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PubMed2003

Learning patterns of online students.

The virtual explosion of online education has prompted questioning of the quality of the learning. In addition, the effect of online learning on learner outcomes is receiving scrutiny. In this study, online students became more independent and self-disciplined as learners. In addition, the students reported they learned to trust their own judgment and delve deeper into the content than they did in traditional lecture-driven courses. The effect of online courses on learning styles is described.

Education, Distance↗

PubMed2004

Lesions of dorsolateral striatum preserve outcome expectancy but disrupt habit formation in instrumental learning.

Habits are controlled by antecedent stimuli rather than by goal expectancy. Interval schedules of feedback have been shown to generate habits, as revealed by the insensitivity of behaviour acquired under this schedule to outcome devaluation treatments. Two experiments were conducted to assess the role of the dorsolateral striatum in habit learning. In Experiment 1, sham operated controls and rats with dorsolateral striatum lesions were trained to press a lever for sucrose under interval schedules. After training, the sucrose was devalued by inducing taste aversion to it using lithium chloride, whereas saline injections were given to the controls. Only rats given the devaluation treatment reduced their consumption of sucrose and this reduction was similar in both the sham and the lesioned groups. All rats were then returned to the instrumental chamber for an extinction test, in which the lever was extended but no sucrose was delivered. In contrast to sham operated controls, rats with dorsolateral striatum lesions refrained from pressing the lever if the outcome was devalued. To assess the specificity of the role of dorsolateral striatum in this effect a second experiment was conducted in which a group with lesions of dorsomedial striatum was added. In relation now to both the sham and the dorsomedial lesioned groups, only rats with lesions of dorsolateral striatum significantly reduced responding after outcome devaluation. In conclusion, this study provides direct evidence that the dorsolateral striatum is necessary for habit formation. Furthermore, it suggests that, when the habit system is disrupted, control over instrumental performance reverts to the system controlling the performance of goal-directed instrumental actions.

Animals↗

PubMed2004

Learning for real life: patient-focused interprofessional workshops offer added value.

OBJECTIVES: This paper reports relevant findings of a pilot interprofessional education (IPE) project in the Schools of Medicine and Healthcare Studies at the University of Leeds. The purpose of the paper is to make a contribution towards answering 2 questions of fundamental importance to the development of IPE. Is there a demonstrable value to learning together? What types of IPE, under what circumstances, produce what type of outcomes? DESIGN: Pre-registration house officers (PRHOs), student nurses and pre-registration pharmacists attended a series of 3 workshops intended to develop participants' understanding about each other's professional roles, to enhance teamworking and to develop communication skills. Evaluation covered the process of development of the workshops, the delivery of the workshops and their effects on both facilitators and participants. RESULTS: The course was well received by the participants. The learning reported by the participants reflected 2 project objectives. Participants emphasised communication skills--both with other professionals and patients--and the development of increased awareness of others' roles. These 2 aspects were interlinked. CONCLUSIONS: The project aims and 2 of the learning outcomes were achieved. There was a demonstrable value to learning together, particularly with regard to interprofessional communications. This project was effective and can make a contribution towards answering the question 'What types of IPE, under what circumstances, produce what type of outcomes?'

Communication↗

PubMed1977

The effects of family presence and brief family intervention on global outcome for hospitalized schizophrenic patients.

Virtually all modern inpatient psychiatric units operate on the assumptions that family presence, when the identified patient has schizophrenia, does affect outcome and that adding brief family intervention to the treatment prescription will enhance hospital and posthospital outcome. Often the family intervention is believed not adequate in terms of duration or frequency or quality (since trainees are the family therapists), given the standards of some experienced family clinicians. This report addresses these issues by comparing outcome measures for hospitalized patients with schizophrenia by (a) presence of a family and (b) amount and/or kind of family intervention. Most importantly, we wished to learn if global outcome would show change by virtue of family therapy (within the constraints imposed by the above limitations of family intervention).

Adolescent↗

PubMedDate not supplied

Teaching electrocardiography: computer assisted learning vs lecture method.

This study investigated nursing students' responses to a basic electrocardiography computer assisted learning (CAL) program and a lecture on the same topic. There were no significant differences between the CAL and lecture groups on cognitive outcomes (measured by a 20 item test on electrocardiogram knowledge) or transfer of learning outcomes (measured in the clinical setting by the students' ability to identify and interpret six electrocardiogram tracings). However, CAL students displayed more positive affective responses. They also took between 10 and 32 minutes to complete the program while all lecture students took a mandatory 50 minutes or more.

