasting lesion-induced neuronal changes are likely to underlie the facilitation of learning with the less-affected forelimb.

Animals↗

PubMed1982

Teaching clinical skills to pre-clinical medical students: integration with basic science learning.

Clinical skills are usually learned by pre-clinical students in a manner divorced from their basic science foundations. The value of previously learned basic sciences thus fails to be re-enforced. A clinical skills course was developed for an experimental curriculum of medical students in their first year. It was organized and taught by a team of basic and clinical scientists and emphasized the basic pathophysiological principles underlying clinical skills. Sessions were supported by related basic science audiovisual resources and a series of clinical problems with questions obliging the student to reason through basic-science mechanisms. Over the span of the course, students' interest shifted dramatically from a focus on proficiency in motor skills to an understanding of basic pathophysiological mechanisms underlying observed phenomena. Compared to conventional curriculum students, those in the experimental curriculum failed to show a diminution in perceived value of basic sciences in their future career and, on cumulative, cognitive examinations, scored equally in basic science, but significantly higher in clinical science subjects. A clinical skills course integrating both teachers and concepts from basic, as well as clinical sciences can improve student attitudes toward basic sciences.

Clinical Competence↗

PubMed2005

Smart tutor: a pilot study of a novel adaptive simulation environment.

Computer-based learning environments create the possibility of dynamic adaptation to address learner capabilities and user performance. Software algorithms, code-named Smart Tutor, for motor skill learning were developed and applied to an abstract environment for laparoscopic surgery (RapidFire). Smart Tutor dynamically adjusts the environment to minimize frustration and optimize learning conditions for all learners. This study compared the first generation RapidFire / Smart Tutor (RF / ST) to the Minimal Invasive Surgery Trainer Virtual Reality (MIST VR) system for laparoscopic performance improvement and level of frustration. Two groups of novice laparoscopic learners were assessed by pre- and post- training paper cutting exercise and subjective surveys. Users of both systems showed improvement of laparoscopic skills as measured by the paper cutting exercises. No differences were shown between groups for level of improvement. However, a significant difference was seen in the subjective ratings on the post-training survey with less frustration for the RF / ST training group. Important information was acquired for refinements of the Smart Tutor algorithms.

Clinical Competence↗

PubMed1999

What are the computations of the cerebellum, the basal ganglia and the cerebral cortex?

The classical notion that the cerebellum and the basal ganglia are dedicated to motor control is under dispute given increasing evidence of their involvement in non-motor functions. Is it then impossible to characterize the functions of the cerebellum, the basal ganglia and the cerebral cortex in a simplistic manner? This paper presents a novel view that their computational roles can be characterized not by asking what are the "goals" of their computation, such as motor or sensory, but by asking what are the "methods" of their computation, specifically, their learning algorithms. There is currently enough anatomical, physiological, and theoretical evidence to support the hypotheses that the cerebellum is a specialized organism for supervised learning, the basal ganglia are for reinforcement learning, and the cerebral cortex is for unsupervised learning.This paper investigates how the learning modules specialized for these three kinds of learning can be assembled into goal-oriented behaving systems. In general, supervised learning modules in the cerebellum can be utilized as "internal models" of the environment. Reinforcement learning modules in the basal ganglia enable action selection by an "evaluation" of environmental states. Unsupervised learning modules in the cerebral cortex can provide statistically efficient representation of the states of the environment and the behaving system. Two basic action selection architectures are shown, namely, reactive action selection and predictive action selection. They can be implemented within the anatomical constraint of the network linking these structures. Furthermore, the use of the cerebellar supervised learning modules for state estimation, behavioral simulation, and encapsulation of learned skill is considered. Finally, the usefulness of such theoretical frameworks in interpreting brain imaging data is demonstrated in the paradigm of procedural learning.

Journal Article↗

PubMed1995

Enhancing peer review with communication skill building.

