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PubMed1993

Psychiatric rehabilitation.

The financial, personal, and societal costs of severe mental illness are extraordinarily high. Individuals suffering from schizophrenia occupy 25 percent of all hospital beds and account for 40 percent of all long-term care days. The rate of Supplemental Security income (SSI) and Social Security disability insurance (SSDI) beneficiaries who are disabled because of a mental disorder has increased more than 50 percent since 1986, and a total of more than 1.1 million individuals received benefits in 1991 because of their mental disorders. All of these costs have continued to rise despite the nearly ubiquitous administration of antipsychotic medication with its well-documented benefits. The most promising treatment to complement medication and produce better outcomes is psychiatric rehabilitation. It is based on the same rationale as rehabilitation for physically challenged individuals--illness produces impairments that make individuals less able to perform basic life skills that handicap them when they try to be students, workers, spouses, parents, etc. Rehabilitation teaches individuals to perform the basic skills using methods that compensate for the impairments, and modifying the environment so the new methods are successful or the skills are not required. Rehabilitation with severely mentally ill individuals is particularly challenging because of the extent of their impairments and disabilities. The impairments--flagrant symptoms that unpredictably wax, wane, and persist even with medication; reduced motivation to participate in community life; residual deficits in the most elemental cognitive processes of attention, memory, and abstraction--clearly limit individuals' abilities to perform life skills and function in major societal roles. Moreover, the challenge of successful rehabilitation is magnified by the individual-to-individual, time-to-time, and disorder-to-disorder variations in these impairments and disabilities. Given this challenge, how well does psychiatric rehabilitation work in practice? Two types of studies provide answers to this question; those that have focused exclusively on teaching skills to severely mentally ill individuals, and those that have focused on larger units of care, case management, and vocational rehabilitation, that typically include skills training as one of their services. The first type of study provides "pure" information but sacrifices, to some extent, clinical utility and immediate generality. The second provides information that can be transferred to clinical practice but sacrifices clarity about what is the effective ingredient in a set of intermingled services. The results of the first type have generally indicated, with some qualifications, that severely mentally ill individuals learn skills, use them in their own environments, and may receive other clinically meaningful benefits.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗

PubMed1990

Using informed strategies for learning to enhance the reading and thinking skills of children with learning disabilities.

The purpose of this study was to improve the reading performance of children with learning disabilities using a classroom-based metacognitive reading program. The participants were third- and fourth-level 8- and 9-year-olds (13 boys and 5 girls) at a school for children with learning disabilities. A cross-sectional time series design was used. During pre- and posttesting participants were assessed on two measures of strategy awareness and a measure of perceived self-competence. During the instructional phase the metacognitive reading program was introduced. Participants were assessed on measures of reading performance throughout the study. In general, the findings were positive: Students increased in performance and awareness of strategies from pre- to posttesting. In addition, participants were placed in subgroups based on pretesting assessments. The subgroups differed on their improvements over time. This study provides preliminary evidence that a metacognitive reading program can be used with children with learning disabilities to improve their awareness about reading and their comprehension skills.

Awareness↗

PubMed2004

Creating a web-enhanced interactive preclinic technique manual: case report and student response.

This article describes the development, use, and student response to an online manual developed with off-the-shelf software and made available using a web-based course management system (Blackboard) that was used to transform a freshman restorative preclinical technique course from a lecture-only course into an interactive web-enhanced course. The goals of the project were to develop and implement a web-enhanced interactive learning experience in a preclinical restorative technique course and shift preclinical education from a teacher-centered experience to a student-driven experience. The project was evaluated using an anonymous post-course survey (95 percent response rate) of 123 freshman students that assessed enabling (technical support and access to the technology), process (the actual experience and usability), and outcome criteria (acquisition and successful use of the knowledge gained and skills learned) of the online manual. Students responded favorably to sections called "slide galleries" where ideal and non-ideal examples of projects could be viewed. Causes, solutions, and preventive measures were provided for the errors shown. Sections called "slide series" provided cookbook directions allowing for self-paced and student-directed learning. Virtually all of the students, 99 percent, found the quality of the streaming videos adequate to excellent. Regarding Internet connections and video viewing, 65 percent of students successfully viewed the videos from a remote site; cable connections were the most reliable, dial-up connections were inadequate, and DSL connections were variable. Seventy-three percent of the students felt the videos were an effective substitute for in-class demonstrations. Students preferred video with sound over video with subtitles and preferred short video clips embedded in the text over compilation videos. The results showed it is possible to develop and implement web-enhanced and interactive dental education in a preclinical restorative technique course that successfully delivered information beyond the textual format.

