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Students' motivations for data handling choices and behaviors: their explanations of performance.

Cries for increased accountability through additional assessment are heard throughout the educational arena. However, as demonstrated in this study, to make a valid assessment of teaching and learning effectiveness, educators must determine not only what students do, but also why they do it, as the latter significantly affects the former. This study describes and analyzes 14- to 16-year-old students' explanations for their choices and performances during science data handling tasks. The study draws heavily on case-study methods for the purpose of seeking an in-depth understanding of classroom processes in an English comprehensive school. During semistructured scheduled and impromptu interviews, students were asked to describe, explain, and justify the work they did with data during their science classes. These student explanations fall within six categories, labeled 1) implementing correct procedures, 2) following instructions, 3) earning marks, 4) doing what is easy, 5) acting automatically, and 6) working within limits. Each category is associated with distinct outcomes for learning and assessment, with some motivations resulting in inflated performances while others mean that learning was underrepresented. These findings illuminate the complexity of student academic choices and behaviors as mediated by an array of motivations, casting doubt on the current understanding of student performance.

Adolescent↗

Case managed residential care for homeless addicted veterans. Results of a true experiment.

OBJECTIVES: The effectiveness of case-managed residential care (CMRC) in reducing substance abuse, increasing employment, decreasing homelessness, and improving health was examined. METHODS: A five-year prospective experiment included 358 homeless addicted male veterans 3, 6, and 9 months during their enrollment and at 12, 18, and 24 months after the completion of the experimental case-managed residential care program. The customary control condition was a 21-day hospital program with referral to community services. RESULTS: The experimental group averaged 3.4 months in transitional residential care with ongoing and follow-up case management for a total of up to 1 year of treatment. The experimental group showed significant improvement compared with the control group on the Medical, Alcohol, Employment, and Housing measures during the 2-year period. An examination of the time trends indicated that these group differences tended to occur during the treatment year, however, and to diminish during the follow-up year. CONCLUSIONS: Within groups, significant improvements were observed with time from baseline to all posttests on the four major outcomes. We learned, however, that veterans had access to and used significant amounts of services even without the special case-managed residential care program. This partially may account for improvements in the control group and may have muted the differences between groups.

Adult↗

Coordination learning in stag hunt games with application to emergency management.

Response teams for natural disaster emergencies require coordinated and self-organized efforts for rescue, medical services, damage containment, and evacuation. The unfolding of events depends on initial conditions of specific time, location, and preparedness of the response teams. This study considered a new range of emergency response situations where the perpetrator is a sentient attacker that learns with repeated exchanges. The strategy is conceptualized as a stag hunt coordination game on the part of the defense agents and a strictly competitive game with respect to the attacking adversary. Participants were 28 university students who played an iterative board game (The Creature that Ate Sheboygan) wherein a team of three Humans represented military and civil resources, against one Godzilla-type monster. The Monster gained points by destroying buildings and human combat power. The Humans gained points by wearing down the Monster's defenses and containing damage caused by the Monster. Experimental manipulations and empirical analysis showed the following: Communication outages among the Humans assisted the Monster, but the ability to communicate only equalized the Humans' chances rather than providing them with an advantage. Coordination among Humans was instant, but it fluctuated greatly as a result of the Monster's progress. Nonlinear analysis showed an asymptotic decline in coordination to a non-zero level in response to outcome uncertainty. Learning effects were noted for Humans and Monsters, but there were significant interactions with communication blackout conditions

Adult↗

Recovery in memory function in the first year following TBI in children.

