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PubMed2005

Resident as teacher: the Mount Sinai experience and a review of the literature.

Residents play a pivotal role in the education of medical students and junior house staff but are rarely provided with the tools to help them teach effectively. Residents value their roles as teachers and desire training programs in teaching skills. Teaching skills courses for residents have been shown to improve residents' self-confidence and self-assessed use of effective teaching behaviors. They have also been shown to improve residents' evaluations by students. The Institute for Medical Education at the Mount Sinai School of Medicine has developed a successful, multidisciplinary curriculum to improve the teaching and leadership skills of all of our residents at the Mount Sinai Hospital and its affiliate institutions. The Resident Teaching Development Program (RTDP) has already been implemented in the departments of Medicine, Surgery, Pediatrics, Psychiatry, and Obstetrics and Gynecology. This adaptable, seven-hour curriculum has been well received by residents and faculty. We are currently evaluating the effects of the program on residents' confidence and use of learned skills. And we are working to expand this program to every department and to create innovative means of measuring resident competency in teaching and its ultimate effect on student learning.

Curriculum↗

PubMed2000

Associative learning and latent inhibition in a conditioned suppression paradigm in humans.

A paradigm based on conditioned suppression of ongoing motor activity, sensitive to latent inhibition (LI), was developed and tested in healthy volunteers. Subjects were trained to move disks from one peg to another with a high degree of regularity in the Tower of Toronto puzzle, a well-known cognitive skill learning task. Once this was achieved, they were submitted to a Pavlovian conditioning procedure. The conditioned stimulus (CS) was a pure tone and the unconditioned stimulus (US) a loud white noise. The resulting response suppression was assessed by a transient increase in latency of the hand movements. In control subjects, there was non-contingent CS and US presentation. The results evidenced conditioning after a single CS-US pairing. Following five preexposures to the to-be-conditioned CS, however, conditioning was abolished, seemingly expressing LI. Because a weak unconditioned response to the tone was observed after its first two presentations, an additional experiment was performed with two preexposures to the to-be-conditioned CS. With such procedure, conditioning was obtained, supporting the existence of LI in the preceding experiment. These results indicate that the present paradigm may be useful for the study of LI in human subjects, having the advantage of being similar to the experimental conditions used in the majority of LI studies in experimental animals.

Acoustic Stimulation↗

PubMed1990

Procedural memory in Parkinson's disease: impaired motor but not visuoperceptual learning.

A current model proposes that memory consists of two functionally separate systems that have different neurological substrates. Declarative memory appears to be dependent on the diencephalic medial temporal lobe system whereas some speculate that the basal ganglia may be a neurological substrate for procedural memory. This study tested the role of the basal ganglia in regulating different types of procedural skills by comparing performance on a motor and a visuoperceptual skill learning task. Twenty Parkinson's (PD) patients and 20 normal control subjects performed two procedural learning tasks (rotary pursuit and mirror reading) and one declarative learning task (paired associates) over 3 days. The results showed that PD patients were not impaired on mirror reading or paired associate learning. On rotary pursuit, performance levels on day 1 were similar between groups, but the PD group showed less improvement across days than controls. However, only patients with more advanced symptoms of PD showed impaired rotary pursuit learning, and this could not be attributed directly to deficits in primary motor or general cognitive function. These findings suggest that the underlying processes/procedures for procedural learning are specific to the task, and are supported by different neuroanatomical systems.

Attention↗

PubMed1986

Student response to gynecologic teaching associates.

Gynecologic teaching associates teach the communication and psychomotor skills for breast and pelvic examinations in most medical schools in the United States and Canada. Evaluations of these gynecologic teaching associate programs have included faculty impressions of program effectiveness and measurement of student retention of skills but not student evaluations of the effectiveness and value of such programs. At the University of Illinois at Chicago students evaluated their gynecologic teaching associate program. High ratings were given to program organization and content; the knowledge, ability, and professionalism of the teaching associates; and the outcomes of the sessions with respect to the learning skills needed to perform the examinations. Students emphasized the importance of the ability of the teaching associates to provide immediate informative feedback and to reduce anxiety during the teaching sessions. Students tended to view their ability to perform breast examination to be greater than for the pelvic examinations but felt they learned more about both in the sessions. This information supports the value of the gynecologic teaching associate model in medical education.

Breast↗

PubMed1987

Ontogeny of spatial navigation behaviors in the rat: dissociation of "proximal"- and "distal"-cue-based behaviors.

