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At least 721 records · Page 40Linked to original sources
PubMed2006

Impact of self-assessment questions and learning styles in Web-based learning: a randomized, controlled, crossover trial.

PURPOSE: To determine the effect of self-assessment questions on learners' knowledge and format preference in a Web-based course, and investigate associations between learning styles and outcomes. METHOD: The authors conducted a randomized, controlled, crossover trial in the continuity clinics of the Mayo-Rochester internal medicine residency program during the 2003-04 academic year. Case-based self-assessment questions were added to Web-based modules covering topics in ambulatory internal medicine. Participants completed two modules with questions and two modules without questions, with sequence randomly assigned. Outcomes included knowledge assessed after each module, format preference, and learning style assessed using the Index of Learning Styles. RESULTS: A total of 121 of 146 residents (83%) consented. Residents had higher test scores when using the question format (mean +/- standard error, 78.9% +/- 1.0) than when using the standard format (76.2% +/- 1.0, p = .006). Residents preferring the question format scored higher (79.7% +/- 1.1) than those preferring standard (69.5% +/- 2.3, p < .001). Learning styles did not affect scores except that visual-verbal "intermediate" learners (80.6% +/- 1.4) and visual learners (77.5% +/- 1.3) did better than verbal learners (70.9% +/- 3.0, p = .003 and p = .033, respectively). Sixty-five of 78 residents (83.3%, 95% CI 73.2-90.8%) preferred the question format. Learning styles were not associated with preference (p > .384). Although the question format took longer than the standard format (60.4 +/- 3.6 versus 44.3 +/- 3.3 minutes, p < .001), 55 of 77 residents (71.4%, 60.0-81.2%) reported that it was more efficient. CONCLUSIONS: Instructional methods that actively engage learners improve learning outcomes. These findings hold implications for both Web-based learning and "traditional" educational activities. Future research, in both Web-based learning and other teaching modalities, should focus on further defining the effectiveness of selected instructional methods in specific learning contexts.

Cross-Over Studies↗
PubMed2002

Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD).

BACKGROUND: The Health of the Nation Outcomes Scales (HoNOS) have been developed to measure outcomes in people with mental health problems. AIMS: Frequent impaired social functioning, problems with communication and associated physical conditions meant that a bespoke instrument was needed for people with learning disabilities. We describe the development of the Health of the Nation Outcomes Scales for People with Learning Disabilities (HoNOS-LD). METHOD: HoNOS-LD was piloted at 26 sites. Two raters, at two points in time, rated 372 subjects. Analysis determined acceptability, ease of use, interrater reliability, sensitivity to change and reliability with the Aberrant Behavior Checklist (ABC). RESULTS: The resulting 18-item instrument demonstrated good reliability and validity characteristics and is generally acceptable to clinicians. CONCLUSIONS: HoNOS-LD is an appropriate instrument for measuring outcome in people with learning disabilities with additional mental health needs.

England↗
PubMed2006

Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learning curves, and clinical outcome.

BACKGROUND: Remote access perfusion and robotics have enabled totally endoscopic closure of atrial septal defect and patent foramen ovale. The aim of this study was to address learning curve issues of totally endoscopic atrial septal defect repair on the basis of a single-center experience and to investigate whether long cardiopulmonary bypass and aortic occlusion times influence intraoperative and postoperative outcomes. METHODS: Seventeen patients (median age, 35 years; range, 16 to 55 years) underwent totally endoscopic atrial septal defect repair using remote access perfusion and robotic technology (da Vinci telemanipulation system). Learning curves were assessed by means of regression analysis with logarithmic curve fit. The effect of operative variables on clinical outcome was analyzed by linear regression using the Spearman's rho coefficient. RESULTS: No operative mortality or serious surgical complications were observed. No residual shunt was detected at intraoperative or postoperative echocardiography. Significant learning curves were noted for total operative time: y(min) = 406 - 49 ln(x) (r2 = 0.725; p = 0.002); cardiopulmonary bypass time: y(min) = 225 - 42 ln(x) (r2 = 0.699; p = 0.003); and aortic occlusion time: y(min) = 117 - 25 ln(x) (r2 = 0.517; p = 0.04), x = number of procedures. Median ventilation time, intensive care unit stay, and hospital length of stay were 7 hours (range, 2 to 19 hours), 26 hours (range, 15 to 120 hours), and 8 days (range, 5 to 14 days), respectively. No correlation was detected between cardiopulmonary bypass time and intubation time (r2 = 0.283; p = 0.326), intensive care unit stay (r2 = -0.138; p = 0.639), or total length of stay (r2 = 0.013; p = 0.962). CONCLUSIONS: Totally endoscopic atrial septal defect repair can be performed safely, and learning curves for operative times are steep. Longer cardiopulmonary bypass times had no negative impact on intraoperative and postoperative outcome.

