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PubMed1996

[Initial experience with the PCDiary: software for physicians for documenting and evaluating individual learning].

A computer diary was developed for physicians to create a portfolio of their self-directed learning. Each item of learning is recorded in the form of a question along with the stimulus, the learning resources used and the outcome planned for the learning. The records of 123 physicians which volunteered to use the diary were analyzed. Their response to the software, elicited by survey, is described. Items of learning were most often stimulated by scanning the literature and while seeking information to manage a patient. The physicians recorded their intent to change their practice as the outcome to learning most often when the learning was stimulated while managing a patient. One-half of the physicians reported that keeping the diary made them think about their patient care.

Attitude of Health Personnel↗

PubMedDate not supplied

Faculty and student dialogue through journal writing.

ISSUES AND PURPOSE: To explore how journal writing promotes and fosters an ongoing dialogue between students and faculty during an acute care pediatric clinical experience. DESIGN AND METHODS: Unstructured, self-report data were collected via students' clinical journal entries and during a focus group interview. Content analysis was used to identified recurrent themes. RESULTS: Two themes were generated: building a bond of trust and saving face. PRACTICE IMPLICATIONS: The findings have implications for preceptors of nursing professionals. Implementing journal writing as a component to teaching-learning in the practice environment provides a means to recognize the affective outcomes of learning, such as increasing self-awareness and professional growth.

Adaptation, Psychological↗

PubMed2004

Signaling a change in cue-outcome relations in human associative learning.

In three experiments, we assessed the role of signals for changes in the consequences of cues as a potential account of the renewal effect. Experiment 1 showed recovery of responding following extinction when acquisition, extinction, and test phases occurred in different contexts. In addition, extinction treatment in multiple contexts attenuated context-induced response recovery. In Experiment 2, we used presentations of an extraneous stimulus (ES), instead of context shifts, and found that responding recovered from extinction only when the ES was presented both between acquisition and extinction and between extinction and test. In Experiment 3, we used a reversal learning design in which, during training, two cues were first paired with different outcomes, then paired with the alternative outcomes, and finally paired again with the original outcomes. In this experiment, presentation, just prior to testing, of an ES that had previously been presented between the different phases produced an expectation of reversal in the meaning of the cues.

Adolescent↗

PubMed2004

Laparoscopic adrenalectomy: ascending the learning curve.

BACKGROUND: Soon after its introduction, laparoscopic adrenalectomy (LA) became the procedure of choice in the surgical management of most adrenal tumors. The aim of this study was to assess the outcome and learning curve of the first 100 cases operated by the same surgical team. METHODS: Retrospective analysis of prospectively collected data of 100 consecutive LAs was performed. The parameters studied were indication for surgery, side and length of operation, intra- and postoperative complications, size of tumor, conversion to open surgery, final diagnosis, and length of stay. RESULTS: Between 1996 and 2002, 100 LAs were performed in 90 patients. The procedures included 45 left, 35 right, and 10 bilateral resections for pheochromocytoma (29), Cushings syndrome (27), Conns syndrome (16), nonfunctioning adenoma (13), and others (5). Mean tumor size was 4.16 cm (range, 0.3-11). Overall major morbidity occurred in eight patients (9%); there was one mortality due to cerebrovascular accident in an elderly patient. Five cases (5%) were converted to open surgery. The mean length of stay for the whole group was 4.7 days (range, 2-25). In order to assess the learning curve, procedures were divided into three, equal consecutive groups (n = 33, 33, and 34). Intraoperative complications in the intermediate and late groups were significantly less compared to those in the early group (2/33, 2/34, and 7/33, respectively; (p < 0.05). Similarly, the mean operating time was significantly reduced between the early (169 min) and both intermediate (116 min) and late (127 min) groups (p < 0.005). The conversion rate was reduced between the three groups (3/33, 2/33, and 0/34), but this was not significant (p = 0.06). CONCLUSIONS: As expected, the outcome of LA is associated with a steep learning curve. According to this study, it seems that performance of approximately 30 cases by an experienced laparoscopic surgeon is required to master the procedure.

Adolescent↗

PubMed2005

Re-engineering the process of medical imaging physics and technology education and training.

