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PubMed1989

The effects of scopolamine and clonidine upon the performance and learning of a motor skill.

Twenty-eight subjects practised a task involving procedural knowledge in which a moving target has to be followed for two 3-min sessions. They were then randomly allocated to receive an IV injection of 0.4 mg scopolamine, 0.15 mg clonidine or saline. General impairment due to both active treatments was seen 20 min later in significantly decreased tracking performance. Subjects then had to learn a mirror-reversed version of the tracking task. This involved acquiring novel procedural knowledge. Subjects who had either saline or clonidine treatment showed rapid temporary improvements and also considerable permanent learning. Subjects treated with scopolamine, however, showed only slow temporary improvement and little permanent improvement in their performance at this task. This result suggests that a normally functioning cholinergic system is necessary not only for an efficient working memory but also for the long term acquisition of some kinds of procedural knowledge.

Adolescent↗
PubMedDate not supplied

Critical care clinical experience for novice students: reinforcing basic nursing skills.

To better match students' learning priorities with their practicum experiences and to facilitate skills learning, undergraduate faculty devised the innovative strategy of incorporating a critical care rotation into the first semester of students' clinical experience. The authors describe the basics of this previously untested critical care clinical experience and the essential planning steps prior to implementation, including faculty approval, hospital administrative and nurse manager approval, preceptor identification and education, means of evaluating and grading the students, and evaluation of the overall experience.

Attitude of Health Personnel↗
PubMed1980

Preserved learning and retention of pattern-analyzing skill in amnesia: dissociation of knowing how and knowing that.

Amnesic patients acquired a mirror-reading skill at a rate equivalent to that of matched control subjects and retained it for at least 3 months. The results indicate that the class of preserved learning skills in amnesia is broader than previously reported. Amnesia seems to spare information that is based on rules or procedures, as contrasted with information that is data-based or declarative--"knowing how rather than "knowing that." The results support the hypothesis that such a distinction is honored by the nervous system.

Alcohol Amnestic Disorder↗
PubMed2004

The effect of a 13-hour curriculum to improve residents' teaching skills: a randomized trial.

BACKGROUND: Although resident physicians often teach, few trials have tested interventions to improve residents' teaching skills. A pilot trial in 2001-2002 found that 13 trained resident teachers taught better than did untrained control residents. OBJECTIVE: To determine whether a longitudinal residents-as-teachers curriculum improves residents' teaching skills. DESIGN: Randomized, controlled trial from May 2001 to February 2002 (pilot trial) and March 2002 to April 2003. SETTING: 4 generalist residencies affiliated with an urban academic medical center. PARTICIPANTS: 62 second-year residents: 23 in the 2001-2002 pilot trial and 39 more in 2002-2003; 27 of the 39 participants were medicine residents required to learn teaching skills. INTERVENTION: A 13-hour curriculum in which residents practiced teaching and received feedback during 1-hour small-group sessions taught twice monthly for 6 months. MEASUREMENTS: A 3.5-hour, 8-station, objective structured teaching examination that was enacted and rated by 50 medical students before and after the intervention. Two trained, blinded raters independently assessed each station (inter-rater reliability, 0.75). RESULTS: In the combined results for 2001-2003, the intervention group (n = 33) and control group (n = 29) were similar in sex, specialty, and academic performance. On a 1 to 5 Likert scale, intervention residents outscored controls on overall improvement score (post-test-pretest difference, 0.74 vs. 0.07; difference between intervention and control groups, 0.68 [95% CI, 0.55 to 0.81]; P < 0.001) by a magnitude of 2.8 standard deviations and on all 8 individual stations. The intervention residents improved 28.5% overall, whereas the scores of control residents did not increase significantly (2.7%). In 2002-2003, 19 intervention residents similarly outscored 19 controls (post-test-pretest difference, 0.83 vs. 0.14; difference between intervention and control groups, 0.69 [CI, 0.53 to 0.84]; P < 0.001). Twenty-seven medicine residents required to learn teaching skills achieved scores similar to those of volunteers. LIMITATIONS: The study was conducted at a single institution. No "real life" assessment with which to compare the results of the objective structured teaching examination was available. CONCLUSIONS: Generalist residents randomly assigned to receive a 13-hour longitudinal residents-as-teachers curriculum consistently showed improved teaching skills, as judged by medical student raters. Residents required to participate improved as much as volunteers did.