Adult↗

PubMed2004

What kind of motivation drives medical students' learning quests?

AIMS: To describe the patterns of medical students' motivation early in the undergraduate programme and to examine their relationships with learning features and motivational outcomes. METHODS: The Academic Motivation Scale (AMS) was administered after the first medical year to 297 students of both sexes from consecutive classes within a 4-year timeframe. Measures of learner orientation and reflection in learning were also obtained. Academic achievement and peer tutoring experience were recorded during a 2-year follow-up. Quantitative approaches included analysis of variance, correlational and classificatory analyses of the data. RESULTS: The profile of the students' responses revealed higher levels of autonomous motivation than of controlled motivation although such measures were positively related. Correlation analysis showed significant association of autonomous motivation with higher levels of meaning orientation, reflection in learning, academic achievement, cross-year peer-tutoring experience, and intention to continue with studies. Classificatory analysis identified 4 student groups with distinct patterns of motivation. Analysis of variance revealed significant and consistent differences in learning features and outcomes among such groups. CONCLUSIONS: The findings indicate that medical students portray distinct patterns of autonomous and controlled motivation that seem to relate to the learners' frame of mind towards learning as well as the educational environment. Autonomous motivation had closer relationships than controlled motivation with measures of self-regulation of learning and academic success in the context of a demanding medical programme.

Achievement↗

PubMed2003

Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve.

OBJECTIVE: Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon's 'learning curve'. We examined trends in patient selection over time as a single surgeon's practice evolved to routine OPCAB. METHODS: Between 10-1-96 and 12-31-01, 1479 consecutive patients had isolated coronary artery bypass grafting (CABG). Clinical data were gathered prospectively and reviewed retrospectively. Trends in adoption of OPCAB and clinical outcomes were examined. RESULTS: There were 756 OPCAB and 723 CABG/cardiopulmonary bypass patients. The practice evolved from 90% conventional CABG to 93% OPCAB. An abrupt transition coincided with evolution of techniques to expose the obtuse marginal arteries, and improvements in suction-based coronary stabilizers. Mortality was 1.0% for the off-pump group and 2.1% for the on-pump group. Careful patient selection helped maintain acceptable outcomes during the 'learning curve'. Patients with depressed left ventricular ejection fraction, left main disease, and complex three vessel disease were excluded from OPCAB until significant experience (>200 cases) was attained. Presently, all isolated coronary bypass cases are candidates for OPCAB except patients with ischemic ventricular arrhythmias, those in cardiac arrest, and those for whom previous left pneumonectomy or deep pectus excavatum prevent rightward mobilization of heart. CONCLUSIONS: Despite a significant learning curve, evolution to routine OPCAB can be achieved while maintaining good patient outcomes. The development of specialized techniques, coronary stabilizers, and apical suction devices allows the application of OPCAB to virtually all coronary bypass patients, as surgeon experience matures.

Aged↗

PubMed2004

Habit learning in Tourette syndrome: a translational neuroscience approach to a developmental psychopathology.

BACKGROUND: The etiology of Tourette syndrome (TS) involves disturbances in the structure and function of the basal ganglia. The basal ganglia mediate habit learning. OBJECTIVE: To study habit learning in persons with TS. DESIGN: Patients with TS were compared with normal controls in performance on a probabilistic classification, or habit-learning task (weather prediction). SETTING: University research institute. PARTICIPANTS: One hundred twenty-three children and adults, 56 with a diagnosis of TS and 67 healthy control subjects. MAIN OUTCOME MEASURES: Habit learning was assessed by the extent of improvement in accuracy of predictions and reaction times over trial blocks during performance of the weather prediction task. Declarative learning was assessed by performance on 3 tasks that required intact declarative memory functioning. RESULTS: Children with TS were impaired at habit learning relative to normal controls (P = .01). This finding was replicated in the independent sample of adults with TS (P = .01). The rate of learning correlated inversely with the severity of tic symptoms across both samples (r = -0.34; P = .01). Thus, impaired learning accompanied more severe symptoms. Measures of declarative memory functioning, in contrast, were normal in the TS groups. CONCLUSIONS: Striatal learning systems are uniquely dysfunctional in both children and adults with TS. The correlation of habit learning with symptom severity suggests that the number and severity of tics are a function of the degree to which the system for habit learning is dysfunctional. Thus, both the deficits in habit learning and the tic symptoms of TS are likely to be consequences of the previously reported anatomical and functional disturbances of the striatum in children and adults who have TS. The existence of a well-developed animal model for this learning system, which permits study of the neural and molecular bases of habit learning, has important implications for the neurobiological study of TS and for the development of new or improved therapeutics for this condition.

