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PubMed2006

Educational challenges of international medical graduates in psychiatric residencies.

Suggestions have been made on how to meet the educational challenges of international medical graduates (IMGs) such as learning to do psychodynamic psychotherapy. These suggestions include providing more structured instruction with explicit feedback. More demonstration of interviewing by faculty and more opportunity to do practice interviews are necessary. Language, slang, and accent reduction training needs to be incorporated into the training program. Courses in American culture are essential for IMGs. Focusing on board preparation with special courses might well improve pass rates. Including psychological theory from the start of the residency and discussing the psychological aspects of the doctor-patient and staff encounters in many clinical settings will place the psychological issues on a sounder footing. IMGs could benefit from having a mentor available to discuss both personal and professional issues.

Curriculum↗
PubMed1994

[Generation effect on implicit and explicit memory tasks: influence of instructions and proportion overlap of lists].

The proportion of the words that were common to the study phase and the test phase was manipulated in two experiments. Subjects previously studied either 20% or 80% of the words appearing in the test. In Experiment 1, the subjects performed a word fragment completion test. In the 20% condition, reading words produced more priming than generating words. In the 80% condition, however, generating words produced priming as much as that of the 20% condition. Experiment 2 examined this proportion overlap effect on fragment cued recall test. The generation effect was observed in the 80% condition, but not in the 20% condition. These findings indicate that performance on memory tests is determined by the manipulations of both encoding and retrieval conditions.

Adult↗
PubMed1999

[Coding specificity of orthogonal S-R compatibility].

According to Weeks and Proctor (1990), stimulus-response compatibility effects with vertically oriented stimuli and horizontally oriented responses are a result of coding stimuli and responses with respect to their salient features. The corresponding asymmetries in salience are assumed to hold for both verbal and spatial codes. In contrast, Umiltá (1991) argued that these effects are restricted to verbal coding. Experiment 1 tested the coding specificity of the orthogonal compatibility effect by instructing the S-R mapping either verbally or pictorially, varying the stimulus-response mapping unpredictably within experimental blocks. In Experiment 2, the sequences of trials with changed and unchanged mappings were controlled more extensively. Experiment 3 employed incomplete instructions by explicitly denoting the mapping of one stimulus to one response only. The results of Experiments 1 and 2 are consistent with the assumption of a verbal mediation of the orthogonal compatibility effect under investigation, whereas Experiment 3 shows that it is not verbal coding as such that is responsible for the occurrence of the effect.

Adult↗
PubMed1982

Cigarette smoking and duodenal coating with barium.

A review of two hundred and fifty-eight double contrast barium meal examinations was carried out in a single blind study of the relationship between smoking and the ability to visualize gastric and duodenal mucosal detail. A strong correlation was found between poor duodenal visualization and smoking in the period immediately prior to the examination. Patient compliance with a typed instruction sheet forbidding smoking was found to be poor. It may be possible to improve compliance by including, in the written instructions, an explicit statement that smoking shortly before barium meal examination may cause lesions to be missed.

Barium Sulfate↗
PubMedDate not supplied

[The situational diagnosis of the medical units of Petróleos Mexicanos].

The Medical Service Management of Petróleos Mexicanos developed a situational diagnosis of 30 medical units in 1992. This evaluation covered 94 per cent of the institutional population. The basis for this evaluation was a formulary with more than 70 per cent closed questions and instructions with explicit explanations about them. The main points that the formulary investigated were: geography, demography, sociocultural and economics aspects, epidemiology, morbidity, mortality, preventive medicine, service availability and others. With this situational diagnosis we have been able to identify the main problems with a possible solution, presented in terms of planning, organization and execution of actions.

Diagnostic Services↗
PubMed1995

Disulfiram (antabuse) contracts in treatment of alcoholism.