The purpose of this pilot was to improve the peer review process by enhancing the communication skills of staff nurses. Communication skill building was taught to staff members with practice time allotted. The paradigm shift occurred in teaching staff that communication is a learned skill built through practice and not solely a cognitive skill. The results of this pilot demonstrated improved verbal communication, increased comfort with peer review, improved ability to separate performance from individual style differences, and increased accuracy with which staff rate themselves on self evaluations. An indirect benefit has been improved teamwork from increased support among the staff.

Colorado↗

PubMed1998

Interhemispheric coordination of premotor neural activity during singing in adult zebra finches.

The song system, a neural network that mediates the learning and production of song by oscine songbirds, is investigated extensively as a model system for understanding the neural basis of complex skill learning. Part of the complexity of birdsong arises from the coordinated recruitment of multiple groups of muscles on both sides of the body. Although the song system is bilaterally organized, little is known about how premotor activities on the two sides are coordinated during singing. We investigated this by unilaterally recording neural activity in the forebrain song nucleus HVc (also known as the high vocal center) during singing and by forcing the premotor activities in the two hemispheres out of synchrony by perturbing neural activity in the contralateral HVc with electrical stimulation. Perturbing the activity in one HVc at any time during a song led to a short-latency readjustment of activity in the contralateral HVc. This readjustment consisted of a true resetting of the temporal pattern of activity in the contralateral HVc rather than merely a transient activity suppression overlaid on an unaltered pattern of premotor activity. These results strongly suggest that the output of song premotor areas in the forebrain is continuously monitored and that an active mechanism exists for resynchronizing the outputs from the two hemispheres whenever their gross temporal patterns differ significantly. The possible anatomical substrates for these coordinating mechanisms and their potential roles in song learning are discussed.

Animals↗

PubMed2005

Night call does not impair learning of laparoscopic skills.

Investigators have looked at the effect of night call on surgical residents but not at learning of laparoscopic skills. The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) tests 6 tasks similar to a laparoscopic cholecystectomy. We hypothesized that night call would impair laparoscopic performance and that skills would not improve but rather deteriorate after night call. Seventeen volunteers were tested before and after night call. Data collected included economy of movement, time, and number of errors for each hand/foot. A paired Student t test was used for statistical analysis. On the first 2 tasks, there was an improvement in all parameters post-call, with significance reached in 5 of 18 parameters (P<or=.05). In the "running of the bowel,'' 8 of 9 parameters were significantly improved (P<or=.05). In the final task, 9 of 11 parameters showed a deterioration post-call, but only economy of movement of the foot was significant (P<or=.05). Most parameters (16) showed improvement rather than deterioration post-call, which is consistent with learning of laparoscopic skills despite lack of sleep from night call.

Educational Measurement↗

PubMed1990

Motor learning in patients with cerebellar dysfunction.

This study examined whether cerebellar dysfunction resulted in deficiencies of motor learning. Patients with cerebellar atrophy only or cerebellar atrophy combined with atrophy of the brainstem and age-matched normal subjects performed two tasks to assess improvements in skilled performance. The first task was repetitive tracing with the hand of an irregular geometric pattern with normal visual guidance, and the second task was repetitive tracing of a different geometric pattern with mirror-reversed vision. Patients with pathology limited to the cerebellum showed impairments in the skilled performance of the movement performed with normal vision that may have been related to a failure to alter movement strategy. Patients with added pathology in the brainstem exhibited impairments in adapting to mirror-reversed vision. Subsidiary experiments indicated that improvements of movements guided by mirror-reversed vision were mediated by vision. These results indicate that the cerebellum and its associated input pathways are involved in motor skill learning.

Adaptation, Physiological↗

PubMed1992

Focal retrograde amnesia following bilateral temporal lobe pathology. A neuropsychological and magnetic resonance study.

A patient who suffered a severe closed head injury was left with a dense retrograde amnesia for events which she had experienced prior to her injury, but she showed only mild, patchy anterograde memory impairment. Her retrograde amnesia included both public events and autobiographical material, and it extended back to her childhood. Previously learned skills such as playing a piano and driving a car were spared, even though she had no recollection at all of the original learning experience. A series of focused magnetic resonance scan images revealed major pathology in the anterior portion of both temporal lobes. No significant abnormality was found in the hippocampus, thalamus or other medial structures in the limbic-diencephalic system. Our findings indicate the independence of anterograde and retrograde memory mechanisms, and point to structures and pathways in the anterior temporal lobes as playing a critical role in memory for past events.