Rats can use both "proximal" and "distal" cues to locate goal objects in their environments (Morris, 1981). In the proximal-cue situation, local stimuli that spatially co-occur with the goal are available to guide behavior. In the distal-cue situation, there are no cues that co-occur with the goal object; thus to directly locate the goal, the rat must learn about the spatial location of the goal relative to distal cues. Using the Morris water maze, we found that these two navigation behaviors are dissociated during ontogeny. Rats only 17-days-old are capable of using proximal cues to locate a safe platform. It was not until the rats were 20-days-old, however, that they began to display minimal evidence of distal-cue utilization. Control experiments indicated that the 17-day-old subjects' failure on the distal problem was likely due to their inadequate spatial learning skills. These results were interpreted within a Jacksonian perspective of brain-behavior relations.

Aging↗

PubMed1993

Imitative learning of actions on objects by children, chimpanzees, and enculturated chimpanzees.

In this study we compared the abilities of chimpanzees and human children to imitatively learn novel actions on objects. Of particular interest were possible differences between chimpanzees raised mostly with conspecifics (mother-reared) and chimpanzees raised in a human-like cultural environment (enculturated). Subjects were thus 3 enculturated and 3 mother-reared chimpanzees, along with 8 18-month-old and 8 30-month-old human children. Each subject was tested over a 2-day period with 16 novel objects. The introduction of each object was preceded by a baseline period in which the subject's natural proclivities toward the object were determined. For 12 objects, a human experimenter demonstrated first a simple and then a complex novel action, instructing the subject in each case to "Do what I do" (chimpanzees were prepared for the task behaviorally as well). For the other 4 objects, demonstration of a single action took place on the first day and the subject's opportunity to imitate was delayed until the second day, 48 hours later. Actions that a subject produced in baseline were excluded from further analysis. For each analyzed action, the subject's behavior was scored as to whether it successfully reproduced (1) the end result of the demonstrated action, and (2) the behavioral means used by the demonstrator. Results showed that in immediate imitation the mother-reared chimpanzees were much poorer imitators than the enculturated chimpanzees and the human children, who did not differ from one another. Surprisingly, on the delay trials, the enculturated chimpanzees significantly outperformed the other 3 groups. We conclude from these results that a human-like sociocultural environment is an essential component in the development of human-like social-cognitive and imitative learning skills for chimpanzees, and perhaps for human beings as well.

Animals↗

PubMed1986

Learning is improved by a soybean oil diet in rats.

A semi-synthetic diet containing 20% polyunsaturated fat (soybean) oil was fed to young male hooded rats for 21 days. These animals exhibited improved performance on an environmentally-cued testing paradigm which is thought to reflect cognitive learning skills (i.e., Place Navigation Water Task). Other rats fed the same base diet but containing 20% saturated fat (lard) showed no such improvement compared to chow-fed (4.5% mixed fat) controls. The animals fed soybean oil also exhibited a transient resistance to extinguish this learning. This improved learning could not be explained by changes in general motor activity, basal body temperature, energy consumption, body weight, or in the brain activity of choline acetyltransferase, the marker enzyme for cholinergic neurons. These findings constitute the first evidence that short-term variations in the quality of dietary fat can enhance mammalian learning.

Animals↗

PubMed1989

Neuropsychological evidence for multiple implicit memory systems: a comparison of Alzheimer's, Huntington's, and Parkinson's disease patients.

The performances of patients with dementia of the Alzheimer type (DAT), patients with Huntington's disease (HD), and demented and nondemented patients with Parkinson's disease (PD) were compared on 2 tests of implicit memory that do not require the conscious recollection of prior study episodes: (1) a pursuit-rotor motor learning task and (2) a lexical priming test. The HD patients were found to be impaired on the motor learning but not the lexical priming task, whereas the DAT patients evidenced the opposite relationship on these tasks. The demented, but not the nondemented, PD patients were found to be impaired on both tests of implicit memory. For both the HD and PD patients, deficits on the motor learning task correlated significantly with severity of dementia but not with level of primary motor dysfunction. The noted double dissociation between HD and DAT patients indicates that different forms of implicit memory, all of which are intact in amnesia, are dependent upon distinct neuroanatomic systems. Motor skill learning may be mediated by a corticostriatal system, whereas verbal priming may depend upon the integrity of the neocortical association areas involved in the storage of semantic knowledge. The results for the PD patients suggest that the demented PD patients have endured damage to the neurologic systems subserving both motor learning and lexical priming.

Alzheimer Disease↗

PubMed2007

End-of-life communication in veterinary medicine: delivering bad news and euthanasia decision making.

