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Results for “skill learning”

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PubMed1988

A case study approach to health care facility construction projects.

In this paper, the authors present a useful overview of the planning, design, and construction process, emphasizing the importance of the practical application of management skills to that process. They suggest that health administration students develop "real life" skills by participating in case studies and role playing, led by planning and health care professionals. Educators frequently look for ways to assist the student in transferring the didactic skills learned in the classroom to their practical application. Case studies and role playing have been used in the management curriculum for this purpose. In this article, the authors use the construction project management process as a model for exploring the many interactions which take place during this process and relate those interactions to specific management skills needed by the health care executive. The use of the construction project as a case study allows the student an opportunity to experience a multidisciplinary team effort and to relate the principles of such academic disciplines as economics, organizational behavior, financial management, and labor relations to a real life setting.

Facility Design and Construction↗

PubMed1993

Disorders of memory in humans.

Memory is composed of dissociable systems that accomplish different forms of learning and that are mediated by distinct neural networks. Knowledge about the psychological nature and neural basis of specific memory systems has come primarily from lesion analysis, but this year functional brain imaging has provided a new source of convergent evidence. Recent findings are reviewed that provide new information about a limbic-diencephalic system critical for learning new declarative information, a temporal lobe system that stores long-term semantic knowledge in a domain-specific fashion, an occipital system that subserves visuoperceptual implicit memory, and a fronto-thalamo-neostriatal system that mediates the executive component of working memory and that plays an important role in some forms of sensorimotor skill learning.

Brain↗

PubMed1975

A response evocation program for /retroflex/.

A response evocation program, some principles underlying its development and administration, and a review of some clinical experiences with the program are presented. Sixty-five children with developmental articulation errors of the /retroflex/ phoneme were administered the program by one of 19 clinicians. Approximately 70 percent of program administrations resulted in a child emitting a good /retroflex/ within six minutes. Approximately 10 percent of children who were given additional training on program step failures emitted good /retroflex/'s in subsequent sessions. These preliminary observations are discussed in relation to the role of task analysis and motor skills learning principles in response evocation, clinician influences in program outcomes, and professional issues in service delivery to children with developmental articulation errors.

Child↗

PubMed2006

Contralesional neural plasticity and functional changes in the less-affected forelimb after large and small cortical infarcts in rats.

Some studies have found that unilateral cerebral damage produces significant deficits in the ipsilesional, "less-affected", body side. Other studies have found that such damage results in a paradoxical hyperfunctionality of the ipsilesional body side and a facilitation of learning-induced neuroplastic changes in the contralesional motor cortex. The purpose of this study was to determine whether these effects co-exist and/or vary with lesion severity. After small or large unilateral ischemic lesions of the sensorimotor cortex (SMC) or sham operations, adult male rats were trained for 20 days to acquire a motor task, skilled reaching for food, for the first time with the ipsilesional forelimb. Analyses of movement patterns indicated lesion-size-dependent ipsilesional abnormalities in grasping, retrieving and releasing food pellets. Despite these impairments, success rates were significantly increased and aiming errors reduced in lesion groups compared with sham operates. Performance was best in rats with small lesions that had more minor ipsilesional impairments. In the motor cortex contralateral to the lesion and trained limb, there were significant increases in the density of dendrites immunoreactive for microtubule-associated protein-2 (MAP2) and of N-methyl-D-aspartate receptor subunit 1 (NMDAR1) immunoreactivity compared with sham operates. These effects were correlated with reaching performance. Therefore, enhanced motor skill learning in the "less-affected" forelimb and contralesional neuroplastic changes are muted after larger lesions and co-exist with ipsilesional impairments. These effects may be related to a denervation-induced neural restructuring of the contralesional cortex that both disrupts pre-existing motor engrams and facilitates the establishment of new ones.

Animals↗

PubMed1995

Exit rounds: a reflection exercise.

This paper questions the long-held assumption that "experience is the best teacher". Reflection, it is argued, is the element that turns experience into learning. Unfortunately, reflection is the experiential learning skill in which student are most deficient. Further, clinical teachers may not appreciate the reciprocal and synergistic relationship of experience and reflection, and therefore they may not exploit its full potential. This paper argues for the formal and explicit use of reflection to clinical teaching. In addition to providing a theoretical rationale for the use of reflection is learning, one example of a reflection exercise--exit rounds--is described. Exit rounds focus on recently discharged patients and provide students with an opportunity to reflect on what they have learned from working with these patients. In addition to being a learning exercise, exit rounds provide attending physicians with an opportunity to address emotional issues, to evaluate students' learning and performances, to deal with "housekeeping" details, and to provide closure.