Computer-Assisted Instruction↗

PubMed1981

Vocational skill assessment of severely mentally retarded adults.

The Trainee Performance Sample, a vocational skills assessment instrument, was revised to enhance content validity and utility in making vocational skill learning placements for severely retarded individuals. The Trainee Performance Sample employs a process measurement approach; i.e., each of the 30 test items (a variety of benchwork tasks) includes both training and correction procedures within the item. To some extent, the examinee's ability to benefit from various training strategies is measured. Psychometric analyses demonstrated that the revised Trainee Performance Sample meets standard test development criteria. Thus, a dynamic approach to vocational skills assessment of severely retarded individuals--one that involves training while testing--has been shown to have both utility and psychometric adequacy.

Aptitude Tests↗

PubMed2002

Final consonant discrimination in children: effects of phonological disorder, vocabulary size, and articulatory accuracy.

Preschool-age children with phonological disorders were compared to their typically developing age peers on their ability to discriminate CVC words that differed only in the identity of the final consonant in whole-word and gated conditions. The performance of three age groups of typically developing children and adults was also assessed on the same task. Children with phonological disorders performed more poorly than age-matched peers, and younger typically developing children performed more poorly than older children and adults, even when the entire CVC word was presented. Performance in the whole-word condition was correlated with receptive vocabulary size and a measure of articulatory accuracy across all children. These results suggest that there is a complex relationship among word learning skills, the ability to attend to fine phonetic detail, and the acquisition of articulatory-acoustic and acoustic-auditory representations.

Adult↗

PubMed2004

Demonstration of the effectiveness and acceptability of self-study module use in residency education.

Educators face increasing challenges to promote lifelong learning skills, to include new content areas in an already full curriculum and to maximize limited resources for curriculum implementation. Self-study modules (hereafter modules) offer potential solutions. Three modules on preventive medicine topics were evaluated in Family Medicine residencies. A retrospective pre-/post-test of a resident's ability to meet the module's objectives was used for evaluation. Additionally, residents rated the appropriateness and acceptability of the modules, their preference for 13 methods of learning, and completed a multiple-choice knowledge test. This study demonstrates the effectiveness of modules at multiple levels of evaluation in accordance with a modified version of Kirkpatrick's hierarchy of levels of evaluation. Residents found the modules to be acceptable and useful. Significant gains were seen in residents' abilities to meet objectives. The multiple-choice knowledge test was used to demonstrate mastery of the module materials at an appropriate performance level for future practitioners. Module use was in the top five choices of preferred learning methods. No correlation was seen between residents' preference for learning using modules and educational outcomes. Modules are an effective and acceptable learning method for residents. Even those who prefer other learning methods show improved educational outcomes.

Humans↗

PubMed2003

Practice schedule and acquisition, retention, and transfer of a throwing task in 6-yr.-old children.

Earlier studies have raised questions about the usefulness of variable and random practice in learning motor tasks so this study was designed to investigate the effects of contextual interference in young children, and specifically to evaluate the effectiveness of variable or random practice structure in 6-yr.-old boys and girls. Participants on a variable practice schedule showed better performances than those on a blocked schedule. The differences between the two groups were significant in the acquisition, retention, and transfer phases. These results support the hypothesis that contextual interference enhances skill learning. Because the study involved groups of young children in the setting of their normally scheduled physical education class, the practical applications of the results are evident.

Child↗

PubMed1996

A survey of graduates in practice from the University of New Mexico's conventional and community-oriented, problem-based tracks.