Although studies repeatedly demonstrate that alcoholics who consistently take disulfiram experience more favorable drinking outcomes, serious problems with compliance among the majority of alcoholic patients have reduced the effectiveness of disulfiram as a therapeutic adjunct. In general, alcoholism counseling with disulfiram simply prescribed seems no more effective than counseling without disulfiram (Fuller et al. 1986). Problems with compliance as well as problems with acceptance by patients and likely by clinical staff reduce the utility of disulfiram in the treatment of alcoholism. Implants, incentives, and various forms of observed or supervised disulfiram have been studied as possible solutions to the problems with compliance. Disulfiram implants appear largely ineffective due to failure to release adequate levels of disulfiram and risks of surgical complications and rejection. Newer techniques (see Allen and Litten 1992) may ultimately lead to a more effective implant. Incentives with personally relevant and obvious reinforcement value such as money, avoidance of incarceration, remaining employed, and continuation of methadone for opiate addicts, have been used effectively. Enhancement strategies with less tangible incentives also show promise. Among these are feedback on results of biochemical measures of disulfiram compliance and continuation in a familiar treatment program. Although each of the studies of incentives suffers from specific methodological limitations, the findings uniformly demonstrate better disulfiram compliance, less drinking, and better clinical outcomes for those who received a meaningful incentive for taking disulfiram. External monitoring of the patient taking disulfiram to assure compliance is typically used in studies evaluating incentives for taking the medication. Observed or supervised disulfiram in its own right and without tangible incentives also has received increasing attention as a method for enhancing compliance. Incorporation of such a strategy would seem to have potential for wide applicability in alcoholism treatment programs. Three forms of supervised disulfiram have been studied: (1) a written disulfiram contract, such as in BMT, with instructions about the benefits of the disulfiram contract and methods to establish disulfiram use as a daily habit and specifying that the alcoholic will take disulfiram daily while the spouse observes, that the couple will mutually thank each other, and that they will refrain from arguments or discussions about the alcoholic's drinking; (2) the disulfiram contract used in CRA, which is identical in form to the BMT contract except that talk about drinking is not prohibited; and (3) supervised disulfiram without a written contract, special instructions, or explicit verbal thanking. Studies of these three forms of observed disulfiram have been among the better controlled studies. Each approach has produced very promising results. A disulfiram contract with BMT produced less short-term drinking than disulfiram accompanied either by couples or individual counseling. Unfortunately, the superior BMT drinking results eroded because many couples discontinued their disulfiram contract after treatment ended (O'Farrell et al. 1985, 1992). Adding couples RP sessions after BMT led to better fulfillment of the disulfiram contract and better drinking and marital outcomes than BMT alone. These better RP outcomes persisted for 18 to 24 months after BMT for the entire sample and throughout the entire 30-month followup after BMT for those with more severe drinking and marital problems (O'Farrell et al. 1993). Thus, disulfiram contracts used with BMT are associated with less drinking and greater disulfiram compliance, while the specific contribution of disulfiram contracts to BMT remains to be investigated.(ABSTRACT TRUNCATED AT 400 WORDS)

Alcohol Deterrents↗
PubMed1997

Effects of aging on implicit sequence learning: accounting for sequence structure and explicit knowledge.

The present research was intended to examine the sequence learning ability of elderly people-with a focus on comparing sequences with different structural characteristics and on properly assessing explicit knowledge. Experiment 1 showed that learning-related improvements in serial reaction time task performance were greater for young than elderly subjects, and elderly subjects were especially poor at learning a sequence with complex structural characteristics. Measures of recognition memory showed that neither young nor elderly subjects showed above-chance explicit knowledge of the sequences. Experiment 2 was designed to test the validity and sensitivity of the explicit recognition measures by comparing young subjects in groups given all random trials, given sequence trials with implicit instructions, or given sequence trials with explicit instructions. Experiment 2 confirmed the sensitivity of the recognition measures to explicit knowledge, so it is concluded that group effects in Exp. 1 reflect age-related differences in implicit learning.

Adult↗
PubMed1997

Time course of cortical activations in implicit and explicit recall.

The distinction between implicit and explicit retrieval of learned material is central to recent thinking about the neural systems underlying memory. Word stem completion is one task in which subjects can be instructed either to make a deliberate recall (explicit instruction) or to be told to complete the stem with any appropriate word (implicit instruction). Positron emission tomography (PET) studies have indicated that during implicit retrieval, there is reduced blood flow in right posterior areas, whereas some tasks of explicit retrieval involve frontal and hippocampal activation. However, there is no information about the timing of these activations or how implicit and explicit retrieval might be related. We used word stem completion tasks similar to those used in the PET studies, but used high-density electrical recording designed to allow localization of the regions involved in the tasks and to provide temporal information. We found reduced activity for primed words in right posterior cortex corresponding to previous PET results. The reduction occurred within the first 200 msec after input, suggesting early interaction with the information stored in this area. Similar reductions observed during explicit recall of the previously presented words indicate that priming is similar under implicit and explicit conditions. In addition, when priming was not an adequate basis for response, then frontal areas were active. Retrieval of unprimed words under implicit instruction elicited right frontal activation, whereas explicit retrieval activated frontal areas bilaterally. Left frontal and hippocampal activations appear to occur only when the retrieval involved use of the words from the list studied previously.

Adult↗
PubMed2007

Psychometric intelligence dissociates implicit and explicit learning.