Given the expectations of clients and the resultant impact of end-of-life conversations on pet owners and the veterinary team, compassionate end-of-life communication is considered to be an ethical obligation, a core clinical skill, and integral to the success of a veterinary team. End-of-life communication is related to significant clinical outcomes, including enduring veterinarian-client-patient relationships and veterinarian and client satisfaction. Effective techniques for end-of-life communication can be taught and are a series of learned skills. The purpose of this article is to present best practices for delivering bad news and euthanasia decision-making discussions. In this article, the SPIKES six-step model (setting, perception, invitation, knowledge, empathize, and summarize) currently employed in medical curricula is utilized to structure end-of-life conversations in veterinary medicine.

Animals↗

PubMed2005

Transfer of communication skills training from workshop to workplace: the impact of clinical supervision.

OBJECTIVE: Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process. METHODS: A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns. RESULTS: Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues. CONCLUSIONS: The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.

Adult↗

PubMed2001

The use of a skill-based activity in therapeutic induction.

This paper describes a hypnotherapeutic intervention for a brain damaged 36-year-old male who has suffered from asthma since infancy and seizure disorder from the age of eight. In early sessions it was discovered that conventional "passive-relaxation" induction techniques seemed to exacerbate certain disturbing somatic experiences, which he refers to as scary feelings. It was found that his performance of a previously learned skilled activity (the playing of the computer game Tetris) permitted the experience of a highly focused but relaxed state that was conducive to therapeutic interaction. This approach to induction bears similarity to "active-alert" procedures but may be more importantly related to Mihaly Csikszentmihalyi's principle of flow, in that it involves engagement in a subjectively meaningful, skill-based activity.

Adult↗

PubMed2000

Neural bases of learning and memory: functional neuroimaging evidence.

Positron emission tomography and functional magnetic resonance imaging studies have identified brain regions associated with different forms of memory. Working memory has been associated primarily with the bilateral prefrontal and parietal regions; semantic memory with the left prefrontal and temporal regions; episodic memory encoding with the left prefrontal and medial temporal regions; episodic memory retrieval with the right prefrontal, posterior midline and medial temporal regions; and skill learning with the motor, parietal, and subcortical regions. Recent studies have provided higher specificity, by dissociating the neural correlates of different subcomponents of complex memory tasks, and the cognitive roles of different subregions of larger brain areas.

Brain↗

PubMed2003

Switching memory systems during learning: changes in patterns of brain acetylcholine release in the hippocampus and striatum in rats.

This experiment measured acetylcholine (ACh) release simultaneously in the hippocampus and striatum while rats were trained in a cross maze. Consistent with past findings, rats initially showed learning on the basis of place (i.e., turning to the correct position relative to the room), but after extensive training, rats shifted to learning on the basis of response (i.e., turning to the right/left to find the food). Profiles of ACh release in the hippocampus and striatum were markedly different during training. In the hippocampus, ACh release increased by approximately 60% at the onset of training and remained at that level of release throughout training, even after the rats began to show learning on the basis of turning rather than place. In the striatum, increases in ACh release occurred later, reaching asymptotic increases of 30-40%, coincident with a transition from expressing place learning to expressing response learning. These findings suggest that the hippocampal and striatal systems both participate in learning in this task, but in a manner characterized by differential activation of the neural systems. The hippocampal system is apparently engaged first before the striatum is activated and, to the extent the hippocampus is important for place learning, promotes the use of a place solution to the maze. Later in training, although the hippocampus remains activated, the striatum is also activated in a manner that may enable the use of a response strategy to solve the maze. These findings may offer a neurobiological marker of a transition during skill learning from declarative to procedural learning.

Acetylcholine↗

PubMed2001

Effects of ageing on allocentric and egocentric spatial strategies in the Wistar rat.

This study was designed to assess the effect of ageing on spatial (allocentric and egocentric) strategies in rats. Two different tasks were designed for this purpose: one involving Morris' circular pool (distal extramaze cues) and another using the T water maze (egocentric cues). In the first task, the aged rats showed some difficulty in acquiring allocentric spatial learning skills. After increasing the number of trials in this task, there was no significant improvement in the performance of the aged group of rats compared to the adult group. However, in the second spatial task (using egocentric cues), both age groups gave a similar performance. Therefore, the effect of ageing on spatial learning depends on the strategy required to acquire this learning.

Journal Article↗

PubMedDate not supplied

Training experiences of current and former community pharmacy residents, 1986-2000.