Clinical Competence↗

PubMed2002

Cerebellar hemispheric activation ipsilateral to the paretic hand correlates with functional recovery after stroke.

An experimental lesion in the primary motor or sensory cortices in monkeys leads to functional reorganization in areas surrounding the lesion or in contralateral homologous regions. In humans, task-dependent brain activation after motor stroke seems to be multifocal and bilateral. Although many active structures are seen after stroke, their roles are unclear. For instance, the uninjured primary motor cortex may play a significant role in recovery or may be associated with mirror movements. Other motor areas, particularly those outside the affected middle cerebral artery distribution, have also been thought to play such a role, including the medial pre-motor areas and both cerebellar hemispheres. The lateral pre-motor areas might also contribute but the demarcation of primary motor and pre-motor cortices is not trivial. It is not known from existing studies how brain activation relates to behavioural change over the time course of recovery. We used functional MRI (fMRI) to study 12 patients longitudinally over the first 6 months of stroke recovery. All subjects had acute stroke causing unilateral arm weakness and had some ability to move the impaired hand within 1 month. Each patient had both motor testing and fMRI during finger and wrist movements at four points during the observed period. Six of these patients showed good motor recovery, whereas the other six did not. The imaging results support a role for the cerebellum in mediating functional recovery from stroke. The data suggest that patients with good recovery have clear changes in the activation of the cerebellar hemisphere opposite the injured corticospinal tract. Patients with poor recovery do not show such changes in cerebellar activation. No other brain region had a significant correlation with recovery. Interestingly, activation in the cerebellum ipsilateral to the injury increases transiently after stroke, independently of the success of recovery. The present work suggests a possible link between cerebellar activation and behavioural recovery from hand weakness from stroke. The underlying mechanism is not known, but it could relate to haemodynamic changes such as diaschisis or to the postulated role of the cerebellum in motor skill learning.

Acute Disease↗

PubMed1996

Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys.

This study was undertaken to document plastic changes in the functional topography of primary motor cortex (M1) that are generated in motor skill learning in the normal, intact primate. Intracortical microstimulation mapping techniques were used to derive detailed maps of the representation of movements in the distal forelimb zone of M1 of squirrel monkeys, before and after behavioral training on two different tasks that differentially encouraged specific sets of forelimb movements. After training on a small-object retrieval task, which required skilled use of the digits, their evoked-movement digit representations expanded, whereas their evoked-movement wrist/forearm representational zones contracted. These changes were progressive and reversible. In a second motor skill exercise, a monkey pronated and supinated the forearm in a key (eyebolt)-turning task. In this case, the representation of the forearm expanded, whereas the digit representational zones contracted. These results show that M1 is alterable by use throughout the life of an animal. These studies also revealed that after digit training there was an areal expansion of dual-response representations, that is, cortical sectors over which stimulation produced movements about two or more joints. Movement combinations that were used more frequently after training were selectively magnified in their cortical representations. This close correspondence between changes in behavioral performance and electrophysiologically defined motor representations indicates that a neurophysiological correlate of a motor skill resides in M1 for at least several days after acquisition. The finding that cocontracting muscles in the behavior come to be represented together in the cortex argues that, as in sensory cortices, temporal correlations drive emergent changes in distributed motor cortex representations.

Animals↗

PubMed1991

Learning a complex nursing skill: student anxiety and the effect of preclinical skill evaluation.

The purpose of this study was to identify the anxiety profile of undergraduate nursing students when learning a complex psychomotor skill, and to determine the effect of preclinical skill evaluation on student anxiety and performance when applying the skill in a patient situation. Findings support preclinical skill evaluation as an effective strategy for reducing anxiety related to initial transfer of skill learning from a laboratory to a clinical setting and enhancing self-confidence.

Adult↗

PubMed1996

The advantages of problem-based curricula.