The hypothesis that performance on implicit learning tasks is unrelated to psychometric intelligence was examined in a sample of 605 German pupils. Performance in artificial grammar learning, process control, and serial learning did not correlate with various measures of intelligence when participants were given standard implicit instructions. Under an explicit rule discovery instruction, however, a significant relationship between performance on the learning tasks and intelligence appeared. This finding provides support for Reber's hypothesis that implicit learning, in contrast to explicit learning, is independent of intelligence, and confirms thereby the distinction between the 2 modes of learning. However, because there were virtually no correlations among the 3 learning tasks, the assumption of a unitary ability of implicit learning was not supported.

Adolescent↗
PubMed2006

Giving learners the best of both worlds: do clinical teachers need to guard against teaching pattern recognition to novices?

PURPOSE: There has been much debate in the medical education literature regarding the extent to which feature-driven and nonanalytic (similarity-based) reasoning strategies define expertise, but the relative value of teaching these strategies, together or in isolation, remains uncertain. The purpose of this study was to compare the diagnostic accuracy achieved upon receiving instruction to use each strategy in isolation to that of a combined approach. METHOD: In 2003-04, 48 undergraduate psychology students from McMaster University in Ontario, Canada, were taught to diagnose ten cardiac disorders (including normal) via electrocardiogram (ECG) presentation. Twelve students were instructed to carefully identify all features present before assigning a diagnosis (feature first). Twelve were given the same instruction with notice that some test ECGs had been seen during training (implicit combined). Twelve were simply instructed to trust familiarity and diagnose based on this impression (similarity-based). Finally, 12 students were given feature first and similarity-based instructions in combination (explicit combined). RESULTS: No difference in diagnostic accuracy was observed between the groups given the feature first (42%) and first impression (41%) instructions (p > .4), but the groups instructed to use both strategies (explicitly or implicitly) performed significantly better (56% and 53%, respectively; p < .01). CONCLUSIONS: The results support an additive model of clinical reasoning in which instructions to be feature oriented and to trust similarity improve performance in novice diagnosticians.

Adult↗
PubMed1999

An examination of the effects of adult age on explicit and implicit learning of figural sequences.

Memory for previously learned figural sequences and item-to-item covariations within figural sequences was examined under explicit and implicit instructional conditions in three age groups: young adults (17-23 years); middle-aged adults (35-45 years); and older adults (55-65 years). In Phase 1 of the experiment, the acquisition phase, half the subjects in each age group learned sequences of three to eight items in which the item-to-item changes conformed to an artificial grammar, and the other half of the subjects in each age group learned strings in which the item-to-item changes were nongrammatical. In Phase 2, the implicit/explicit test phase, subjects made forced-choice judgments about parts of the strings that they learned in Phase 1, under either explicit or implicit instructions. Analyses of Phase 2 data revealed that subjects in both instructional conditions used item-to-item covariations in making decisions about grammatical strings. However, use of previously learned covariations as well as the number of correct judgments about previously learned strings was greater in the explicit condition than in the implicit condition. An age-related deficit was found for explicit recognition of grammar-following sequences.

Adolescent↗
PubMed1981

Development of knowledge about communication: children's evaluations of explicitly ambiguous messages.

Kindergartners and second graders evaluated the communicative clarity of brief oral instructions under 3 conditions: (1) unambiguous: referentially unambiguous instructions that the subjects saw a puppet listener correctly carry out; (2) no closure: ambiguous instructions that the puppet explicitly identified as ambiguous and refused to try to carry out; (3) closure: equally ambiguous instructions that the puppet also explicitly identified as ambiguous but nonetheless carried out, confidently asserting that he thought the speaker meant a specific 1 of the 2 equally possible referents. The younger, but not the older, subjects were influenced by the listener's behavior as well as by the speaker's: That is, they rated the closure instructions as clearer than the no-closure instructions, although less clear than the unambiguous ones. These results suggest that the growth of children's knowledge about communication includes the developing awareness that, in communication situations like the above, an ambiguous message is intrinsically unclear and remains a poor message regardless of the listener's response to it.

Child↗
PubMedDate not supplied

Integrated learning: explicit strategies and their role in problem-solving instruction for students with learning disabilities.

This study investigated the effectiveness of an explicit strategy as a means of linking facts, concepts, and problem solving in an unfamiliar domain of learning. Participants were 37 secondary students with learning disabilities. All students were taught health facts and concepts, which they then applied to problem-solving exercises presented through computer-simulation games. Students in the experimental group were taught an explicit strategy for solving the problems; the comparison group was given supportive feedback and encouraged to induce their own strategies. The explicit strategy group performed significantly better on two transfer measures, including videotaped problem-solving exercises.

Adolescent↗
PubMed1997

Fostering reader response and developing comprehension strategies in deaf and hard of hearing children.