PRIMARY OBJECTIVE: To examine memory skills, at acute, 6- and 12-monthly stages, following childhood traumatic brain injury (TBI). RESEARCH DESIGN: Prospective, longitudinal, between-group design, comparing pre-injury and postinjury intellectual and memory measures, across three levels of injury severity. METHODS AND PROCEDURES: Investigation of memory skills in a group of 76 children who had sustained a mild, moderate or severe TBI. Specific tests were used to measure immediate and short-term memory, and more complex multi-trial learning. MAIN OUTCOMES AND RESULTS: The severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6- and 12-month post-injury stages, in comparison to mild and moderate TBI groups. Performance was dependent on both injury severity and task demands. CONCLUSIONS: Memory difficulties are present during the acute, 6- and 12-months following childhood TBI. With a clearer understanding of the memory deficits following TBI, appropriate strategies can be taught and interventions implemented for these children.

Amnesia↗

The relationship between service learning and medical student academic and professional outcomes.

BACKGROUND: Little is known about the relationship between medical student participation in service and performance outcomes. PURPOSE: To examine relationships between involvement in required service learning and measures of academic and professional achievement and specialty choice. METHODS: Using preexisting, self-reported data for Tulane University School of Medicine's class of 2004, we categorized students as low, moderate, or high on commitment and involvement in service learning (CISL) and compared to multiple outcomes: class rank; election to the Alpha Omega Alpha (AOA) Honor Society; election to the Gold Humanism in Medicine Honor Society; total percent scores on 2 multistation, structured, clinical examinations; and specialty choice per 2004 residency match results. RESULTS: Service learning involvement was related to class rank. There was a marginal relationship between CISL and election to AOA but no association with election to the Gold Humanism in Medicine Honor Society, Year 2 or 3 clinical skills examination results, or specialty choice. CONCLUSIONS: High participation in service learning and service learning leadership identify a group of students less likely to be in the top quartile of their class yet who are making important contributions to the community and profession.

Curriculum↗

Factors influencing the growth in knowledge of trainees in general practice.

OBJECTIVES: The relation between the content of postgraduate training for general practice and the outcome in terms of the growth in knowledge of trainees was investigated. The training variables included were: (1) the number of patients seen per day, (2) the trainer, (3) the practice and (4) the theoretical curriculum. METHODS: Subjects were 58 trainee-trainer pairs. Growth in knowledge was assessed by two written tests administered with eight months interval. Training variables were evaluated by means of questionnaires and logbook-registration. The correlation was explored between each of the training variables and the knowledge tests scores. To correct for interactional effects, a step-wise multiple regression analysis was performed with the second test as dependent variable and the first test as well as the training variables as independent variables. RESULTS: Significant growth in knowledge was demonstrated. Non of all training variables investigated explained the variance in scores on the second test equally good or better than the scores on the entry test. CONCLUSIONS: The impact of the separate training-components on the growth in knowledge, remains unclear. We may speculate, that the sort of knowledge assessed with the written literature based true/false test is different from the sort of knowledge transferred during every day training: evidence based knowledge versus experience based knowledge. Equally valid is the conclusion that these findings fit into the theory that in adult learning the outcome is more learner than teacher dependent.

Journal Article↗

Consonant production and language skills in Mandarin-speaking children with cochlear implants.

OBJECTIVES: To investigate the phonemic inventories of syllable-initial consonants in Mandarin-speaking children with cochlear implants, assessing the relationship between the children's mastery levels of consonant production and their receptive and expressive language skills. DESIGN: Descriptive study. SETTING: Chi-Mei Medical Center, Tainan, Taiwan. PATIENTS: The 30 prelingually deaf children with cochlear implants who participated in the study ranged in age from 6 years to 12 years 6 months, and their age at implantation ranged from 2 years 3 months to 10 years 3 months. The average length of device experience was 3 years 7 months (range, 1 year 7 months to 6 years 5 months). None of the children was identified with concomitant learning disabilities. OUTCOME MEASURES: The 21 Mandarin syllable-initial consonants were elicited using a set of 105 pictures. Two language assessment tools were used to evaluate the children's receptive vocabulary skills as well as their overall receptive and expressive language development. RESULTS: The mean +/- SD score for correct consonant production was 57.9% +/- 19.5%. Regarding the manner of articulation, plosives received the highest average correct percentage whereas nasals, affricates, fricatives, and the lateral approximant /l/ were less frequently correct. The children's overall percentage of correct scores for consonant production and receptive vocabulary measure were significantly correlated (r = 0.51; P =.005). Additionally, correlation coefficients were significant between the overall score for correct consonant production and both the scores for receptive language measure (r = 0.65; P<.001) and expressive language measure (r = 0.76; P<.001). The participants' consonant production skills were negatively correlated with age at implantation (r = - 0.46; P =.01) and positively correlated with length of experience with cochlear implant (r = 0.45; P =.02). CONCLUSIONS: Mastery levels of Mandarin syllable-initial consonants remained moderately low in prelingually deaf children with cochlear implants. The present results suggest a significant association between consonant production skills and language development in these children.