Adolescent↗
PubMed2005

Improving patient care: learning more from bad outcomes.

Many quality improvement efforts look in detail at episodes in which things have gone awry through error, to learn how to prevent repetition of that or related errors, with a particular focus on adverse drug reactions. Looking in a more global fashion at the various scenarios in which matters go amiss, rather than solely at the negative consequences of administering a therapy in error, allows us to derive more useful evidence about best therapeutic practice. An analytic strategy is presented to accomplish this aim, looking at the respective adverse effects associated with giving or with omitting a therapy, in each case both in situations in which the therapy is indicated and in situations in which it is contraindicated.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2003

Learning together: clinical skills teaching for medical and nursing students.

OBJECTIVE: To evaluate the feasibility and effectiveness of shared learning of clinical skills for medical and nursing students at the University of Manchester. DESIGN: Medical and nursing students learned clinical skills in either uniprofessional or multiprofessional groups. These groups rotated through skills stations taught by multiprofessional facilitators. The groups stayed together for a series of 3 sessions held at weekly intervals (an induction meeting followed by 2 3-hour teaching sessions). Both quantitative and qualitative methods were used to evaluate the project. CONTEXT: A total of 113 Year 3 students registered on the Medical (n = 41), Bachelor of Nursing (Honours) (n = 43) or the Diploma for Professional Studies in Nursing (n = 29) courses participated in the project which was set in the clinical skills unit of a teaching hospital. RESULTS: Pre- and post self-evaluation of confidence levels for the taught skills revealed a statistically significant increase for all skills. The primary reason students gave for participation in the project was to learn or consolidate skills. An additional inducement for participation was the opportunity to share knowledge and observations between professional groups. Tutors also evaluated the experience favourably, particularly with regard to small group discussions. They indicated that the programme provided an opportunity to standardise clinical skills teaching. CONCLUSION: Collaborative learning opportunities for nursing and medical students are feasible and add value to the learning experience. Data indicate positive outcomes of learning in multiprofessional groups, comprising increased confidence levels, increased understanding of others' professional roles and personal development.

Clinical Competence↗
PubMed2006

Student and community outcomes in service-learning: part 1--student perceptions.

Service-learning has a long and distinguished history of providing valuable experiences to students across all academic levels. Professional disciplines are well situated to provide students with opportunities related to service-learning while also providing needed health care services to communities. This article and Part 2 on pages 516-518 of this issue describe a service-learning initiative implemented in a bachelor of science in nursing program. Part 1 details students' perceptions of outcomes realized from the program, and Part 2 describes community outcomes. The purposes of the program were to enhance students' skills in history-taking, blood pressure and heart rate assessment skills, and beginning counseling skills, as well as provide the university community with blood pressure screening and counseling in a convenient and accessible location. Data on students' perceptions were collected for each semester of the program and for 1 year after students' participation in the program. Students perceived gains in blood pressure and heart rate skill performance, beginning counseling skills, their understanding of tailored client action plans, and their professional commitment to the health of the community.