Adult↗

PubMed2006

Chronic conditions, functional limitations, and special health care needs in 10- to 12-year-old children born at 23 to 25 weeks' gestation in the 1990s: a Swedish national prospective follow-up study.

BACKGROUND: Children born extremely immature (gestational age < 26 weeks' gestation) increasingly reach school age. Information on their overall functioning and special health care needs is necessary to plan for their medical and educational services. This study was undertaken to examine neurosensory, medical, and developmental conditions together with functional limitations and special health care needs of extremely immature children compared with control subjects born at term. METHODS: We studied 11-year-old children born before 26 completed weeks of gestation in all of Sweden from 1990 through 1992. All had been evaluated at 36 months' corrected age. Identification of children with chronic conditions lasting > or = 12 months was based on a questionnaire administered to parents. Neurosensory impairments were identified by reviewing health records. Information regarding other specific medical diagnoses and developmental disabilities was obtained by standard parent and teacher questionnaires. RESULTS: Of 89 eligible children, 86 (97%) were studied at a mean age of 11 years. An equal number of children born at term served as controls. Logistic-regression analyses adjusting for social risk factors and gender showed that significantly more extremely immature children than controls had chronic conditions, including functional limitations (64% vs 11%, respectively), compensatory dependency needs (59% vs 25%), and services above those routinely required by children (67% vs 22%). Specific diagnoses or disabilities with higher rates in extremely immature children than in controls included neurosensory impairment (15% vs 2%), asthma (20% vs 6%), poor motor skills of > 2 SDs above the mean (26% vs 3%), poor visual perception of > 2 SDs above the mean (21% vs 4%), poor learning skills of > 2 SDs above the mean (27% vs 3%), poor adaptive functioning with T scores of < 40 (42% vs 9%), and poor academic performance with T score < 40 (49% vs 7%). CONCLUSIONS: Children born extremely immature have significantly greater health problems and special health care needs at 11 years of age. However, few children have severe impairments that curtail major activities of daily living.

Child↗

PubMed1998

Competency-based instruction in critical invasive skills improves both resident performance and patient safety.

BACKGROUND: Correct performance of invasive skills is essential, but residents often undertake such procedures after no or minimal instruction. METHODS: We instructed eight postgraduate year 1 (PGY1) residents in the cadaver laboratory using a competency-based approach (CBI). Each resident had been evaluated before the laboratory during patient encounters. Group instruction in endotracheal tube insertion (ET), venous cutdown (VC), and chest tube insertion (CT) was followed by individual pretesting and hands-on teaching, with 100% competency the goal. Failure was considered an inability to perform the task correctly or within 120 seconds. After the laboratory, residents were evaluated for correctness and rapidity of performance. RESULTS: Prelaboratory failures consisted of ET, 7; CT, 5; VC, 7. Postlaboratory failures were 0 for all. Prelaboratory complications consisted of ET, 3.3 +/- 1.1; CT, 1.9 +/- 1.0; VC, 3 +/- 1.0. Postlaboratory complications were 0 for all. Prelaboratory times (seconds) were ET, 66.5 +/- 30.8; CT, 104 +/- 4.1; VC, 116.3 +/- 0.7. Postlaboratory times were ET, 25 +/- 7; CT, 65.5 +/- 10.7; VC, 81.3 +/- 2.5. Changes were statistically significant for all (P < .03, nonparametric). Residents performed 20 CTs with 1 pneumothorax, 80 ETs with 2 failures, and 20 VCs with no complications. Initial trauma resuscitation time decreased from 25 to 10 minutes. CONCLUSIONS: (1) Residents' skills rapidly improve with CBI; (2) skills learned through CBI in the laboratory can be translated to and sustained in the clinical setting; (3) CBI produces competent residents who perform skills rapidly and with minimal complications.

Cadaver↗