Problem-based curricula provide a learning environment in which competence is fostered not primarily by teaching to impart knowledge, but through encouraging an inquisitive style of learning. Preliminary discussion in small groups, contextual learning, integration of knowledge and an emphasis on patient problems, have several cognitive effects on student learning. These effects are increased retention of knowledge, enhancement of integration of basic science concepts into clinical problems, the development of self-directed learning skills, and the enhancement of students' intrinsic interest in the subject matter. In this paper a number of studies will be reviewed that provide empirical evidence for these premises.

Curriculum↗

PubMed2004

Anesthetized Long Evans rats show similar protein expression and long-term potentiation as Fischer 344 rats but reduced short-term potentiation in motor cortex.

A number of studies describe strain-related differences in the motor behavior of rats. Inbred albino F344 rats are found to be impaired in procedural spatial learning, skilled reaching, and over ground locomotion in relation to pigmented out bred Long Evans (LE) rats. These deficits could be related to the functional differences in the motor cortex of the two strains, and the objective of the present study was to examine this hypothesis. Synaptic transmission was examined in the two rat strains, using long-term potentiation (LTP) and short-term potentiation (STP), two electrophysiological measures of neural function and learning. Field potentials were evoked in the motor cortex of anesthetized Long Evans and Fischer 344 (F344) rats in response to contralateral white matter stimulation. The main findings indicated that (1) baseline-evoked responses in the two strains was similar, indicating similar basal levels of synaptic strength, (2) LTP was induced in both strains of rats, suggesting similar synaptic efficacy in the two strains of rats, and (3) STP was enhanced in the Fischer 344 rats, suggesting differences in synaptic function. Protein expression also revealed that the two strains did not differ with respect to structural or synaptic protein expression. Thus, the two strains exhibit motor skill differences despite a great degree of physiological similarity in motor cortex. The results are discussed in relation to the greater utility of using the Long Evans rat for examining the neural basis of plasticity and models of disease, especially if motor tasks are evaluated.

Analysis of Variance↗

PubMed1994

Parental-based intervention with pre-school language-delayed children.

Mothers of children randomly allocated to an experimental group attended fortnightly group parental language training sessions, over a 6-month period. Mothers of children allocated to a matched no intervention control group received no special attention. The results showed significantly greater gains in the expressive language skills of the experimental group compared to the control group. A second experiment was designed to compare the parental involvement approach with direct, individual treatment and to clarify the role of non-specific 'Hawthorne-type' effects. The experimental group mothers attended parental language training sessions, as above. The parental control group mothers also attended training sessions, with the emphasis on general learning skills rather than language. A third group of children received individual, direct speech and language therapy. Results showed significantly greater language gains in the parental language training group and in the individual group in comparison with the non-specific training group. The two former groups did not differ significantly, indicating that, for these groups and this methodology, parental language training is as effective as individual speech and language therapy. The results also indicate that the effectiveness of the parental involvement approach cannot be accounted for by non-specific factors. The research findings are discussed, together with the professional implications of the study and recommendations for further research.

Adult↗

PubMedDate not supplied

Career development: enhancing your networking skills.

Can you walk into a room full of strangers and chat easily, get to know people, and let them get to know you? Networking is not just a job search strategy; it is a critical professional career development enrichment strategy that can help you build your knowledge and expertise. When you need help, do you have a network of available people or do you know how to develop a network to assist you? Networking sounds easy and we tend to think it should come naturally. However, networking is a learned skill that just about everyone struggles with at some time or another (1). This article provides a how- to network process, summarized in Table 1, that will enhance your career development.

Career Mobility↗

PubMed2001

Impaired motor learning in children with hydrocephalus.

Hydrocephalic (n = 19) and normal (n = 20) children in two age groups (averaged at 10 and 14 years old) were asked to learn 5 predetermined timing rhythm interval tasks (including timing duration and relative timing pattern) by pressing keys on a computer keyboard. In the acquisition phase, visual and auditory goal timing intervals, as well as visualized feedback were presented to all participants before and after their key presses, respectively. A retention test without the auditory information and visualized feedback was administered 1 day later. By using the computerized timing test, we demonstrated in this study that the hydrocephalic group had significantly (ANOVA analysis) increased relative timing errors; this function depends on the formation of an internal model or a motor program related to long-term memory disorders. These findings could lead to the formulation of training procedures with simplified movements that may help hydrocephalic children improve their motor skill learning.

Adolescent↗

PubMed2006

[Breaking bad news in medicine: strategies that turn necessity into a virtue].

