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PubMed2004

Evaluation of clinical relevance of a problem-orientated head and neck module.

Current trends in medical education focus on outcomes-based learning as a means to facilitate student learning. The aim of this study was to evaluate a clinically applied module in head and neck anatomy for third-year dental students. The module linked clinical examination, regional dental blocks simulated on cadaver specimens, radiographic images and clinical case scenarios. A Likert-type questionnaire, completed by all students (n = 49), was used to evaluate student perceptions of this module objectively. The results indicate that an average number of students found that clinical examination received sufficient time (mean: 2.98) during the module, while a substantial number of students agreed that the integration of dental procedures stimulated them to study specific regional anatomy (mean: 3.82) and increased their interest in their future careers as dentists (mean: 4.04). The radiographs improved their understanding of anatomy (mean: 3.41) while the clinical case studies were a positive learning experience (mean: 3.10). The majority of students (mean: 4.12) felt that they were continuously made aware that they were studying appropriate matter for their future work as dentists. It seems evident that the integration of clinically relevant content facilitates and encourages the understanding of anatomy.

Anatomy↗
PubMed1979

Comfort, care for families who must wait.

Volunteers staff a special waiting room that extends humanistic care to meet the needs of families as they wait to learn the outcomes of their relatives' surgery or tests.

Family↗
PubMed1994

Conscious awareness and memory during general anesthesia.

Conscious awareness is an infrequent complication of general anesthesia. All methods of anesthesia have been implicated, and no method guarantees amnesia. This article examines implicit and explicit memory and discusses factors associated with awareness. Common methods of detection are unreliable, and symptoms resembling post-traumatic stress disorder may result if awareness goes unrecognized and untreated. Patients who experience awareness may sue on grounds of malpractice, breach of contract, and lack of consent. Overhearing negative stimuli may affect patient outcome, because learning and language comprehension can occur during what appears to be clinically adequate anesthesia. Strategies to block threatening auditory stimuli include use of earphones, music tapes, white noise, reassuring statements, or positive suggestion. Behavioral anesthesia decreases patient stress to enhance recovery. Evidence of patient benefit resulting from therapeutic suggestion is inconclusive.

Anesthesia, General↗
PubMed1993

Contraceptive health programs for adolescents: a critical review.

Many adolescents are neither educated about contraception nor consistently practice it as part of their sexual health behavior. Contraceptive education has taken many forms and has been questioned as to its effectiveness. This paper reviews some of the contraceptive education programs that have been designed for adolescents. These programs, although targeting the adolescent population, differ in educational process based on the delivery setting. School-based, community-based, and college/university-based programs are reviewed and discussed in terms of their effectiveness, potential, and limitations. Educating adolescents about contraception should incorporate the cognitive, affective, and skill-based domains of learning, with outcome expectations based on the specific delivery setting. However, not all settings have the freedom to select from a variety of teaching methodologies. Thus, educational accountability in each setting should differ in terms of outcome expectations, particularly if the program evaluation includes behavioral components.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Hippocampal lesions facilitate instrumental learning with delayed reinforcement but induce impulsive choice in rats.

BACKGROUND: Animals must frequently act to influence the world even when the reinforcing outcomes of their actions are delayed. Learning with action-outcome delays is a complex problem, and little is known of the neural mechanisms that bridge such delays. When outcomes are delayed, they may be attributed to (or associated with) the action that caused them, or mistakenly attributed to other stimuli, such as the environmental context. Consequently, animals that are poor at forming context-outcome associations might learn action-outcome associations better with delayed reinforcement than normal animals. The hippocampus contributes to the representation of environmental context, being required for aspects of contextual conditioning. We therefore hypothesized that animals with hippocampal lesions would be better than normal animals at learning to act on the basis of delayed reinforcement. We tested the ability of hippocampal-lesioned rats to learn a free-operant instrumental response using delayed reinforcement, and what is potentially a related ability -- the ability to exhibit self-controlled choice, or to sacrifice an immediate, small reward in order to obtain a delayed but larger reward. RESULTS: Rats with sham or excitotoxic hippocampal lesions acquired an instrumental response with different delays (0, 10, or 20 s) between the response and reinforcer delivery. These delays retarded learning in normal rats. Hippocampal-lesioned rats responded slightly less than sham-operated controls in the absence of delays, but they became better at learning (relative to shams) as the delays increased; delays impaired learning less in hippocampal-lesioned rats than in shams. In contrast, lesioned rats exhibited impulsive choice, preferring an immediate, small reward to a delayed, larger reward, even though they preferred the large reward when it was not delayed. CONCLUSION: These results support the view that the hippocampus hinders action-outcome learning with delayed outcomes, perhaps because it promotes the formation of context-outcome associations instead. However, although lesioned rats were better at learning with delayed reinforcement, they were worse at choosing it, suggesting that self-controlled choice and learning with delayed reinforcement tax different psychological processes.

