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PubMed2000

Cognitive models in training health professionals to protect patients' confidential information.

Recent advances in theories of learning and knowledge acquisition in culturally-situated environments have illuminated the role of cognition in changing behavior, and in turn on influencing performance for the long term. One such advance focuses on the relationship between explicit formal training and implicit knowledge acquired through daily interactive activities in schools and organizations. The former relates more to instruction regarding the policy issues whereas the latter is tied closely to cultural, moral and organizational values. In this paper, we draw on these theories of cognition and learning to show the shift in thinking that is needed regarding education of health professionals, including steps required to assure that the protection of confidential information becomes part of their routine practices. Illustrative examples are used to show the nature of conceptual change in the health professional's knowledge organization and reasoning strategies that is necessary for more sustained behavior change with regards to protecting data confidentiality and privacy of individual patients. This re-conceptualization is intended to be reflected at various levels of training and education for health professionals, including influences on personal and organizational practices as well as revisions in medical-school and graduate-medical curricula.

Cognition↗
PubMed2005

Animal welfare training at the Ontario Veterinary College.

The University of Guelph is internationally recognized as a leader in animal welfare and is home to the Colonel K.L. Campbell Centre for the Study of Animal Welfare and to numerous faculty with expertise in the discipline. However, while animal welfare receives significant attention within the agricultural college, its didactic teaching within the veterinary curriculum has been limited. Veterinary students receive four hours of instruction in animal ethics and apply their knowledge within the communication lectures and laboratories, totaling 11-15 hrs. Compulsory coursework explicitly addressing factual components of animal welfare science, welfare assessment, and associated animal-related policy constitute only 12 hrs throughout the four-year Doctor of Veterinary Medicine curriculum. However, an elective final-year clinical rotation and a graduate course specific to animal welfare were offered for the first time in 2004/2005. Student interest in animal welfare is evident through their participation in summer research projects in animal welfare, an animal welfare mentor group, and a student-run animal welfare club that organizes an Animal Welfare Forum each October. Veterinarians have important contributions to make in decision making about animal welfare issues, at clinician and policy levels. Although motivated individuals can seek out opportunities to expand their knowledge of animal welfare, a compulsory senior-level course in animal welfare is needed to develop the necessary depth of understanding of this discipline if veterinarians, as a profession, are to meet society's expectations about animal welfare.

Animal Husbandry↗
PubMed2002

Tobacco intervention training: current efforts and gaps in US medical schools.

CONTEXT: Research has documented that US medical schools inadequately teach tobacco intervention skills. OBJECTIVE: To examine effective training methods for tobacco intervention in undergraduate medical education. DATA SOURCES: Using indexing terms related to tobacco intervention and medical education, we searched MEDLINE (1966-June 2002) and the Cochrane Database of Systematic Reviews (through issue 2, 2002). Reference lists of relevant articles were also read to identify additional articles. Because of their importance to tobacco intervention, we also reviewed Ockene and colleagues' tobacco education research and the tobacco treatment guidelines of the United States Public Health Service and the United States Preventive Services Task Force. STUDY SELECTION: All study designs that incorporated process or outcome evaluation of tobacco intervention educational methods for medical students were included in this review. Of an initial 1241 articles retrieved, 82 included medical students. Reviewing abstracts and references of these articles identified 13 pertinent studies. DATA EXTRACTION: Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified all evaluations and any problems in program implementation. DATA SYNTHESIS: Enhanced instructional methods (eg, the use of patient-centered counseling, standardized patient instructors, role playing, or a combination of these) are more effective for teaching tobacco intervention than are traditional didactic methods alone and can be effectively inserted into medical school curricula. CONCLUSIONS: Various educational methods have been used to train medical students in tobacco intervention. Nonetheless, gaps still exist within undergraduate medical education, including a lack of integration of tobacco dependence information throughout all 4 years of medical school curricula, specific training in smokeless tobacco intervention, tobacco intervention training that addresses cultural issues, and long-term studies showing that such training is retained.

Counseling↗
PubMed1991

Violent patients. Are you prepared to deal with them?

The medical community is becoming increasingly concerned about violent patients in healthcare settings. Healthcare professionals should be trained to deal with aggressive patients, and they should have access to a room free of dangerous objects for evaluation and examination. Having security personnel stand by may be appropriate in some cases. Verbal intervention is the key to dealing with violent patients. The safest and most effective pharmacologic intervention is use of benzodiazepines, either alone or in conjunction with antipsychotic agents when indicated. Seclusion or restraint may be needed for some violent patients; in such situations, close patient monitoring and explicit documentation are essential. Physicians can be held liable for injuries patients sustain while being restrained, so staff members should receive instruction in safe physical intervention techniques.