OBJECTIVE: To identify why current and former community pharmacy residents chose a community pharmacy residency program (CPRP), what factors in the program were emphasized and not emphasized, what opportunities were available to them postresidency, and, for former residents, what skills learned during their residency have been most useful in their careers to date. DESIGN: Mail survey. PARTICIPANTS: 1999-2000 residents and former residents dating back to 1986. MAIN OUTCOME MEASURES: Reasons residents chose a CPRP over other residency or employment opportunities and respondents' ratings of the emphasis placed on a variety of skills and activities in their training programs. RESULTS: A total of 44 surveys were included in the final analysis, 18 (41%) of which were completed by 1999-2000 CPRP residents performing their residency at the time of the survey. The most common reasons for choosing a CPRP over other types of programs were opportunities for developing innovative services and direct patient interaction. Communication skills, clinical skills, and level of patient interaction were reported as being most highly emphasized. Management of the distribution system was most frequently cited as having "low" or "no" emphasis in their residency. Respondents listed marketing skills as the most common area requiring improvement or additional focus in their residency. Former residents cited leadership skills and the development of patient care services as the factors in their residency having the greatest impact on their careers to date. Postresidency opportunities most frequently sought included faculty, staff pharmacist, and clinical pharmacist positions. CONCLUSION: Candidates are drawn to CPRPs because of the opportunities such residencies offer to develop innovative services and provide direct patient care. Residents feel that many programs fail to provide adequate training in the areas of marketing services and obtaining reimbursement. Residency program directors should consider these findings when evaluating and marketing their programs.

Career Choice↗

PubMed1995

Using bandwidth knowledge of results to alter relative frequencies during motor skill acquisition.

This investigation examined the predictions of the guidance and specificity hypotheses by manipulating different distributions of relative frequency of knowledge of results (KR) using bandwidth (BW) conditions. Subjects (N = 120) were randomly assigned to either a BW0%, BW10%, Shrinking-BW, or Expanding-BW condition. After 100 acquisition trials were completed, a double transfer design was employed in which the subjects were divided in half and randomly assigned to a no-KR or KR retention condition. Retention tests of 10 min and 48 hr were completed under a no-KR or KR retention condition. Results of the 48-hr retention test under the no-KR retention condition suggested that receiving high relative frequencies of KR at the end of the acquisition phase was as detrimental to motor skill learning as receiving high relative frequencies of KR throughout acquisition. The results are discussed with respect to the guidance and specificity hypotheses.

Adult↗

PubMed2001

Patterns of intellectual development among survivors of pediatric medulloblastoma: a longitudinal analysis.

PURPOSE: To examine two competing hypotheses relating to intellectual loss among children treated for medulloblastoma (MB): Children with MB either: (1) lose previously learned skills and information; or (2) acquire new skills and information but at a rate slower than expected compared with healthy same-age peers. PATIENTS AND METHODS: Forty-four pediatric MB patients were evaluated who were treated with postoperative radiation therapy (XRT) with or without chemotherapy. After completion of XRT, a total of 150 examinations were conducted by use of the child version of the Wechsler Intelligence SCALES: These evaluations provided a measure of intellectual functioning called the estimated full-scale intelligence quotient (FSIQ). Changes in patient performance corrected for age (scaled scores) as well as the uncorrected performance (raw scores) were analyzed. RESULTS: At the time of the most recent examination, the obtained mean estimated FSIQ of 83.57 was more than one SD below expected population norms. A significant decline in cognitive performance during the time since XRT was demonstrated, with a mean loss of 2.55 estimated FSIQ points per year (P =.0001). An analysis for the basis of the intelligence quotient (IQ) loss revealed that subtest raw score values increased significantly over time since XRT, but the rate of increase was less than normally expected, which resulted in decreased IQ scores. CONCLUSION: These results support the hypothesis that MB patients demonstrate a decline in IQ values because of an inability to acquire new skills and information at a rate comparable to their healthy same-age peers, as opposed to a loss of previously acquired information and skills.

Adolescent↗

PubMed2006

Motor learning in children with spina bifida: intact learning and performance on a ballistic task.

Learning and performance on a ballistic task were investigated in children with spina bifida meningomyelocele (SBM), with either upper level spinal lesions (n = 21) or lower level spinal lesions (n = 81), and in typically developing controls (n = 35). Participants completed three phases (20 trials each) of an elbow goniometer task that required a ballistic arm movement to move a cursor to one of two target positions on a screen, including (1) an initial learning phase, (2) an adaptation phase with a gain change such that recalibration of the ballistic arm movement was required, and (3) a learning reactivation phase under the original gain condition. Initial error rate, asymptotic error rate, and learning rate did not differ significantly between the SBM and control groups. Relative to controls, the SBM group had reduced volumes in the cerebellar hemispheres and pericallosal gray matter (the region including the basal ganglia), although only the pericallosal gray matter was significantly correlated with motor adaptation. Congenital cerebellar dysmorphology is associated with preserved motor skill learning on voluntary, nonreflexive tasks in children with SBM, in whom the relative roles of the cerebellum and basal ganglia may differ from those in the adult brain.

Adaptation, Physiological↗