The extensive availability of digital technology provides an opportunity for enhancing both the effectiveness and efficiency of virtually all functions in the process of medical imaging physics and technology education and training. This includes degree granting academic programs within institutions and a wide spectrum of continuing education lifelong learning activities. Full achievement of the advantages of technology-enhanced education (e-learning, etc.) requires an analysis of specific educational activities with respect to desired outcomes and learning objectives. This is followed by the development of strategies and resources that are based on established educational principles. The impact of contemporary technology comes from its ability to place learners into enriched learning environments. The full advantage of a re-engineered and implemented educational process involves changing attitudes and functions of learning facilitators (teachers) and resource allocation and sharing both within and among institutions.

Biomedical Engineering↗

PubMed2004

Use of artificial neural networks to predict biological outcomes for patients receiving radical radiotherapy of the prostate.

BACKGROUND AND PURPOSE: This paper discusses the application of artificial neural networks (ANN) in predicting biological outcomes following prostate radiotherapy. A number of model-based methods have been developed to correlate the dose distributions calculated for a patient receiving radiotherapy and the radiobiological effect this will produce. Most widely used are the normal tissue complication probability and tumour control probability models. An alternative method for predicting specific examples of tumour control and normal tissue complications is to use an ANN. One of the advantages of this method is that there is no need for a priori information regarding the relationship between the data being correlated. PATIENTS AND METHODS: A set of retrospective clinical data from patients who received radical prostate radiotherapy was used to train ANNs to predict specific biological outcomes by learning the relationship between the treatment plan prescription, dose distribution and the corresponding biological effect. The dose and volume were included as a differential dose-volume histogram in order to provide a holistic description of the available data. RESULTS: It was shown that the ANNs were able to predict biochemical control and specific bladder and rectum complications with sensitivity and specificity of above 55% when the outcomes were dichotomised. It was also possible to analyse information from the ANNs to investigate the effect of individual treatment parameters on the outcome. CONCLUSION: ANNs have been shown to learn something of the complex relationship between treatment parameters and outcome which, if developed further, may prove to be a useful tool in predicting biological outcomes.

Gastrointestinal Hemorrhage↗

PubMed1992

Quantitative effects of cerebral infarction on spatial learning in rats.

Outcome following stroke is difficult to measure because the behavioral response to infarction is variable. We hypothesized that cognitive function, such as spatial learning, may be a reproducible and sensitive outcome variable. We developed an animal model of multifocal cerebral ischemia in order to study the effects of infarction on learning. To cause ischemia, several hundred microspheres were injected into the internal carotid arteries of rats. After ischemia, behavior was measured using a global rating and a Morris water maze. Postmortem serial brain sections were stained and the size of the infarctions was measured. We found that intracerebral microspheres caused cortical infarction and an impairment of spatial learning. This impairment was not due to occlusion of the internal carotid artery and was not found in animals who received a sham injection of saline. The degree of learning impairment was not correlated with the volume density of the infarctions or with the volume density of the remaining cerebral hemisphere. The learning impairment clearly differentiated normal from lesioned animals, and the impairment was probably due to a delay in acquisition of spatial information rather than a defect in retention or retrieval. Measurement of learning deficit after cerebral ischemia is an efficient and sensitive method for evaluating new stroke treatments and possibly for exploring structure function relationships.

Animals↗

PubMed1995

Assessment of the learner: physiological readiness.

Patients with end-stage renal disease (ESRD) who undergo dialytic therapy or who receive a kidney transplant are expected to learn a great deal of information about their disease and treatment. As this population encompasses a vast number of persons of varying age, education, and life skills, the ability to learn new information may be a challenge for both the patient and staff. The uremic state and its effect on cognitive function influences the patient's physiological readiness and ability to learn. Recent research, testing methods, and understanding of other effects of renal failure on cognitive function have provided more information about the patient's physiological readiness/ability to learn. Health care professionals can incorporate these new findings into their teaching programs and strategies to assure successful patient learning and outcomes.

Aptitude↗

PubMed2006

Designing quality course management systems that foster intra-professional education.