PURPOSE: To survey graduates in practice from the first four classes of the University of New Mexico School of Medicine's (UNMSOM's) parallel curricular tracks, and compare data about the graduates' practice patterns, learning behaviors, and satisfaction with the profession of medicine. METHOD: Between 1979 and 1993, the UNMSOM had two tracks for the first two years of medical school: a conventional track and the Primary Care Curriculum (PCC), a community-oriented, problem-based track. In 1990, a survey was conducted of the 140 graduates from the first four classes (1983-1986) who had completed their postgraduate training: 40 from the PCC and 100 from the conventional track. Statistical methods included two-way analyses of variance, logistic regression, and chi-square, adjusted by Bonferroni methods. Comparisons between tracks are reported after adjustments were made for specialty effects. RESULTS: Thirty-three graduates (83%) from the PCC and 87 (87%) from the conventional tracks responded. The PCC graduates were much more likely to work in medically underserved areas, practice in publicly funded health care settings, and care for non-paying patients. The PCC graduates more often identified patient problems and curiosity as providing motivation for their learning. They more frequently studied clinical medicine and community health topics and spent time in community activities. The PCC graduates felt better prepared for practice by their undergraduate medical education. There was no difference between the graduates of the two tracks in the sizes of the populations in which they practiced, in the criteria they used for deciding on referrals to other physicians, in the ranges of community resource utilization, or in the degrees of satisfaction within their chosen professions. Large percentages of graduates from both tracks (67% conventional and 79% PCC) considered themselves to be practicing either primary care or a combination of primary care and non-primary care. In addition, 38% of all the graduates practiced in the state of New Mexico. More PCC graduates chose careers in family practice; however, no significant difference was found in a comparison between the proportions of PCC and conventional-track graduates who chose primary care careers. CONCLUSION: Track differences favorable to the PCC were evident in relation to the two major goals established by the program: to attract graduates to careers in primary care in rural and underserved areas and to provide graduates with self-directed, lifelong learning skills. Some expected track effects were not found.

Academic Medical Centers↗

PubMedDate not supplied

APA summit on medical student education task force on informatics and technology: steps to enhance the use of technology in education through faculty development, funding and change management.

OBJECTIVE: This article provides an overview of how trainees, faculty, and institutions use technology for acquiring knowledge, skills, and attitudes for practicing modern medicine. METHOD: The authors reviewed the literature on medical education, technology, and change, and identify the key themes and make recommendations for implementing technology in medical education. RESULTS: Administrators and faculty should initially assess their own competencies with technology and then develop a variety of teaching methods that use technology to improve their curricula. Programs should decrease the general knowledge-based content of curricula and increase the use of technology for learning skills. For programs to be successful, they must address faculty development, change management, and funding. CONCLUSIONS: Willingness for change, collaboration, and leadership at all levels are essential factors for successfully implementing technology.

Advisory Committees↗

PubMed2006

Electro-encephalogram based brain-computer interface: improved performance by mental practice and concentration skills.

Mental imagination is the essential part of the most EEG-based communication systems. Thus, the quality of mental rehearsal, the degree of imagined effort, and mind controllability should have a major effect on the performance of electro-encephalogram (EEG) based brain-computer interface (BCI). It is now well established that mental practice using motor imagery improves motor skills. The effects of mental practice on motor skill learning are the result of practice on central motor programming. According to this view, it seems logical that mental practice should modify the neuronal activity in the primary sensorimotor areas and consequently change the performance of EEG-based BCI. For developing a practical BCI system, recognizing the resting state with eyes opened and the imagined voluntary movement is important. For this purpose, the mind should be able to focus on a single goal for a period of time, without deviation to another context. In this work, we are going to examine the role of mental practice and concentration skills on the EEG control during imaginative hand movements. The results show that the mental practice and concentration can generally improve the classification accuracy of the EEG patterns. It is found that mental training has a significant effect on the classification accuracy over the primary motor cortex and frontal area.

Attention↗

PubMed2002

Use of a computerized risk-appraisal instrument for cancer prevention education of medical students.