Animals↗
PubMedDate not supplied

Learning contracts in clinical education.

This study explored the outcomes of using learning contracts in a radiologic science program. Telephone surveys of contract learning participants and other radiologic science graduates provided data regarding graduate career satisfaction, lifelong learning habits and attitudes toward learning. Statistical comparison data found that contract learning participants reported higher job satisfaction, participated more in continuing education, demonstrated more self-motivation and independence, felt less competitive and anxious about courses and grades and felt more involved in their clinical courses.

Humans↗
PubMed2005

Interdisciplinary service-learning substance abuse projects: processes and outcomes.

The purpose of this paper is to describe the development and implementation of community-based, service-learning field projects by 30 health professional faculty fellows of Project MAINSTREAM, a faculty development program on substance abuse. The fellows worked together for two years in 10 Interdisciplinary Faculty Learning Groups (IFLGs), which consisted of three academics of different disciplines. The ten projects are viewed within the context of service- learning and are based on a balance between the provision of services to the community and furthering the learning objectives of Project MAINSTREAM.

Adolescent↗
PubMed1997

Learning disability and epilepsy. 1, towards common outcome measures.

A major component of the population of people who have epilepsy are people with a learning disability. As a group, such individuals often have complex epilepsy which is refractory to treatment. Current available measures to assess the outcomes of therapeutic interventions in epilepsy are based on seizure frequency, seizure severity and quality-of-life measures, but have not been validated in people with a learning disability. Thus, we do not know if such measures of outcome serve the needs of this group. This review examines how able we are to assess the efficacy of our interventions to control epilepsy in people with learning disability. It is suggested that a standard data set is necessary as the basis of the assessment of any therapeutic intervention. Central components of this data set would encompass a definition of important characteristics of an individual, a description of their epilepsy and an assessment of the impact of their condition on both their own and their carer's health. The approach to obtaining this information should employ a methodology which can allow for environmental influences.

Epilepsy↗
PubMed2002

Spinal cord injury medicine. 3. Rehabilitation outcomes.

UNLABELLED: This self-directed learning module highlights rehabilitation outcomes in spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the multiple concerns for functional recovery after SCI, chiefly, the potential for ambulation, upper-extremity recovery, options for functional neuromuscular stimulation (FNS), sexual activity, and optimal outcome after a metastatic lesion. Motor incomplete patients have a better prognosis for ambulation than persons with sensory incomplete injury. Positive predictors for ambulation, including pinprick and lower-extremity motor scores greater than 20, are discussed. Meaningful recovery can occur in the upper extremities for at least 1 year. FNS options have been developed to promote functional control of the upper extremities for persons with tetraplegia, phrenic pacing, and bladder continence. A critical component of an individual's expression of self is his/her sexuality; sexual function after SCI is described in detail, including options for treatment of erectile dysfunction and various birth control methods for women. Expectations for an appropriate rehabilitation stay for a person with metastatic SCI differ for an individual with traumatic SCI. Differences may include changing routine pathways and timelines to focus on patient-centered quality of life for transition to home. OVERALL ARTICLE OBJECTIVE: To identify potential outcomes in ambulation, upper-extremity function, FNS, and sexual function after SCI and after metastatic cancer.