Asian People↗

Personality disorders: a discussion of current status and future directions for research, practice, and policy.

This article is the result of a panel discussion on future directions in personality disorders held at the 1998 Meeting of the Society for Psychotherapy Research in Snowbird Utah. Three experts in the field of personality disorders were invited to participate in a dialogue on priorities and directions for research, practice, and policy in this area. Topics discussed amongst the panelists included the following: 1) relevance of psychotherapy process research for treatments of personality disorders, and potential fruitful directions for such research; 2) what has been learned from outcome research in treatment of personality disorders, and directions for such research that are likely to be most productive in improving treatments; 3) the extent to which research has influenced clinical practice and how existing gaps might be addressed; 4) policy questions related to payment for treatment of personality disorders.

Evidence-Based Medicine↗

Predictive testing for Huntington disease in Canada: adverse effects and unexpected results in those receiving a decreased risk.

By January 1, 1991, a total of 388 persons had enrolled in the Canadian collaborative study of predictive testing for Huntington disease (HD). Of these participants, 105 persons have been given a decreased risk result. Contrary to expectations, approximately 10% of persons with a decreased risk result have had psychological difficulties coping with their new status. Here, we describe the individual responses of 6 such persons and experimental themes emerging after following these persons for up to 2 years. Individuals who are more likely to suffer an adverse reaction to a decreased risk result include those persons who have made irreversible decisions based on the belief they would develop HD or those who had unrealistic overoptimistic expectations of the positive effects of a decreased risk result. In contrast to those receiving an increased risk result, the most vulnerable time for persons receiving a decreased risk result is between 2 and 12 months after learning the outcome. The need for assessment and counselling of participants in predictive testing programs, even when there is a decreased risk result, is emphasized.

Adult↗

Effects of cognitive challenge on self-directed behaviors by chimpanzees (Pan troglodytes).

In primates, including humans, scratching and other self-directed behaviors (SDBs) have recently been reported to be differentially displayed as a function of social interactions, anxiety-related drugs, and response outcomes during learning tasks. Yet few studies have focused on the factors influencing SDBs in our closest living relatives, the chimpanzees (Pan troglodytes). Furthermore, no previous experimental study has examined handedness of SDBs as a function of changes in task difficulty. Using matching-to-sample tasks of varying difficulty, the present study examines the effect of manipulations of task difficulty on rates, handedness, and type of SDBs in an experimental study of eight chimpanzees. SDBs were categorized as rubs, gentle scratches, and rough scratches. SDBs increased during difficult discriminations, but only for subjects who started the experiment on an easy discrimination; subjects who started on a difficult discrimination exhibited no differential rates of SDBs as a function of task difficulty. There was a tendency to exhibit relatively more SDBs with the right hand in the more difficult task. Rates of SDBs decreased after auditory feedback signals, suggesting a link between SDBs and uncertainty. Rubs were directed more to the face (trigeminal), and gentle and rough scratches more to the body (spinothalamic), suggesting that face-directed SDBs may index a different motivational basis than scratches. Taken together, these results extend previous research on SDBs to the domain of cognitive stress in nonsocial contexts, demonstrating that SDBs are sensitive to manipulations of task difficulty in chimpanzees.

Animals↗

Psychological reactions to fetoscopy: a controlled study.