BACKGROUND: Interactive computer-based tools are increasingly used for patient and medical student instruction. METHOD: To assess medical students' responses to a computer-based risk-appraisal instrument aimed at teaching concepts of risk and cancer prevention, and to evaluate perceived barriers to using such tools in clinical practice and knowledge about risk factors for colon cancer. DESIGN: An electronic survey of 133 second-year medical students elicited their responses to the instrument after using it for a case-based learning exercise. RESULTS: The students identified several potential barriers to use, including inadequate time during the office visit (75% of students) and problems with literacy (48%). They were generally knowledgeable about risk factors for colon cancer. 84% found the instrument "very helpful" or "somewhat helpful" in understanding a case patient's health and setting priorities for behavioral changes. CONCLUSIONS: Medical students may benefit from exposure to interactive, computer-based tools such as health-appraisal instruments when learning skills in risk counseling and cancer prevention. Second-year students were already concerned about having adequate time during office visits to use such instruments.

Clinical Competence↗

PubMed1977

Locus of control and law knowledge: a comparison of normal, retarded and learning disabled adolescents.

Individualization of instruction of mentally handicapped adolescents may be facilitated by understanding of relevant variables associated with the learning skills required for coping with community life. This study explores the relationship between knowledge of such skills and locus of control (belief concerning the relative contribution of chance or others to outcomes and events which follow one's behavior). Comparisons of scores of 94 high school students on the Bialer-Cromwell Locus of Control Scale and a test of knowledge of law about such matters as credit, theft, and marriage, indicated that: (1) High school students in standard and college preparatory programs were more likely to see outcomes as determined by their own behaviors than were retarded and learning disabled students; (2) High school students in standard and college preparatory programs were better informed about legal matters crucial to community life than were mentally retarded and learning disabled students; (3) Mentally retarded and learning disabled students did not differ in law knowledge or on locus of control; (4) Locus of control was not directly related to IQ within the retarded-learning disabled group; (5) A moderate positive correlation was found between locus of control and law knowledge for the total group. Findings support Rotter's social learning theory. These findings also suggest that educators may need to provide more direct and specific training in critical aspects of layman's law for most retarded and learning disabled adolescents, as well as for average students who manifest external locus of control beliefs.

Activities of Daily Living↗

PubMed2002

Investigating cognitive neuroplasticity in single cases: lessons learned from applying functional neuroimaging techniques to the traditional neuropsychological case study framework.

We summarize two case studies as a context for discussing the use of neuroimaging as a convergent methodology in the study of neuroplasticity in single subjects. Throughout this paper we argue for a different approach for including neuroimaging in these types of study. Previous case studies of neuroplasticity in patients (ours as well as others reported elsewhere) have added neuroimaging to the traditional neuropsychological framework of comparing patient results with matched control groups, and synthesized results through descriptions of anatomical and behavioral dissociations. This type of approach is referred to as the comparison approach. We advocate a different approach that builds on findings from previous behavioral skill learning research. Specifically, we propose adding neuroimaging throughout learning or recovery of the ability of interest and making inferences from systematic changes in activation topography and intensity that occur within the context of predicted behavioral changes. We dub this approach the online approach. This approach should allow future investigators to circumvent many of the interpretation pitfalls that are common in comparison studies.

Adult↗

PubMed1998

Structural stability within the lateral cerebellar nucleus of the rat following complex motor learning.

Complex motor learning, but not mere motor activity, has been previously shown to induce structural modifications within the cerebellar cortex. The present experiment examined whether similar changes occur within one of the primary output targets of the region of the cerebellar cortex in which these structural changes were described, the lateral cerebellar nucleus (LCN; dentate nucleus). Adult female rats were randomly allocated to one of three training conditions. Acrobatic condition (AC) rats were trained to complete a complex motor learning task consisting of a series of elevated obstacles while motor control (MC) condition animals were forced to traverse a flat obstacle-free runway equal in length to the AC task. Inactive condition (IC) animals received no motor training. Unbiased stereological techniques and electron microscopy were used to obtain estimates of synapse number and postsynaptic density (PSD) length within the LCN. Results showed that neither synapse number nor PSD length was significantly altered as a function of training condition. These results indicate that complex motor skill learning is associated with structural plasticity within the cerebellar cortex and with structural stability within the lateral cerebellar nucleus.

Analysis of Variance↗

PubMed1998

Problem based learning as a curricular strategy for medical undergraduates: a tutor's experience.