Adult↗
PubMed2006

Is avoiding an aversive outcome rewarding? Neural substrates of avoidance learning in the human brain.

Avoidance learning poses a challenge for reinforcement-based theories of instrumental conditioning, because once an aversive outcome is successfully avoided an individual may no longer experience extrinsic reinforcement for their behavior. One possible account for this is to propose that avoiding an aversive outcome is in itself a reward, and thus avoidance behavior is positively reinforced on each trial when the aversive outcome is successfully avoided. In the present study we aimed to test this possibility by determining whether avoidance of an aversive outcome recruits the same neural circuitry as that elicited by a reward itself. We scanned 16 human participants with functional MRI while they performed an instrumental choice task, in which on each trial they chose from one of two actions in order to either win money or else avoid losing money. Neural activity in a region previously implicated in encoding stimulus reward value, the medial orbitofrontal cortex, was found to increase, not only following receipt of reward, but also following successful avoidance of an aversive outcome. This neural signal may itself act as an intrinsic reward, thereby serving to reinforce actions during instrumental avoidance.

Adult↗
PubMedDate not supplied

[The outlook for the experimental study of the network functions of cortical cells during learning].

The main outcome of the experiments described in the paper is an idea on the gnostic cortical microset. Multineuronal activity recorded from the motor cortex of cats with a conditioned response to time and the following cross-correlation analysis revealed a strict distribution of interneuronal connections within the microsystems (between the adjacent neurons) and variable connections between the remote neurons during the active waiting stage of two minute interval. Additional analysis of the narrow (0.5 ms) peaks of the histograms allowed to form a view on the synaptic interaction in time. It was found that there was different temporal distribution of the spikes in the peak obtained due to correlograms of neuronal pairs. Some cortical neurons demonstrated a visible synaptic activation at the end of the waiting period when other signs of the temporary behaviour were absent. Pharmacological testing functional interneuronal connections with acetylcholine and Ca(2+)-suppressing drug EGTA have raised a question on the neurochemical specificity of the intra- and extracortical synapses.

Acetylcholine↗
PubMed1994

[Effects of an intensive therapy program for behaviorally disordered mentally handicapped patients on staff personnel in residential care].

This study evaluates the effects of an intensive therapy program designed for mentally handicapped persons with severely disturbed or autistic behavior on their staff personal which had an active role in the program. The staff members rated their professional competence, quality of interaction with the client, team culture and work satisfaction before and after being engaged in the program, with additional ratings of their personal aims at the beginning of the program. Three sets of data were obtained with the program being conducted three times in a row. The testings of the related as well as the independent samples show differentiated program effects. The main effect is an increase of the professional competence and quality of interaction, especially by the qualified staff members. Trainees put emphasis on the development of their personal relationship with the client. The results are discussed in terms of the impact of learning processes specific to the roles of the staff members and motivational factors on learning and therapy outcome, along with institutional conditions influencing successful learning. Thus the program facilitates the professional and interpersonal learning process of staff members in a specific way with success as well as with limitations.

Autistic Disorder↗
PubMed2000

Outcomes and experiential education.

Outcomes-based assessment in education involves continuous use of assessment measures to provide feedback about the efficacy of the curricular structure, content, and teaching methods. This process is initiated by establishing educational outcome statements for the Doctor of Pharmacy curriculum, selecting assessment methods that most appropriately measure the educational outcomes, and establishing a learning environment that is congruent with both the outcomes and assessment methods. To ensure a successful continuous outcomes-based assessment process, a systematic assessment plan should be prepared that focuses the process by identifying only the most essential hypotheses, uses a practical yet appropriate methodology, ensures efficient data collection, includes data analyses that link the educational outcomes to the learning environment, and promotes timely development and implementation of an action plan. An overview of outcomes-based education and the use of outcomes-based practice experiences in pharmacy education is presented.

Accreditation↗
PubMed1999

Portfolios in continuing medical education--effective and efficient?