Curriculum↗
PubMed2001

Transfer of training in acquiring laparoscopic skills.

BACKGROUND: Building on skills already learned in acquiring more complex or related skills is termed transfer of training (TOT). This study examined the TOT effects of previous open and laparoscopic surgical experience on a laparoscopic training module. STUDY DESIGN: Intracorporeal knot tying was chosen for evaluating TOT among three groups of surgical residents: interns (n = 11) with limited open and laparoscopic surgical experience, junior residents (n = 9) with recent and ongoing open and laparoscopic surgical experience, and senior residents (n = 8) with remote and limited laparoscopic experience but ongoing open surgical experience. After receiving a lecture, demonstration, and written instructions on three knot-tying techniques, residents rotated through three performance stations, one for each technique, over 2 days. After 15 minutes of practice, the residents were videotaped completing a test knot. Time to completion and economy of motion were recorded and analyzed. RESULTS: Junior residents had fewer performance errors than senior residents (reported as mean +/- standard error of the mean) and were significantly faster than interns. No significant differences between interns and senior residents for mean time or error performance were observed. Senior residents did not demonstrate TOT from open surgical experience to laparoscopic knot tying. No significant differences were obtained across the three sessions for errors or for time. CONCLUSION: No evidence was found for TOT from open surgical experience to newly introduced laparoscopic knot-tying techniques or from one skill training session to a different skill session at least 4 hours later. This study indicates that specific minimally invasive surgery training is needed to develop laparoscopic surgery skills.

Clinical Competence↗
PubMed2000

Social determinants of (un)healthy behaviors.

Medical education has historically relied on the rational choice model as a vehicle for promoting health behavior change, and has largely overlooked the powerful relationships between social class and health behaviors. The rational choice model, which assumes that people can choose to pursue behaviors that are needed for their health, has some clinical utility, especially in some circumstances, but it runs the risk of missing key sources of influence and of blaming the victim. The biopsychosocial model provides an alternative basis for teaching about health behavior change. Health behavior needs to be understood in a broad social context, in which social class is recognized as playing a large part in shaping many people's health behaviors through multiple pathways, including limited opportunities for self-fulfillment, financial constraints, health beliefs, self-efficacy, stress, and social support. In addition to highlighting the limitations of the rational choice model, we illustrate how to integrate the socio-cultural context into teaching about behavior change. Specific curricular suggestions include exercises for: (1) increasing students' awareness of their own biases regarding unhealthy behaviors and individual responsibility for change; (2) enhancing knowledge of social factors that impact health; (3) building advocacy skills; (4) learning from patients; and (5) practicing counseling skills through role-plays.

Journal Article↗
PubMed2005

Teaching and learning end-of-life care: evaluation of a faculty development program in palliative care.

PURPOSE: To evaluate the effectiveness of the Program in Palliative Care Education and Practice (PCEP), an intensive faculty development program at Harvard Medical School. METHOD: PCEP is a two-week program offered annually with two on-site sessions in Boston, MA, and an interim period distance-learning component. Training integrates palliative care clinical skill development, learning theory and teaching methods, and leadership and organizational change. Longitudinal surveys (preprogram, retrospective preprogram, and postprogram) of participants from 2000-03 assessed self-reported preparation in providing and teaching palliative care; teaching and patient care practices; and satisfaction with program. RESULTS: The response rate was 96% (n=149) for Session I and 72% for both Session I and II (n=113). Questionnaire responses demonstrated statistically significant improvements with large effect sizes (range 0.7-1.8) on nearly all measures. Preparation increased from 3.0+/-1.1 to 4.2+/-0.7 for providing end-of-life care (1=not well prepared, 5=very well prepared), and from 2.6+/-1.0 to 4.3+/-0.7 for teaching this topic. Respondents reported behavioral changes in patient care and teaching; e.g., after the program, 63% noted that, specifically as a result of attending the course, they encouraged learners to reflect on their emotional responses to dying patients, and 57% conducted experiential exercises (e.g., role-play). Eighty-two percent rated the experience as "transformative," and many responses to open-ended items described powerful learning experiences. Participants rated the program highly (4.9+/-0.1, 1=lowest, 5=highest rating). CONCLUSIONS: Integrating clinical content with learning about educational methods is an efficient and effective approach to enhancing clinical faculty's capacity to model and teach clinical care. This program offers an educational model that engages practitioners, stimulates changes in practice, and offers opportunities for reflection and professional revitalization.