This paper draws on the experiences of the author in designing and implementing quality course management policies and procedures for vocational and higher educational programs, both overseas and in Australia. In particular, the paper focuses on those programs of study that require practicums within the curriculum. Whether these are clinical nursing placements, physiotherapy hands-on practical blocks or teacher training instruction, there are many principles of adult education that can be applied to the design and development of course management systems that foster inter-professional education. It is important that the components of any such system allow for a multi-faceted approach that relates collaborative learning to collaborative practice and supports a team of professionals through the skilled use of group-based learning, interactive assessments and inter-organisational processes and practices. The term 'course management system' is used here to describe all those policies and procedures that form the framework of any higher education department or faculty that has the overall responsibility for developing curriculum, teaching and learning resources that ensure quality educational outcomes for its students. In these days of multi-skilling, the benefits of inter-professional education may be significant. To guarantee that standards are kept high and learning outcomes are achievable, the management of an educational system must cover many areas of professional practice. It needs to be supported by all stakeholders in the organisation so that there is an environment of understanding, good interpersonal communication, supportive inter-group relations and an atmosphere of professionalism that is pervasive. This paper introduces a third definition to the model and suggests that intra-professional education be added to form a tripartite foundation for quality professional learning outcomes.

Australia↗

PubMed2001

Carotid artery stenting: effect of learning curve and intermediate-term morphological outcome.

PURPOSE: To assess the impact of learning on the rate of success and complications of carotid stenting in a single-center, one-operator series and prospectively follow a patient cohort with regard to restenosis. METHODS: In 303 patients (mean age 70 +/- 8.8 years), 320 internal carotid arteries (ICA) were treated with carotid stenting for stenoses > or = 70%. Four groups of 80 consecutive interventions were compared with regard to primary technical success and periprocedural complications. Stent patency in follow-up was assessed using duplex scanning. RESULTS: Stenting was successful in 298 (93%) arteries. The combined neurological complications (transient ischemic attacks and all strokes) and 30-day death rate was 8.2% (n = 25), but the all stroke and 30-day death rate was 3.0% (n = 9). A significant reduction in the frequency of neurological complications after the initial 80 interventions was observed (p = 0.03), but technical success was not appreciably improved with increasing experience thereafter. Over a median 12 months (interquartile range 6 to 24), cumulative patency rates were 91%, 90%, and 91% at 6, 12, and 36 months, respectively. CONCLUSIONS: Elective carotid stenting can be performed with excellent technical success, an acceptable frequency of periprocedural complications, and good intermediate-term patency. However, our findings suggest that a larger number of interventions should be performed to overcome the negative effects of the initial learning phase.

Aged↗

PubMed2001

Does dyslexia develop from learning the alphabet in the wrong hemisphere? A cognitive neuroscience analysis.

A new perspective is described which views developmental dyslexia as the outcome of learning to write the alphabet in the nondominant (right) hemisphere. The letter-level and whole-word subtypes of dyslexia are seen as differing responses adopted to cope with this predicament. Striking similarities between dyslexics and callosotomy patients in the allocation of covert attention to lateralized stimuli provide direction for integrating a diversity of dyslexic research within this framework. This synthesis, together with information from pure alexia, brain activation, and reading research, lends insight into the neural circuitry of the compensatory strategies adopted by the two dyslexic subtypes.

Brain↗

PubMed1997

The advanced practice nurse role in implementing and evaluating two nurse-managed wellness clinics: lessons learned about structure, process, and outcomes.

By the year 2000, the baby boom generation will be reaching its sixth decade and 34 million U.S. citizens will be over the age of 65. One strategy for promoting healthy aging is having older persons participate in health promotion programs. Nurse-managed wellness clinics (NMWCs) staffed by advanced practice nurses (APNs) offer an option for health promotion among older individuals. This article describes the APN role in implementing and evaluating two NMWCs for older people living in urban, high-rise apartment buildings subsidized by the U.S. Department of Housing and Urban Development. Lessons learned about structure, process, and outcomes in a community-based wellness center are identified and discussed.

Aged↗

PubMed2003

A comparison of student outcomes following problem-based learning instruction versus traditional lecture learning in a graduate pharmacology course.