Attention Deficit Disorder with Hyperactivity↗

PubMed2000

Moving home: costs associated with different models of accommodation for adults with learning disabilities.

This paper reports on variation in the cost and social outcomes of provision for clients with learning disabilities, resettled across different models of community accommodation; identifying personal and service-related characteristics influential on such variation. The study was conducted to inform the community reprovisioning strategy associated with the phased closure of the Gogarburn and Tornaveen learning disability hospitals in the Lothian region, Scotland. Total mean service costs, quality of life and community integration outcome data were collected and compared. Total mean service costs ranged between pound16 438 and pound74 097 per year (mean pound42 023; SD = pound16 712). Cost estimates varied by age and dependency group, with costs for elderly clients comparatively low. Overall, there was an inverse relationship between total mean costs and size of accommodation. There was no evidence of a direct relationship between costs and changes in social outcomes. Services with the lowest mean costs were, however, associated with the smallest increases in social outcomes. The most expensive services did not realise proportionally greater gains in social outcomes. The paper concludes that clients generally benefited from the transition from hospital to community accommodation. However, some experienced better outcomes than others. In the absence of a clear link between levels and type of resource use and social outcomes, it is difficult to identify which service features are more or less efficacious in achieving positive outcomes. Broader evaluation perspectives, embracing a fuller range of costs and benefits, will be required to unpack exactly what it is about different models of community care provision that leads to positive outcomes, or otherwise, for learning disability clients. A more sound evidence base is required before effective strategies can be designed to ensure that key policy outcomes are realised and social integration truly achieved.

Journal Article↗

PubMed2001

Implicit sequence learning with competing explicit cues.

Previous research has shown that the expression of implicit sequence learning is eliminated in a choice reaction time task when an explicit cue allows participants to accurately predict the next stimulus (Cleeremans, 1997), but that two contingencies predicting the same outcome can be learned and expressed simultaneously when both of them remain implicit (Jiménez & Méndez, 1999). Two experiments tested the hypothesis that it is the deliberate use of explicit knowledge that produces the inhibitory effects over the expression of implicit sequence learning. However, the results of these experiments do not support this hypothesis, rather showing that implicit learning is acquired and expressed regardless of the influence of explicit knowledge. These results are interpreted as reinforcing the thesis about the automatic nature of both the acquisition and the expression of implicit sequence learning. The contradictory results reported by Cleeremans are attributed to a floor effect derived from the use of a special type of explicit cue.

Cognition↗

PubMed2001

Distance learning in the health professions: on the verge of collapse or poised to soar?

Distance education provides universal access to education. While the issue of access to education is seemingly resolved, the question "what is the best way to teach?" remains. Thomas Jefferson espoused the creation of the academic village to foster broad, intensive scholarship. John Dewey, Ralph W. Tyler, Malcolm S. Knowles, and Alexander W. Astin echo Jefferson's ideals. To ensure excellence in distance learning, a disciplined rethinking of teaching and a reordering of academic priorities is essential. If consumer confidence in the academy is to be restored, there must be a return to collegial leadership in: defining institutional purpose and resource commitment, improving teacher competence, honing curricular content, perfecting interactive learning, selecting students, and designing outcome measures for both teaching and learning. Then, and only then, will distance learning be ready for "prime time."

Allied Health Personnel↗

PubMed2005

Nucleus accumbens core lesions retard instrumental learning and performance with delayed reinforcement in the rat.