Academic Medical Centers↗
PubMed2003

Adaptation to stable and unstable dynamics achieved by combined impedance control and inverse dynamics model.

This study compared adaptation in novel force fields where trajectories were initially either stable or unstable to elucidate the processes of learning novel skills and adapting to new environments. Subjects learned to move in a null force field (NF), which was unexpectedly changed either to a velocity-dependent force field (VF), which resulted in perturbed but stable hand trajectories, or a position-dependent divergent force field (DF), which resulted in unstable trajectories. With practice, subjects learned to compensate for the perturbations produced by both force fields. Adaptation was characterized by an initial increase in the activation of all muscles followed by a gradual reduction. The time course of the increase in activation was correlated with a reduction in hand-path error for the DF but not for the VF. Adaptation to the VF could have been achieved solely by formation of an inverse dynamics model and adaptation to the DF solely by impedance control. However, indices of learning, such as hand-path error, joint torque, and electromyographic activation and deactivation suggest that the CNS combined these processes during adaptation to both force fields. Our results suggest that during the early phase of learning there is an increase in endpoint stiffness that serves to reduce hand-path error and provides additional stability, regardless of whether the dynamics are stable or unstable. We suggest that the motor control system utilizes an inverse dynamics model to learn the mean dynamics and an impedance controller to assist in the formation of the inverse dynamics model and to generate needed stability.

Adaptation, Physiological↗
PubMed2005

Evaluation of student attitudes to cooperative learning in undergraduate veterinary medicine.

RATIONALE FOR THE STUDY: Recent studies have demonstrated that collaborative or cooperative learning (CL) provides students and teachers with a variety of advantages over traditional instructional methods. To explore the possibility of introducing CL into the veterinary undergraduate curriculum on a larger scale-to facilitate the development of professional competencies-a cooperative learning assignment (CLA) was introduced into the fourth year Bachelor of Veterinary Medicine and Surgery (BVMS) degree course at the University of Glasgow. An evaluation was carried out as a basis for optimizing subsequent CL activities in the undergraduate course. METHODOLOGY: Evaluation of student attitudes to the CLA was conducted using pre- and post-task questionnaires and a focusgroup discussion involving student representatives from several of the small groups. Quantitative questionnaire data were imported into SPSS and a statistical test was used to identify any significant shifts in student attitudes. RESULTS AND CONCLUSIONS: Analysis of the quantitative questionnaire results indicates that students-who regarded themselves generally as team players rather than competing individuals-had few concerns before or after the CLA. There were some significant shifts (negative and positive) in response to some of the questions, but generally the results were encouraging. However, a number of issues emerged from the focus-group discussion with regards to the administration of CL and matching students' expectations to their experiences. In particular, students need to be adequately informed at the outset about the CL process and about how it will be assessed, have access to the required facilities, and be comfortable with learning different skills sets from those their peers are learning. Staff facilitators require adequate guidance on what they are expected to contribute to the CL process.

Animal Welfare↗
PubMed1996

Association between eye dominance and training for rifle marksmanship: a pilot study.

BACKGROUND: This pilot study was performed to determine the effect, if any, exerted by crossed dominance (contralateral hand and eye dominance) on the ability of novice riflemen to learn how to accurately shoot a rifle. METHODS: Sighting dominance was used to determine the dominant eye. Hand dominance was determined by the arm used to shoulder the rifle in the shooting position. Subjects were 308 military recruits at the Fort Benning Army Base in Columbus, Georgia, who had undergone basic training in rifle marksmanship. Qualification scores obtained at the base rifle range were used to measure the subjects' ability to learn marksmanship skills. RESULTS: The subjects with right-hand/right-eye and left-hand/left-eye (uncrossed) dominance had qualification scores that were significantly higher (p = .009) than the subjects with right hand/left-eye and left-hand/right-eye (crossed) dominance. A significantly higher percentage of subjects with uncrossed dominance achieved rifle qualification (86.1 percent) than subjects with crossed dominance (56.5 percent) (p = .000). CONCLUSIONS: The learning of rifle marksmanship is influenced by eye dominance. Individuals who shoot right handed and are left-eye dominant or who shoot left handed and are right-eye dominant do not learn marksmanship skills as readily as individuals who have matched eye and hand dominance. Since crossed hand and eye dominance can be easily determined, it should be possible to identify cross dominant individuals and provide them with special training so that they can perform at a higher level of skill.