This article focuses on the experiences and role of a tutor while conducting a problem based learning (PBL) exercise to facilitate the learning of biochemistry and molecular biology. A case presentation of sickle cell anemia was used to frame a module. The objective of this experimental exercise was to assess the suitability and effectiveness of problem based learning in the first year of undergraduate medical course and to practice self-assessment by tutors in this new role of a facilitator of learning through small group discussion. A tutor during such a learning session encouraged the students to apply their reasoning to analyze the problem and to develop self-directed learning skills in acquiring the knowledge appropriate to their perceived needs to work on a problem. The tutors ensured that they apply this knowledge in their work with other similar problems that they would encounter later in life.

Anemia, Sickle Cell↗

PubMed2006

The PRIME curriculum. Clinical research training during residency.

AIM: The Primary Medical Education (PRIME) program is an outpatient-based, internal medicine residency track nested within the University of California, San Francisco (UCSF) categorical medicine program. Primary Medical Education is based at the San Francisco Veteran's Affairs Medical Center (VAMC), 1 of 3 teaching hospitals at UCSF. The program accepts 8 UCSF medicine residents annually, who differentiate into PRIME after internship. In 2000, we implemented a novel research methods curriculum with the dual purposes of teaching basic epidemiology skills and providing mentored opportunities for clinical research projects during residency. SETTING: Single academic internal medicine program. PROGRAM DESCRIPTION: The PRIME curriculum utilizes didactic lecture, frequent journal clubs, work-in-progress sessions, and active mentoring to enable residents to "try out" a clinical research project during residency. PROGRAM EVALUATION: Among 32 residents in 4 years, 22 residents have produced 20 papers in peer-reviewed journals, 1 paper under review, and 2 book chapters. Their clinical evaluations are equivalent to other UCSF medicine residents. DISCUSSION: While learning skills in evidence-based medicine, residents can conduct high-quality research. Utilizing a collaboration of General Internal Medicine researchers and educators, our curriculum affords residents the opportunity to "try-out" clinical research as a potential future career choice.

Authorship↗

PubMed2003

A hidden curriculum: mapping cultural competency in a medical programme.

BACKGROUND: Cultural competency can be understood as those learned skills which help us understand cultural differences and ease communication between people who have different ways of understanding health, sickness and the body. Recently, medical schools have begun to recognise a need for cultural competency training. However, few reports have been published that articulate and evaluate cultural competency in medical curricula. AIM: This study was performed in order to evaluate the current status of cultural competency training at a medical school in southern Sweden. METHODS: We used a multimethod approach to curriculum evaluation. We reviewed the published list of learning objectives for the medical programme, interviewed curriculum directors and individual teachers for each term about course content and carried out focus group interviews with students in all stages of the medical programme. RESULTS: Cultural competency is a present but mostly hidden part of the curriculum. We found learning objectives about cultural competency. Teachers reported a total of 25 instances of teaching that had culture or cultural competency as the main theme or 1 of many themes. Students reported few specific learning instances where cultural competency was the main theme. Students and teachers considered cultural competency training to be integrated into the medical programme. Cultural competency was not assessed. CONCLUSION: This evaluation showed places in the curriculum where cultural competency is a present, absent or hidden part of the curriculum. The differences between the 3 perspectives on the curriculum lead us to propose curriculum changes. This study illustrates how triangulation with a multifactorial methodology leads to understanding of the current curriculum and changes for the future.

Cultural Diversity↗

PubMed1989

Teaching moderately mentally retarded children basic reading skills.

The present study assessed the efficacy of a program for teaching moderately mentally retarded children basic reading skills. Central to the program were the use of a phonemic alphabet as well as the application of pictorial cueing and stimulus manipulation techniques. The program consisted of six phases. It started with the training of graphemes for vowels (Phase 1) and ended with the training of two-syllable words (Phase 6). Four moderately mentally retarded students participated. Given time constraints, not all subjects completed all phases of the program. The training ended with the reading of one-syllable three letter words for one subject, one-syllable four letter words for two subjects, and two-syllable words for one subject. Subsequent generalization tests revealed that all subjects were capable of reading untrained words of the same complexity as those previously trained; and to read and, to a lesser extent, understand simple sentences. The execution of the program required an average training time of 35 hours per subject. Aspects pertaining to the validity of the program, the efficacy of the procedures, and the relevance of the learned skills are discussed.

Adolescent↗