BACKGROUND: Delays between actions and their outcomes severely hinder reinforcement learning systems, but little is known of the neural mechanism by which animals overcome this problem and bridge such delays. The nucleus accumbens core (AcbC), part of the ventral striatum, is required for normal preference for a large, delayed reward over a small, immediate reward (self-controlled choice) in rats, but the reason for this is unclear. We investigated the role of the AcbC in learning a free-operant instrumental response using delayed reinforcement, performance of a previously-learned response for delayed reinforcement, and assessment of the relative magnitudes of two different rewards. RESULTS: Groups of rats with excitotoxic or sham lesions of the AcbC acquired an instrumental response with different delays (0, 10, or 20 s) between the lever-press response and reinforcer delivery. A second (inactive) lever was also present, but responding on it was never reinforced. As expected, the delays retarded learning in normal rats. AcbC lesions did not hinder learning in the absence of delays, but AcbC-lesioned rats were impaired in learning when there was a delay, relative to sham-operated controls. All groups eventually acquired the response and discriminated the active lever from the inactive lever to some degree. Rats were subsequently trained to discriminate reinforcers of different magnitudes. AcbC-lesioned rats were more sensitive to differences in reinforcer magnitude than sham-operated controls, suggesting that the deficit in self-controlled choice previously observed in such rats was a consequence of reduced preference for delayed rewards relative to immediate rewards, not of reduced preference for large rewards relative to small rewards. AcbC lesions also impaired the performance of a previously-learned instrumental response in a delay-dependent fashion. CONCLUSIONS: These results demonstrate that the AcbC contributes to instrumental learning and performance by bridging delays between subjects' actions and the ensuing outcomes that reinforce behaviour.

Animals↗

PubMed2004

A failure of sleep-dependent procedural learning in chronic, medicated schizophrenia.

BACKGROUND: Schizophrenia patients have difficulty mastering even rote procedural tasks in rehabilitation settings. Although most studies demonstrate intact procedural learning in schizophrenia, recent findings demonstrate that a critical component of procedural learning is dependent on sleep. This study tested the hypothesis that patients with schizophrenia have a deficit in sleep-dependent procedural learning. METHODS: Using a simple, well-characterized test of motor skill learning, the finger tapping motor sequence task (MST), 26 patients with chronic, medicated schizophrenia and 14 demographically matched healthy control subjects were tested on two occasions, 24 hours apart. The main outcome measures were learning of the MST on day 1 (practice-dependent learning) and overnight, sleep-dependent improvement in performance. RESULTS: Although schizophrenia patients and control subjects did not differ in practice-dependent learning, patients failed to show overnight improvement (4% deterioration) and differed significantly from control subjects who showed a significant 11% improvement. CONCLUSIONS: We present here the first demonstration of a failure of sleep-dependent consolidation of procedural learning in chronic, medicated schizophrenia. This deficit occurred in the context of normal practice-dependent learning within a training session. This behavioral dissociation is consistent with evidence that practice- and sleep-dependent motor learning reflect independent processes and suggests that they are differentially affected in schizophrenia.

Adult↗

PubMed2026

Comparative effectiveness of game-based learning modalities in nursing and medical education: a systematic review and Bayesian network meta-analysis.

BACKGROUND: Game-based learning (GBL) is increasingly used in healthcare education, but educators must choose among diverse modalities (e.g., quiz platforms, apps, serious games and metaverse environments). Comparative evidence on which modalities perform best across learning domains (knowledge, attitudes, and practice) remains limited. AIM: To compare the effects of distinct GBL modalities on knowledge, attitudes, and practice outcomes in nursing and medical education and to explore whether comparative effects differ by learner group (pre-licensure students and in-service professionals). DESIGN: PRISMA-NMA-aligned systematic review and Bayesian network meta-analysis. METHODS: We searched eight databases and trial registries through September 2, 2024, for randomized controlled trials comparing GBL with traditional teaching (TT). Outcomes were transformed to a 0-100 scale and analysed as change from baseline in Bayesian consistency models; random-effects models were selected using deviance information criterion (DIC). Risk of bias was assessed using RoB 2. We report mean differences (MDs) with 95% credible intervals (CrIs) versus TT, ranking probabilities, and subgroup NMAs by learner group. RESULTS: Thirty-one RCTs (n = 3439) were included; 15 contributed complete data to the network. Risk of bias was low in 15 trials and raised some concerns in 16. The network was modest for knowledge (11 trials) and sparse for attitudes (3) and practice (4). Compared with TT, metaverse-based learning showed improved attitudes (MD 15; 95% CrI 12 to 18), based on a single trial. For knowledge and practice, Kahoot-based quizzes (MD 9.1; 95% CrI -8.9 to 27) and app-based learning (MD 4.6; 95% CrI -4.4 to 14) had the highest estimated mean improvements, but credible intervals were wide and included the null for most comparisons. Subgroup rankings differed by learner group, but several comparisons were imprecise and uncertainty was substantial, particularly in sparse networks. CONCLUSIONS: GBL modalities may improve learning outcomes compared with TT, but relative effects appear domain-specific and the certainty of rankings is limited by sparse evidence and imprecision. Future trials should prioritise head-to-head comparisons, robust outcome measurement, and longer-term retention and transfer outcomes in both student and in-service populations.