Twenty woman at risk of carrying a fetus with homozygous beta-thalassemia who underwent fetoscopy and a matched control group of pregnant women were administered the Symptom Questionnaire to evaluate changes in distress. Women who were offered fetoscopy had significantly more anxiety, depression, somatic symptoms and hostility than the control group. Psychological distress significantly decreased after the results of fetoscopy were communicated to the patient, and the decrease was similar in normal control women. Five other patients had a diagnosis of homozygous beta-thalassaemia and their pregnancies were terminated. Their psychological distress increased when they learned the outcome of fetoscopy, but decreased again after termination. Psychological reactions to fetoscopy and amniocentesis appear to be similar, yet women who undergo fetoscopy suffer from more psychological distress.

Anxiety↗

Microneurography as a tool in clinical neurophysiology to investigate peripheral neural traffic in humans.

Microneurography is a method using metal microelectrodes to investigate directly identified neural traffic in myelinated as well as unmyelinated efferent and afferent nerves leading to and coming from muscle and skin in human peripheral nerves in situ. The present paper reviews how this technique has been used in clinical neurophysiology to elucidate the neural mechanisms of autonomic regulation, motor control and sensory functions in humans under physiological and pathological conditions. Microneurography is particularly important to investigate efferent and afferent neural traffic in unmyelinated C fibers. The recording of efferent discharges in postganglionic sympathetic C efferent fibers innervating muscle and skin (muscle sympathetic nerve activity; MSNA and skin sympathetic nerve activity; SSNA) provides direct information about neural control of autonomic effector organs including blood vessels and sweat glands. Sympathetic microneurography has become a potent tool to reveal neural functions and dysfunctions concerning blood pressure control and thermoregulation. This recording has been used not only in wake conditions but also in sleep to investigate changes in sympathetic neural traffic during sleep and sleep-related events such as sleep apnea. The same recording was also successfully carried out by astronauts during spaceflight. Recordings of afferent discharges from muscle mechanoreceptors have been used to understand the mechanisms of motor control. Muscle spindle afferent information is particularly important for the control of fine precise movements. It may also play important roles to predict behavior outcomes during learning of a motor task. Recordings of discharges in myelinated afferent fibers from skin mechanoreceptors have provided not only objective information about mechanoreceptive cutaneous sensation but also the roles of these signals in fine motor control. Unmyelinated mechanoreceptive afferent discharges from hairy skin seem to be important to convey cutaneous sensation to the central structures related to emotion. Recordings of afferent discharges in thin myelinated and unmyelinated fibers from nociceptors in muscle and skin have been used to provide information concerning pain. Recordings of afferent discharges of different types of cutaneous C-nociceptors identified by marking method have become an important tool to reveal the neural mechanisms of cutaneous sensations such as an itch. No direct microneurographic evidence has been so far proved regarding the effects of sympathoexcitation on sensitization of muscle and skin sensory receptors at least in healthy humans.

Animals↗

Critical thinking as an outcome of context-based learning among post RN students: a literature review.

Increasingly complex needs and expanding roles in the delivery of health care require professional nurses to be capable critical thinkers and self-directed learners. Problem-based learning (PBL) is promoted as a mean to facilitate critical thinking (CT) in nursing students attending generic and post RN baccalaureate programs. The authors summarize and analyze nursing research and theoretical literature (1992-2005) related to four key topic areas: critical thinking, nursing education, PBL, and post RN education, to determine what is known about the impact of PBL on CT among post RN students. CINAHL, ERIC, Medline and PsychINFO databases were searched and based on the literature retrieved, there is no strong research evidence to suggest changes occur in baccalaureate nursing students' CT during their educational programs, including those using PBL. Similar results were found among post RN students although the literature on this topic is sparse. There is a need for additional research and ongoing development of valid and reliable instruments to measure CT in nurses to guide teaching and learning strategies that effectively facilitate CT among nursing students.

Education, Nursing↗

What happens to the student? The neglected variable in educational outcome research.