INTRODUCTION: A cross over comparison between 'traditional' continuing medical education (CME) activities and portfolio-based learning in general practice is described. METHOD: Thirty-two volunteer general practitioners (GPs) were divided into two cohorts; each cohort spent six months following a 'traditional' route to postgraduate educational accreditation (PGEA) and six months following a portfolio-based learning route supported by three CME tutors. OUTCOME MEASURES: These were the submission of a completed portfolio with evidence of the completion of learning cycles and participants reflections on the educational process. Qualitative and quantitative evaluation data were collected by questionnaire, semi-structured interview, participant observation and review of completed portfolios. RESULTS: The themes identified by GPs as hopes for the portfolios were largely fulfilled and the anxieties generally confounded. The flexibility of the portfolio learning process was particularly important to the participants. The breadth of topics covered by the portfolios was extremely wide and comparison with the submissions for 'traditional' PGEA showed a much smaller spread of learning activities and fewer subjects of study. EFFECTIVENESS: The use of the portfolios of critical incidents and the completion of learning cycles with application to practice provided evidence of the effectiveness of such learning. EFFICIENCY: The mean number of hours spent by GPs preparing the portfolios was 24.5 +/- 12 (SD) which was significantly more than the 15 hours of PGEA awarded. CONCLUSIONS: This study demonstrates that a portfolio-based learning scheme can meet the needs of GPs relevant to their professional practice; it can give learners control over how, what and when they learn and encourage active and peer-supported learning; it can build personal and professional confidence and be thought both valid and reliable by participants. Learning outcomes can also be reliably assessed by PGEA within the context of an individually created learning plan.

Cohort Studies↗
PubMed1986

Learned helplessness as conditioned inattention to the target stimulus.

Learned helplessness theory explains the impaired performance that follows exposure to uncontrollable outcomes by assuming learned expectation of response-outcome independence that is transferred between tasks. Recent evidence has shown that introducing a second neutral stimulus, contingent on the offset of the uncontrollable stimulus, removes the subsequent interference. This finding has been claimed to support the view that the interference is a result of conditioned inattention rather than of the expectation of response-outcome independence. These conflicting explanations were examined in a series of four experiments that varied induction procedures (passive exposure or inescapability) and stimulus quality (aversive or nonaversive). All four experiments found the predicted interference, but only one, in which passive exposure was combined with an aversive stimulus, obtained results supporting the conditioned inattention hypothesis. We conclude that learned helplessness probably involves more than a single mechanism and that the passive exposure procedure may not be appropriate for demonstrating genuine helplessness deficits.

Adult↗
PubMed1994

Peer tutoring and student outcomes in a problem-based course.

Does peer-tutoring affect students' educational outcomes in problem-based learning? Students' characteristics and outcomes were compared along 14 successive classes of a problem-based learning course in the University of Brasilia medical programme. In the first stage of this time series, 26 teacher-tutored groups were formed; in the second stage, 50 groups had both teacher- and peer-tutoring. Both groups had equivalent characteristics in stages one and two as regards membership size and composition (students' learning style, self-confidence and motivation to learn). Results showed that scores for problem-solving tests and self-evaluation of skills were not significantly different between first and second stage groups. However, scores of meaningfulness of course experience and group work usefulness were significantly higher in the peer-tutoring stage. Significant positive correlations were found between scores of meaningfulness of course experience and both self-evaluation and group work usefulness but not between the first measure and group size or motivation to learn. The findings suggest that peer-tutoring can facilitate group work without sustained loss of cognitive achievement in long range conditions of problem-based learning experience.

Brazil↗
PubMed1994

Ageing in learning difficulties: the development of health care outcome indicators.

A system of outcome indicators for the health and social care of ageing people with learning disabilities is required to ensure that clinicians, planners, purchasers and policy makers can monitor and evaluate the impact of health and social care. As longevity is increasing in people with learning disabilities, special problems are found in the physical health, psychological health and social wellbeing of the elderly. This paper reviews theoretical aspects of outcome indicators, and uses the various classes of outcome measures available to draw up a system of indicators for clinicians, researchers and planners. This paper represents the personal view of the authors, prepared for a conference in August 1992.

Adult↗