PURPOSE: To determine if there would be a difference in students' performance and level of satisfaction when taught pharmacology in a problem-based learning format as compared to traditional lecture format. DATA SOURCES: Control (n = 12) and experimental (n = 10) group means for middle-of-term examinations, final examinations, end-of-course numerical averages, and numerical scores of satisfaction were analyzed with a t test for statistically significant differences. CONCLUSIONS: There was no significant difference between groups for any of the items measured, suggesting that problem-based learning and traditional lecture format may be equally effective course delivery methods. Replication with a larger sample is recommended. IMPLICATIONS: The small sample size precludes generalizing results to the entire population, but outcomes of this pilot study suggest that problem-based learning may be at least as effective as traditional lecture and should be explored in larger studies.

Attitude of Health Personnel↗

PubMedDate not supplied

'Helping or something': perceptions of students with aphasia and tutors in further education.

BACKGROUND: Every year, 10 000 people of working age in the UK have a stroke. Although half of all cases occur in those over 75 years of age, stroke affects more than 1000 people under the age of 30 years. The effects of stroke are far reaching and many people will find that they are unable to return to their previous lives. For some, a way to improve their situation is through further or higher education. Despite the increasing opportunities for people with disabilities to participate in further education, comparatively few studies have looked at this route for people who have had strokes. This study attempts to explore these issues. AIMS: This study investigated the experiences, views and expectations of two students with aphasia involved in further education, and those of their tutors. The study aimed to identify factors that acted as enablers and barriers in accessing education. METHODS & PROCEDURES: Two women with aphasia who had enrolled on further education courses following their strokes and their respective tutors contributed to this study. Questionnaires and semi-structured interviews were used to collect the data. Qualitative research methods were then used to reveal issues important to the participants in the teaching and learning dyad. OUTCOMES & RESULTS: Analysis of the interviews revealed that a core problem identified by all parties was access to learning support. The two underlying issues that were important for the students with aphasia were tutors' awareness of needs and problems with explaining their needs. For the tutors, awareness of the students' needs was most important. The perceptions of the students and the tutors of the educational experience were not the same. CONCLUSIONS: The disparities identified in the participants' accounts suggest that both parties need to be more aware of the roles and responsibilities if individuals with disability are to have equal opportunities in further education.

Adaptation, Psychological↗

PubMed2026

Structured robotic colorectal training in a non-tertiary NHS hospital: a 502-case consecutive cohort implementation study.

Robotic-assisted colorectal surgery has expanded rapidly across NHS practice in the UK. Structured unit-wide training pathways are essential for safe technology adoption, yet published outcome data from non-tertiary hospitals remain limited. This study describes the implementation and feasibility of a unit-wide robotic colorectal program at a high-volume non-tertiary hospital, reporting outcomes across 502 consecutive resections performed by eight consultant surgeons and presenting these in the context of nationally published benchmarks. A retrospective cohort study of 502 consecutive robotic colorectal resections performed at York Teaching Hospital between May 2022 and December 2025. Eight consultant surgeons (A-H) participated in a structured four-phase training pathway incorporating simulation training, proctored cases, complexity-based case progression, and formal credentialing. Primary outcomes were 30-day mortality, unplanned return to theatre (RTT), and anastomotic leak (AL). Anastomotic leak was calculated using only patients who underwent anastomosis as the denominator. Procedure-stratified and individual surgeon outcomes with 95% confidence intervals were reported. Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to evaluate learning curves. Outcomes are presented descriptively alongside nationally published reference data; no formal statistical comparison against national benchmarks was performed. 502 robotic colorectal resections were performed. Mean patient age was 70.0 ± 11.3 years; 58.4% were male. Median ASA grade was III. The indication was malignancy in 89.2% of cases. Length of stay was non-normally distributed and is therefore reported using median and interquartile range in the revised analysis. Key outcomes: - 30-day mortality: 1.0% (5/502; 95% CI 0.4-2.3%) - Unplanned return to theatre (RTT): 5.2% (26/502; 95% CI 3.6-7.5%) - Anastomotic leak (AL): 3.3% (15/450; 95% CI 2.0-5.5%; denominator = patients with anastomosis) - 30-day unplanned readmission: 5.0% (25/502; 95% CI 3.4-7.2%) - Conversion to open surgery: 3.6% (18/502; 95% CI 2.3-5.6%) - Lymph node yield ≥12: 91.3% of cancer resections - R0 resection rate: 95.1% of cancer resections All primary outcomes fell within or below the published reference ranges used for descriptive context. RA-CUSUM trajectories were heterogeneous: no surgeon crossed the predefined upper control limit, but several curves showed later upward movement. Accordingly, the analysis is interpreted as safety surveillance rather than evidence of uniform performance improvement. RA-CUSUM monitoring showed that no surgeon crossed the predefined upper control limit; however, heterogeneous trajectories precluded a claim of uniform performance improvement.