Humans↗

PubMed2002

Do left ventricular assist device (LVAD) bridge-to-transplantation outcomes predict the results of permanent LVAD implantation?

BACKGROUND: Implantable left ventricular assist devices (LVADs) were designed for permanent implant, but we began their use for bridge-to-transplant (BTTx) to study their safety and effectiveness. We review our experience in order to compare the BTTx lessons learned with the outcomes and goals of permanent implants. METHODS: From December 1991 until January 2002, 264 patients received 277 LVADs for BTTx. We analyzed temporal trends in pre-LVAD patient factors and device-specific time-related complications. RESULTS: Survival to transplant was 69%. Adverse event analysis demonstrated a high risk of infections (0.56, 1.28, and 1.88 per patient at 30 days and 3 and 6 months). HeartMate devices were more prone to infection than Novacor devices (p < 0.0001). Cerebral infarctions occurred less commonly than infections (0.15, 0.25, 0.30 at 30 days and 3 and 6 months), were more common in Novacor than HeartMate (p = 0.0001), and were decreased by the new Novacor Vascutek conduit (p = 0.07), but these were still slightly higher than the HeartMate (p = 0.04). Device failures occurred in 21 instances (all but one were in HeartMate devices [p = 0.04 vs Novacor]), but have significantly decreased (p < 0.0001) in HeartMate since 1998. CONCLUSIONS: Infections and device durability limit the chronic use of the HeartMate device, but device failures are decreasing. Novacor has fewer problems with infection and durability, and the new Vascutek conduit will reduce, but not eliminate, strokes.

Cerebral Infarction↗

PubMed2001

Long-term affective disorder in people with mild learning disability.

BACKGROUND: Increased risk of affective disorder in learning disability has been reported, although the extent to which this is due to adverse social and material circumstances is uncertain and there have been potential limitations in the measurement of affective disorder. AIMS: To determine risk of affective disorder in those classified with mild learning disability in the British 1946 birth cohort and to investigate whether this risk was accounted for by disadvantage in childhood and adulthood. METHOD: Learning disability was defined as the equivalent of an IQ < or =69 at age 15 years. The Present State Examination at age 36 years and the Psychiatric Symptom Frequency Scale at age 43 years provided psychiatric outcome measures. RESULTS: Learning disability was associated with a fourfold increase in risk of affective disorder, not accounted for by social and material disadvantage or by medical disorder. CONCLUSIONS: Learning disability is strongly associated with risk of affective disorder, persisting well into midlife.

Adolescent↗

PubMedDate not supplied

Teaching portfolios: an effective strategy for faculty development in occupational therapy.

The special challenge of the occupational therapy practitioner embracing the role of faculty member is discovering a formative process of continual improvement that will also serve as an authentic assessment of teaching and learning within the particular disciplinary boundaries of occupational therapy. Although other means achieve such complex aims, the teaching portfolio is a powerful tool for fostering reflective practice and for creating an ongoing record of substantial evidence. A teaching portfolio is an evidence-based written document in which a faculty member, working in collaboration with a mentor, concisely organizes selective details of teaching accomplishment and effort and uses such information to document his or her teaching enterprise. More importantly, the faculty member uses the information for reflective analysis, leading to improvement of teaching and student learning. The emphasis on reflection, analysis, evidence, and mentoring suggests that the teaching portfolio can set the stage for meaningful collaboration in a system of evaluation that is based appropriately on recorded evidence of improvement and demonstrated positive outcomes of student learning.

Documentation↗

PubMed1998

Learning with technology: use of case-based physical and computer simulations in professional education.

This paper describes a multimedia technology project in midwifery education and how it is being developed to improve student learning experiences and outcomes. The role of the university providing quality education relevant to today's world and professional practice is emphasised. A collaborative (Royal Melbourne Institute of Technology and Australian Catholic University) interdisciplinary project 'Pregnancy Simulator: Developing and Enhancing Student Learning of Pregnancy Assessment Skills' was developed with university and direct Commonwealth support. This project consists of a physical simulation of a pregnant woman at term and case-based multimedia computer simulations designed to develop and enhance student learning of abdominal assessment skills. A key feature of the development has been to design a learning experience explicitly on an authoritative theory-based view of teaching, in this case Diana Laurillard's 'Conversational Framework'.

Computer Simulation↗