Breaking bad news is one of physician's most difficult duties. In spite of this, communication skills are considered a minor professional ability. Bad news is defined as any news that drastically and negatively alters the patient's view of his/her future. Patients never forget where, when and what bad news they were told. The factors that make communicating bad new difficult may come from the sociocultural setting of the patient or the doctor. Randomized studies have shown that communication learning skills may cause a positive impact on the person giving and receiving the bad news. In order to facilitate this task, a practical and dynamic 6-step protocol, described by Baile and Buckman, that may be useful for this task, is described.

Attitude of Health Personnel↗

PubMed1985

The lasting value of clinical skills.

To assess the lasting value of clinical skills learned by residents in a subspecialty-oriented training program in internal medicine, we surveyed recent graduates. Graduates received a questionnaire contrasting separate ratings of the amount of training (preparation) they received during residency with the importance of this training in subsequent career activities. Topics included 12 traditional medical disciplines, 15 areas related to the practice of medicine, 15 allied medical disciplines, ten basic skill and knowledge areas, and 28 technical procedures. Response rate was 91.8% (56/61). Ninety-five percent of respondents had certification from the American Board of Internal Medicine, 80% had subspecialty training, and 89% rendered direct patient care. Fifty-six topics showed disparity between preparation and importance scores (45 with P less than .0001). For 14 categories, mainly technical procedures, disparate ratings suggested excessive programmatic emphasis, while for 42 categories, including history taking and physical examination, there may have been inadequate emphasis. These data suggest that basic clinical skills may require greater emphasis, even in traditional programs. The opinion of program graduates is an important resource in designing training programs in internal medicine.

Attitude of Health Personnel↗

PubMed2005

The effects of previously acquired skills on sinus surgery simulator performance.

OBJECTIVE: The Endoscopic Sinus Surgery Simulator is currently being studied as a tool for otolaryngology resident training. While examining performance patterns on the simulator, we sought to define any relationships that may exist between students' previously acquired skills and their performance on the simulator. METHODS: Twenty-six medical students were enrolled in our study. After completing their trials, they were asked to complete a 28-item questionnaire. This questionnaire included yes/no questions as well as 10-point Likert scale instruments. RESULTS: Only 4 students did not respond to the questionnaire. Significant contributions to simulator performance were elucidated for a number of previously learned skills, but most were short-lived. For example, experienced video gamers were significantly better at hazard avoidance in the simulator's novice mode (P = .03), but their advantage dissipated as they advanced to intermediate mode trials. In addition, students' handedness contributed to simulator performance for only the first 3 trials (P = .04), but this relationship, too, was no longer statistically significant in later trials. CONCLUSIONS: Some study students had skills and characteristics that significantly aided them in their ability to perform surgery on the simulator. However, these benefits were short-lived, and these results suggest that practicing plays a more important and long-standing role than other factors in surgical simulator performance. It follows that surgical simulation should play a more prominent role in surgical education because residents who practice on simulators such as this are, in turn, practicing for the reality of the operating room.

Adult↗

PubMed2004

Bimanual directional interference: the effect of normal versus augmented visual information feedback on learning and transfer.

When performing movements with different spatial trajectories in both upper limbs simultaneously, patterns of interference emerge that can be overcome with practice. Even though studies on the role of augmented feedback in motor learning have been abundant, it still remains to be discovered how overcoming such specific patterns of spatial interference can be optimized by instructional intervention. In the present study, one group acquired a bimanual movement with normal vision, whereas a second group received augmented feedback of the obtained trajectories on a computer screen in real time. Findings revealed that, relative to normal vision, the augmented feedback hampered skill learning and transfer to different environmental conditions. These observations are discussed in view of the benefits and pitfalls of augmented feedback in relation to task context and instructional condition.

Adolescent↗

PubMed1998

Uses of virtual reality in clinical training: developing the spatial skills of children with mobility impairments.

In this chapter we review some of the ways in which the skills learned in virtual environments (VEs) transfer to real situations, and in particular how information about the spatial layouts of virtual buildings acquired from the exploration of three-dimensional computer-simulations transfers to their real equivalents. Four experiments are briefly described which examined VR use by disabled children. We conclude that spatial information of the kind required for navigation transfers effectively from virtual to real situations. Spatial skills in disabled children showed progressive improvement with repeated exploration of virtual environments. The results are discussed in relation to the potential future benefits of VR in special needs education and training.

Computer Simulation↗