Disputes about the superiority of teaching methods often remain unresolved. The essential question we continuously want to answer is: Which teaching methods yield the best knowledge and skills in students? Abundant literature, in medical education and in education in general, on research with educational methods as independent variables and measures of outcome (e.g., test scores) as the dependent variable often point at "no significant difference" or only small differences between methods. Many factors do influence the educational outcome in students and large statistical power (such as meta analysis) should be helpful to eliminate many sources of error. However, one source we cannot tackle this way. That is, students will usually adapt quantity and quality of studying to meet testing requirements. In doing so, they may compensate for teaching quality. Some teaching may generate more effort in students than other teaching. Since test scores reflect primarily student activities, it is their efforts that may bring differences in teaching methods close to equality in test scores. Therefore, knowledge and skills should not be considered the primary outcome of teaching but the outcome of learning activities. If we want to discriminate between teaching methods, we must at least consider what happens to students.

Clinical Competence↗

Self-interest and fairness in problems of resource allocation: allocators versus recipients.

Two studies explored the tension between self-interest and the equality norm in problems of resource allocation. Study 1 presented graduate business students with a hypothetical task requiring them to make a series of managerial decisions. On learning the outcome of those decisions, they were asked to divide a bonus pool between self and a rival manager (who had opted for very different decisions and achieved either the same results as self on 2 criteria or a better result on 1 criterion and a worse result on the other criterion). Study 2 required Stanford and San Jose State undergraduates to consider the division of a hypothetical scholarship fund between candidates from their 2 schools. Data from both studies contrasted the apparent evenhandedness and lack of self-interest manifested by allocators with the self-serving responses of evaluators. Furthermore, when faced with different claims, participants were inclined to justify an unequal allocation of resources--provided that they, or a representative of their group, received the larger share--that few personally would have recommended, demanded, or imposed.

Defense Mechanisms↗

Making sense of clinical reasoning: judgement and the evidence of the senses.

BACKGROUND: Close noticing, as keen discrimination and judgement between qualities, is a key capability for work in visual domains in medicine. This generic capability is normally assumed, and its specifics are left to develop through experience, as traditional apprenticeship in a specialty. Discrimination is an outcome of learning in the affective domain, and introduces a vital aesthetic dimension to clinical work that aligns with the interests of the medical humanities. An aesthetic approach to clinical reasoning, however, remains largely unexplored as an explicit focus for medical education. FRAMEWORK AND PRACTICE PARADOXES: We offer a framework for an explicit education of perceptual discrimination in the visual domain as a form of practice 'artistry', turning a surface 'looking' into a deeper 'seeing'. Such an education, however, raises certain paradoxes. While novices typically 'see' what they expect to see in visual images (sign and symptom), experts also make similar errors. Further, experts become familiar with the use of visual heuristics in diagnosis, such as vivid natural referents to aid in rapid pattern recognition in an encompassing diagnostic 'glance', yet this appears to defeat the first principle of describing what you see. Employing a model of imagination as a tacit form of knowing that 'prepares' and enhances perception, we suggest, however, that the judicious use of such heuristics can be positive. Moreover, the mechanics of the process of clinical judgement in visual domains can be detailed to inform educational agendas. A further paradox is that of experts using both idiosyncratic heuristics and protocol-driven practices, where these seem to offer contradictory approaches to gaining knowledge. We recognise this as a facet of medicine's inherent uncertainty, in the face of complex, ambiguous and unique material, that must be addressed through clinical education. CONCLUSION: We equate 'aesthetics' with 'sensibility' and describe clinical expertise as 'connoisseurship' of informational images. Such connoisseurship, a particular form of knowing, can, in turn, be defined as an aesthetic sensibility informing practice artistry. It can be articulated and analysed to provide a basis for educational enhancement. Connoisseurship is not a technical-rational procedure but is inherently paradoxical and such paradox may be valued as an educational resource, rather than seen as a hindrance.

Bible↗