Community Health Services↗
PubMed1999

Minimizing strain and maximizing learning: the role of job demands, job control, and proactive personality.

Using a sample of 268 production employees, this study extended research on R. Karasek's (1979) demands-control model of stress in 2 ways. First, results show that R. Karasek's proposed interaction between demands and control when predicting strain occurred only for more proactive employees. This 3-way interaction helps reconcile previous inconsistent findings about the interaction between demands and control when predicting strain. Second, the study extends research by investigating the demands-control interaction and the moderating influence of proactive personality in relation to learning-oriented outcomes (perceived mastery, role breadth self-efficacy, and production ownership). There were no 3-way interactions among the variables when predicting these learning-oriented outcomes, but all were important predictors. These results show (a) that demands and control can influence learning as proposed in the dynamic version of the demands-control model and (b) that proactive personality plays an important moderating role.

Achievement↗
PubMedDate not supplied

A comparison of three teaching methods on learning and retention.

The purpose of this study was to examine the relationship of the teaching method used with cognitive learning and learning retention outcomes of nurses when instructed in Imogene King's Theory of Goal Attainment. This study's quantitative, quasi-experimental design examined relationships and/or differences between variables or groups. Cognitive learning and learning retention outcomes were measured by pre-, post- and 1-week posttests. Statistically significant learning took place in all three methods. However, no statistically significant difference was found between teaching method used and cognitive learning or retention. The information gained from this study may provide a stepping stone for enhanced education in the orientation phase of employment, and will provide the impetus for further study.

Adult↗
PubMed2006

Removal of a residual portion of a uterine septum in women of advanced reproductive age: obstetric outcome.

BACKGROUND: To learn more about the obstetric outcome after initial septum resection and remnant septum (< or =1 cm) resection. METHODS: In 94 patients with septate uteri who underwent uterine septum resection, the reproductive efficiency was analysed in a prospective observational study. The reproductive outcome was analysed after initial resection and (if required) consecutive procedures. RESULTS: A total of 94 women were enrolled in the study; all had had two or more miscarriages. The septum was completely removed during the first hysteroscopy in 58 (62%) cases. A residual septum was observed in 36 (38%) patients. Subsequent operative hysteroscopy was performed in the cases (29/36; 80.5%) involving repeated miscarriage and unsuccessful conception. The minimum observation time was 24 months. The difference in delivery rate after the first hysteroscopy between those with a normalized uterine cavity (26/58; 44.8%) and those with remnants (7/36; 19.4%) was statistically significant (P < 0.05). In fact, following the normalization of the uterine cavity, 62.1% (18/29) of the patients delivered, as compared with 19.4% of those (7/36) with a residue and Kaplan-Meyer curves revealed a statistically significant difference (P < 0.05). CONCLUSIONS: Women with a remnant uterine septum have an increased chance of successful pregnancy with an improved obstetric outcome after normalization of the uterine cavity.

Abortion, Spontaneous↗
PubMedDate not supplied

Social outcomes for students with and without learning disabilities in inclusive classrooms.

Social outcomes of students who participated in two different educational settings designed to provide special services for students with learning disabilities (LD) placed full-time within the general education classroom were examined. Participants were 185 third-through sixth-grade students: 59 students with LD, 72 low to average achieving, and 54 high achieving. There was an overall educational setting effect, with students on the consultation/collaborative teaching setting demonstrating more positive outcomes than students in the co-teaching setting on friendship quality and peer acceptance. Students with LD in the consultation/collaborative teaching setting also demonstrated moderate increases in the number of reciprocal friendships from fall to spring. Discussion addresses the positive social outcomes for students with LD and high-achieving students in the consultation/collaborative teaching setting, and the importance of monitoring student progress in all settings.

Adolescent↗
PubMed2006

An innovative outcomes-based medical education program built on adult learning principles.