Firearms↗
PubMedDate not supplied

Mothers' perceptions of parenting children with disabilities.

PURPOSE: To describe how mothers of children with physical disabilities identified their parenting strengths and weaknesses, encouraged their child's social skills and learning, nurtured and disciplined their child, and perceived their parenting successes and problems. DESIGN: Grounded theory. METHODS: Focused telephone interviews were conducted with mothers of preschool to elementary schoolage children with mild to moderate physical disabilities. The mothers were asked what they were doing well and "not well" in parenting their disabled child, their difficulties, their child's preparation for other children's questions/teasing, their encouragement of social skills and learning, and their discipline and nurturance. RESULTS: The theory that emerged from the data was parental straddling, which occurred on three levels. Parents were living in the past and the present, striving to view their child as "normal" when, in fact, the child was disabled, and were simultaneously dealing with their own and their child's issues and feelings. CLINICAL IMPLICATIONS: Nurses need to understand the complexity of the parents' straddling their roles and tasks. They can provide needed emotional support by allowing parents to express their fears and feelings in an atmosphere of nonjudgmental acceptance. Nurses can prepare parents for anticipated grief work, reassure them that their experiences are expected and normal, reinforce their use of normalization strategies, and help them separate their own from their child's issues and feelings.

Adaptation, Psychological↗
PubMed1998

Efficacy outcome and sex difference in learning of hypermedia programming skills.

86 occupational therapy students participated in a 20-hr, training course in hypermedia programming for selecting functions for development of rehabilitation software. Analyses showed that the training program significantly enhanced their self-efficacy in development of software for clinical practice. The students generally showed a positive attitude towards the feasibility and significance of applying hypermedia programming in occupational therapy, but no significant sex difference in programming self-efficacy was found.

Adolescent↗
PubMed2002

Improving learning of a clinical skill: the first year's experience of teaching endotracheal intubation in a clinical simulation facility.

BACKGROUND: All medical practitioners should be able to manage the airway of an unconscious patient. Endotracheal intubation is the most effective method of securing the airway but is a complex skill requiring much practice. Traditionally, endotracheal intubation has been taught on patients, but this is not ideal. METHODS: We have developed a short course on endotracheal intubation taught in a clinical simulation unit (CSU). This unit has a large range of airway trainers and patient simulators, some of which can be manipulated to make intubation more difficult. Endotracheal intubation is taught in a series of steps in order to avoid cognitive overload. Each step is taught on an airway trainer that has no difficult features. Once this is mastered, more difficult situations are presented which require application of new techniques and/or equipment. In this way, students learn useful schemas to apply clinically. RESULTS: In 1 year, over 100 students and trainees were taught endotracheal intubation in the CSU. The ideal group size was found to be two students and one trainer. It took 75 to 90 minutes for most students to reach a standard where they could be expected to safely perform the technique on a patient. All comments on learning endotracheal intubation in this setting were positive. Many students felt more comfortable learning on a model than on a patient. CONCLUSION: Learning clinical procedures on simulators is becoming an essential part of medical education. More than one airway trainer may be needed to give students the expertise to perform endotracheal intubation on patients.

Clinical Competence↗
PubMed1999

The clinical skills resource: a review of current practice.

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK. Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency. The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors. The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research. The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.

Clinical Competence↗
PubMed2000

Modernizing the journal club.

Traditionally journal clubs provide a forum to learn presentation skills. We propose a new approach to teaching and learning in journal clubs, focusing on literature acquisition and critical appraisal skills. This approach will enable trainees to use journal clubs for personal professional development as well as for application of new knowledge in clinical medicine to improve patients' outcomes.

Education, Medical, Continuing↗