In response to the increasing use of children's trade books in school reading programs, this article reviews the use of real text, drawing on the application and interaction of two distinct perspectives: reader response theory and comprehension instruction. The authors propose the need to combine knowledge of instruction with the new focus on the role of the reader within response theory and within comprehension research. This article suggests how comprehension instruction and response to literature activities can intersect in the classroom for students who are deaf or hard of hearing. Explicit models and instructional strategies are discussed in the framework of this bimodal approach to reading. A sample list of high quality children's books, including several trade books that feature deaf or hard of hearing characters and issues, is provided as a resource for teachers.

Child↗
PubMed1999

The novel-response procedure in humans.

The novel-response drug discrimination procedure is one of several three-choice procedures developed to address interpretational difficulties that can occur under standard two-response procedures. The novel-response procedure is unique among three-choice discrimination procedures by using instructions, rather than explicit training procedures. With the novel-response procedure, participants are trained under a standard two-response (drug vs. placebo) discrimination, and then instructed that in the presence of a drug stimulus unlike either of the training drugs, responses should be made on the novel-response alternative. Several studies have assessed the utility of the novel-response procedure by comparing effects under a standard two-response and the novel-response procedure in participants trained to discriminate triazolam from placebo. Results indicate that the novel-response procedure can increase the selectivity of both placebo- and drug-appropriate responding, and in this way, allows for finer distinctions to be made among sedatives than a standard two-response procedure.

Anti-Anxiety Agents↗
PubMed2002

The Müller-Lyer illusion in touch and vision: implications for multisensory processes.

In six experiments, we used the Müller-Lyer illusion to investigate factors in the integration of touch, movement, and spatial cues in haptic shape perception, and in the similarity with the visual illusion. Latencies provided evidence against the hypothesis that scanning times explain the haptic illusion. Distinctive fin effects supported the hypothesis that cue distinctiveness contributes to the illusion, but showed also that it depends on modality-specific conditions, and is not the main factor. Allocentric cues from scanning an external frame (EF) did not reduce the haptic illusion. Scanning elicited downward movements and more negative errors for horizontal convergent figures and more positive errors for vertical divergent figures, suggesting a modality-specific movement effect. But the Müller-Lyer illusion was highly significant for both vertical and horizontal figures. By contrast, instructions to use body-centered reference and to ignore the fins reduced the haptic illusion for vertical figures in touch from 12.60% to 1.7%. In vision, without explicit egocentric reference, instructions to ignore fins did not reduce the illusion to near floor level, though external cues were present. But the visual illusion was reduced to the same level as in touch with instructions that included the use of body-centered cues. The new evidence shows that the same instructions reduced the Müller-Lyer illusion almost to zero in both vision and touch. It suggests that the similarity of the illusions is not fortuitous. The results on touch supported the hypothesis that body-centered spatial reference is involved in integrating inputs from touch and movement for accurate haptic shape perception. The finding that explicit egocentric reference had the same effect on vision suggests that it may be a common factor in the integration of disparate inputs from multisensory sources.

Adolescent↗
PubMed2002

[Effects of imagery instructions on false memories produced on implicit and explicit memory tests].

In two experiments, we investigated whether the Deese-Roediger-McDermott paradigm using implicit and explicit memory tests would produce critical lure (CL) words. Participants studied lists of semantic associates (e.g., newspaper, book, write) to induce memories for CL words (e.g., read). Afterwards, participants participated in implicit and explicit memory tests in each experiment. The level of priming of the CL words was quite high and similar to that of the presented words when participants were instructed to image the interword relation on lists during study. Participants explicitly recognized many CL words as having been presented on the lists in Experiment 1 and recalled many CL words in Experiment 2. The results are discussed in light of Underwood's (1965) implicit associative response hypothesis.

Adult↗
PubMed1995

Competence in aspects of behavioral treatment and consultation: implications for service delivery and graduate training.

This study examined the extent to which competence in applying behavioral procedures (time-out from positive reinforcement) was sufficient to establish competence in teaching others to apply the same procedures. During baseline, graduate students attempted to instruct parents with a history of child abuse and neglect in the use of time-out. Students were then instructed in the use of time-out until they achieved proficiency in a role-play context. They then reattempted to instruct the parents. Finally, the students were instructed in certain consultation skills (i.e., teaching others to apply behavioral procedures) and again attempted to instruct parents in the application of time-out. Observations of students' consultation skills, parents' proficiency at administering time-out, and children's compliance to parental instructions revealed that explicit training in behavioral consulting skills was necessary to produce improvements in these behaviors. Students proficiency at administering time-out was insufficient to enable them to instruct others in its application. These results were corroborated by surveys of both students and staff. The implications for graduate training and service delivery are discussed.

Adult↗