An innovative medical curriculum at the University of New South Wales (UNSW) has been developed through a highly collaborative process aimed at building faculty ownership and ongoing sustainability. The result is a novel capability-based program that features early clinical experience and small-group teaching, which offers students considerable flexibility and achieves a high degree of alignment between graduate outcomes, learning activities and assessments. Graduate capabilities that focus student learning on generic outcomes are described (critical evaluation, reflection, communication and teamwork) along with traditional outcomes in biomedical science, social aspects, clinical performance and ethics. Each two-year phase promotes a distinctive learning process to support and develop autonomous learning across six years. The approaches emphasize important adult education themes: student autonomy; learning from experience; collaborative learning; and adult teacher-learner relationships. Teaching in each phase draws on stages of the human life cycle to provide an explicit organization for the vertical integration of knowledge and skills. A learning environment that values the social nature of learning is fostered through the program's design and assessment system, which supports interdisciplinary integration and rewards students who exhibit self-direction. Assessment incorporates criterion referencing, interdisciplinary examinations, a balance between continuous and barrier assessments, peer feedback and performance assessments of clinical competence. A portfolio examination in each phase, in which students submit evidence of reflection and achievement for each capability, ensures overall alignment.

Australia↗
PubMed2005

Self-managed learning groups in higher education: students' perceptions of process and outcomes.

BACKGROUND: Self-managed learning groups are increasingly used in higher education. There is a need for more systematic investigation of university students' perceptions of the processes and outcomes of this learning method. AIMS: This study aimed to identify the domains of process issues that students perceive as relevant to their participation in self-managed learning groups, and how these processes are perceived to influence group outcomes. SAMPLE: Participants were undergraduate psychology students who were members of self-managed learning groups. METHOD: The first study employed qualitative methods (namely, students' written accounts, interviews, and observation) to study learning groups (N = 180 students) and identify the process domains. In the second study, first and second year students (N = 207) used a questionnaire (based on the domains identified in Study 1) to evaluate the processes and outcomes of their learning groups. RESULTS: Analysis of qualitative data (Study 1) identified seven process domains: task focus, staff support, process learning, environmental fit, managing differences, equity and responsibility, and collaboration and cooperation. Factor analysis of students' responses (Study 2) identified an underlying structure of two process factors: personal responsibility and collaborative climate, and staff support and environmental fit. Both process factors were associated with the self-reported satisfaction and productivity of this group of students. CONCLUSIONS: University students' perceptions of the processes of self-managed learning groups have a clear structure. These process factors are associated with perceived group outcomes in systematic and theoretically consistent ways.

Adolescent↗
PubMed2004

When to fire: anticipatory versus postevent reconstrual of uncontrollable events.

These studies examined the conditions under which people engage in anticipatory construal before an evaluative event versus reconstrual after the event. Computer software informed college students that there was a 1.5%, 12%, 88%, or 98.5% chance that an opposite-sex student would pick them for a hypothetical date. When people had extreme expectations (1.5% or 98.5%), they changed their view of the student to be consistent with their expectations before learning the outcome (anticipatory reconstrual). When people had moderate expectations (12% or 88%), they formed relatively unbiased impressions before hand but reconstrued after learning the outcome of the dating game (postevent reconstrual). Either strategy can ameliorate the pain of a negative event in ways that people do not anticipate. Forecasters predicted that loosing would make them feel worse than it did and selected a higher dose of a drug to cope with an anticipated loss than did people who actually lost.

Adaptation, Psychological↗
PubMed2005

Outcome additivity and outcome maximality influence cue competition in human causal learning.

Recent research suggests that outcome additivity pretraining modulates blocking in human causal learning. However, the existing evidence confounds outcome additivity and outcome maximality. Here the authors present evidence for the influence of presenting information about outcome maximality (Experiment 1) and outcome additivity (Experiment 2) on subsequent forward blocking. The results of Experiment 3 confirm that, with outcome maximality controlled, outcome additivity affects backward blocking but not release from overshadowing. Finally, the results of Experiment 4 demonstrate that information about outcome additivity has a similar effect on forward blocking if presented after the blocking training instead of before. The results are compatible with the idea that blocking results from inferential processes at the time of testing and not from a failure to acquire associative strength during training.