Humans↗

PubMed2005

Residential treatment of adolescents with severe behavioural problems.

The development of adolescents with severe behavioural problems receiving residential treatment in Holland was empirically studied during 1 year. Treatment methods included a standard program comprising behavioural modification and three specific treatment programs: psychodynamic treatment, structured community living and adventurous learning. The development of the youngsters who remained in the programs (N=78) was compared with the development of the youngsters who prematurely dropped out (N=20). All programs had positive developmental outcomes, adventurous learning and structured community living yielded the most behavioural improvement and the standard program the least, and psychodynamic treatment lay in between. Despite the positive developmental outcomes, for many of the youngsters prolongation of the treatment was still needed after 1 year. Requirements for outcome research in residential care are discussed.

Adolescent↗

PubMed1999

Learning objectives for medical student education--guidelines for medical schools: report I of the Medical School Objectives Project.

Many observers of medicine have expressed concerns that new doctors are not as well prepared as they should be to meet society's expectations of them. To assist medical schools in their efforts to respond to these concerns, in January 1996 the Association of American Medical Colleges (AAMC) established the Medical School Objectives Project (MSOP). The goal for the first phase of the project--which has been completed and is reported in this article--was to develop a consensus within the medical education community on the attributes that medical students should possess at the time of graduation, and to set forth learning objectives that can guide each medical school as it establishes objectives for its own program. Later reports will focus on the implementation phase of the MSOP. In this report, each of the four attributes agreed upon by a wide spectrum of medical educators is stated and explained, and then the learning objectives associated with the school's instilling of that attribute are stated. The first of the four attributes is that physicians must be altruistic. There are seven learning objectives, including the objective that before graduation, the student can demonstrate compassionate treatment of patients and respect for their privacy and dignity. The second attribute is that physicians must be knowledgeable; one of the six learning objectives is that the student can demonstrate knowledge of the normal structure and function of the body and of each of its major organ systems. The third attribute is that physicians must be skillful; one of the eleven learning objectives is that the student have knowledge about relieving pain and ameliorating the suffering of patients. The last attribute is that physicians must be dutiful; one of the six learning objectives is that the student have knowledge of the epidemiology of common maladies within a defined population, and the systematic approaches useful in reducing the incidence and prevalence of those maladies. The report ends by stating that (1) if a school's curriculum is shaped by the set of learning objectives presented in the report, the graduates will be well prepared to assume the limited patient care responsibilities expected of new residents and also will have begun to achieve the attributes needed to practice contemporary medicine; (2) schools should feel a sense of urgency in responding to the intent of the report; and (3) it is important to measure the outcomes of learning objectives, and better assessment methods should be developed, particularly ones to assess outcomes related to attitudes and values.

Delivery of Health Care↗

PubMed2005

Being a supportive presence in online courses: knowing and connecting with students through writing.

Enacting Narrative Pedagogy, teachers often reflect on how practices, such as knowing and connecting, influence the nature of the experiences they co-create with students. There is a reciprocity in the tone of both students' and teachers' communication-in both classroom and online environments. Through attention to how teachers know and connect with students, the words and phrases they use can help put students at ease and preserve a continual future openness for learning. Without attention to how language "speaks" to students, especially in distance education, teachers perhaps, too often, "look through" experience to the outcomes of learning and do not address the potentially problematic nature of the experiences they co-create with students. Focusing attention on the meaning and significance of language in online learning restores the connective and gathering possibilities of written communication.

Adaptation, Psychological↗