Problem solving skills: what effect does education have?
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Effect of sustained mental work on the first stage of mental rotation was studied by the method of intracortical interaction. It was revealed that during sustained mental work the zone of the high level of connections in the alpha-band was considerably reduced due to an increase of specificity, rationality of thinking. In the beta-band the zone of the high connection level moved from the central and parietal areas to the anterior regions because of a switch of intention of the mental work from the spatial analysis to the quick verbalization of the response. Tired subjects in search for a word for the response did not fulfil the spatial analysis of the pictures. Subjects with high working ability searched for the verbal response on the basis of mental operations with images, that turned to be optimal for the mental rotation task solving.
RATIONALE AND OBJECTIVES: Systems-based practice (SBP) has been the most difficult competency to implement in radiology residency programs, and methods for teaching and learning SBP concepts are needed. Because systems problems are usually multifactorial, a multidisciplinary approach is required. In our institution, survey data indicated patient dissatisfaction with emergency care. Prolonged wait times for radiology procedures were identified as a systems problem. When hospital administration asked the emergency medicine and radiology departments to work together to improve patient care, residents had a "real-world" opportunity to achieve the SBP competency. MATERIALS AND METHODS: Systems problems were identified and categorized. Data on patient transport were collected. Accurate time logs documenting when studies were ordered, performed, and interpreted were maintained. Data were analyzed at interdepartmental meetings and three improvements were planned and implemented. RESULTS: A direct line of communication was established between radiology and emergency medicine via a dedicated cellular telephone. A joint emergency medicine/radiology teaching conference was established. Additional transport personnel were employed. Residents in both departments increased their understanding of their role in the health care system, demonstrated an ability to identify systems problems and appropriately implement improvements, and enhanced their professional relationships. CONCLUSION: This innovative method integrated educational goals with patient care goals, was grounded in "real-life" experience, and held residents accountable for results. Competence in SBP, patient care, professionalism, and interpersonal and communication skills were demonstrated. We recommend this approach as an efficient and effective way to integrate SBP into everyday clinical practice.
The author presents case histories that demonstrate an approach to a spectrum of clinical scenarios that have common to them the complaint of insomnia. In the first, the physician is faced with an acute problem with an easily apparent, but superficial, etiology. The use of a benzodiazepine in this instance would be relatively noncontroversial. Its usage, without an exploration of the patient's perceptual frame, including psychosocial factors, would miss potentially important underlying problems. In the second case, the physician's concern about the habituating effects of benzodiazepines could have resulted in the underutilization of their benefits. The third case represents a scenario in which overutilization with resultant habituation was potentially a problem. It becomes apparent that an "either/or" generalization might hinder good patient outcome. Questioning around the symptom for purposes of gathering information regarding the patient's perceptual frame and the consequences of change may be useful in developing treatment strategies.
The successful strategies of second-year medical students were electronically captured from computer-based simulations in immunology and infectious disease and were used to train artificial neural networks for the rapid classification of subsequent students' and experts' strategies on these problems. Such networks could categorize problem solutions of other students as successful or nonsuccessful > 85% of the time. These neural networks, however, performed poorly (as low as 13%) when classifying experienced immunologists' or internists' successful performances, suggesting an ability to distinguish between novice and expert strategies. The neural networks also identified a group of students who framed the infectious disease problems correctly, but had difficulty discriminating between differential diagnoses.
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