Adolescent↗
PubMed2006

Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes.

OBJECTIVE: The presence of positive surgical margins following radical prostatectomy is a known risk factor for disease recurrence and may lead to adjuvant treatment. Our goal was to assess the incidence of positive surgical margins in our series of robotic-assisted radical prostatectomy (RARP) and its relationship to our learning curve. METHODS: Between February 2003 and August 2005, 140 patients underwent RARP by the same surgical team at our institution. The records of our first 100 consecutive RARPs were retrospectively reviewed. The patients were divided into three groups based on the time of surgery: group I included the first 33 cases; group II included the second 33 cases; and group III comprised the last 34 cases. We compared the incidence and location of positive surgical margins among the groups. Additional variables evaluated included the patient's prostate-specific antigen (PSA) level, preoperative/postoperative Gleason score, clinical/pathologic stage, and pathologic tumour volume. RESULTS: The positive margin rates were 45.4%, 21.2%, and 11.7% for groups I, II, and III, respectively. The difference in positive margin rates in the three groups was statistically significant (p=0.0053). Positive margin rates declined specifically at the apex and bladder neck when comparing the first 33 patients to the last 34 patients. Patient demographics and preoperative staging variables were comparable among all three groups, with no statistically significant differences among them. CONCLUSIONS: This study illustrates that experience gained with time led to a decrease in the incidence of positive surgical margins. We do not feel that a selection bias affected our results because clinical and pathologic staging was evenly distributed within the three study groups. A steady reduction in positive surgical margin rates demonstrates a learning curve, of approximately 30 patients, associated with RARP, and suggests that oncologic outcome is affected by the experience of the robotic surgeon.

Follow-Up Studies↗
PubMed1995

The need for accurate risk-adjusted measures of outcome in surgery. Lessons learned through coronary artery bypass.

OBJECTIVE: The authors review the Pennsylvania Health Care Cost Containment Council reports on coronary artery surgery and compare this reporting structure to others, including the Society for Thoracic Surgeons database, currently used by their own program. The authors review the growing likelihood of a need for outcome measures for all of the surgical subspecialties. SUMMARY AND BACKGROUND DATA: Pressure from consumers and insurers will require surgical specialties to be graded by objective outcome measures. Practitioners must be prepared and become involved in the process. METHODS: The authors reviewed the data, which grades all of Pennsylvania's hospitals at which coronary artery bypass is performed. Apparently, the major risk factors commonly employed in most other risk adjustment schemes for cardiac surgery have been deleted, and the practitioners might be judged unfairly. The Pennsylvania system appears to be insurance driven to reward low-cost providers who operate on patients with the lowest risk. RESULTS: Review of data suggests that the Pennsylvania Health Care Cost Containment Council's annual publication, A Consumer's Guide for Coronary Artery Bypass Surgery, misrepresents fair risk adjustment in favor of lower-risk patients, thereby encouraging better score cards for those institutions with patients who are less ill. Data regarding charges for the procedure have not been risk adjusted or related to a regional economic index. CONCLUSIONS: Surgeons must prepare to better understand relevant models that evaluate outcome. Cardiothoracic surgery is one of the first specialties to feel the pressures of mandated evaluations, and the lessons learned in Pennsylvania should be applicable to other states and their practitioners.

Coronary Artery Bypass↗
PubMedDate not supplied

Improving child welfare performance through supervisory use of client outcome data.

Despite their benefits, there is little evidence that outcome data are being widely used by program managers or field level supervisors. Three interdependent factors that facilitate the use of outcome data are well-constructed reports, and organizational culture that supports learning and outcome achievement, and managerial skills in interpreting data and taking relevant action. This article describes an outcome reporting package and training oriented toward frontline supervisors to help them use outcome data, shape a learning culture, interpret data, and take focused action toward improving outcomes for children and families.

Child↗