Aggression↗
PubMed1995

Deep knowledge and computer-assisted instruction in cardiology.

In this paper, we describe a qualitative heart model that is part of a computing environment, CARDIOLAB, and whose role includes the diagnosis and Computer Assisted Instruction (CAI) in cardiology. The model is based on a "deep knowledge" approach to diagnosis. Deep knowledge representations model the inner works of complex physical systems. Explicit representations of system components, component functions, and behavior allow a principled form of reasoning that extends the classical rule-based, first-generation expert systems. One of the main advantage of model-based diagnosis resides in the possibility of providing explanations to observed facts or measured data. This feature can be incorporated into CAI programs with similar benefits.

Cardiology↗
PubMed2000

The impact of posthypnotic amnesia and directed forgetting on implicit and explicit memory: new insights from a modified process dissociation procedure.

The authors describe a study investigating the relationship between posthypnotic amnesia (PHA) and directed forgetting (DF) and their impact on implicit and explicit memory. This study adopted a recent modification of the process dissociation procedure to accommodate the cross-contamination of memory test performance by implicit and explicit memorial factors. Forty high and 40 low hypnotically susceptible participants were compared in PHA, DF, and control conditions on estimates of voluntary conscious (VCM), involuntary conscious (ICM), and involuntary unconscious memory (IUM) performance. Both groups showed significant decrements in VCM and ICM following instructions for DF, whereas only high susceptibles showed this decrement in the PHA condition; neither DF nor PHA affected IUM. Moreover, there was no relationship between forgetting in PHA and DF. Although both PHA and DF seem to prevent the conscious (i.e., explicit) expression of memorial information while leaving implicit memory intact, the mechanisms underlying these phenomena may nevertheless be different.

Adult↗
PubMed2004

Effects of explicit sway-minimization on postural--suprapostural dual-task performance.

Participants performed a visual search task under immersive visualization conditions while standing in open or closed stance. In the combined instruction condition, participants were asked to minimize their sway while they performed the search task, and in the search-only condition, they were advised that sway was not of interest, and they were asked to focus their efforts on performing the search task. Regardless of instructions, participants swayed more and made more errors as search load increased. Participants also succeeded in reducing their sway when asked to do so. While search in closed stance tended to be faster than in open stance under search-only instructions, this pattern reversed significantly under combined instructions. We suggest that neither the facilitatory control hypothesis nor any resource-competition model of postural--suprapostural dual-tasking can fully account for the observed interplay of task-facilitation and task-interference effects. We offer adaptive resource-sharing as an alternative to these theories.

Adolescent↗
PubMed2003

Treatment algorithms and protocolized care.

PURPOSE OF REVIEW: Excess information in complex ICU environments exceeds human decision-making limits and likely contributes to unnecessary variation in clinical care, increasing the likelihood of clinical errors. I reviewed recent critical care clinical trials searching for information about the impact of protocol use on clinically pertinent outcomes. RECENT FINDINGS: Several recently published clinical trials illustrate the importance of distinguishing efficacy and effectiveness trials. One of these trials illustrates the danger of conducting effectiveness trials before the efficacy of an intervention is established. The trials also illustrate the importance of distinguishing guidelines and inadequately explicit protocols from adequately explicit protocols. Only adequately explicit protocols contain enough detail to lead different clinicians to the same decision when faced with the same clinical scenario. SUMMARY: Differences between guidelines and protocols are important. Guidelines lack detail and provide general guidance that requires clinicians to fill in many gaps. Computerized or paper-based protocols are detailed and, when used for complex clinical ICU problems, can generate patient-specific, evidence-based therapy instructions that can be carried out by different clinicians with almost no interclinician variability. Individualization of patient therapy can be preserved by these protocols when they are driven by individual patient data. Explicit decision-support tools (eg, guidelines and protocols) have favorable effects on clinician and patient outcomes and can reduce the variation in clinical practice. Guidelines and protocols that aid ICU decision makers should be more widely distributed.

Algorithms↗
PubMed1995

Developing study, organization, and management strategies for adolescents with language disabilities.

Developing strategies for learning is important for all individuals, but even more so for students who have difficulty learning and processing information. Because many students with language disabilities have not developed a repertoire of such strategies or do not actively apply the strategies they know, direct instruction in this area is imperative. It is also important that any strategy taught is functional, easily and directly applied to present learning situations, and easy to generalize. Determining the variables in a learning situation (the script) should provide appropriate choices and direction for strategic teaching and learning. The acquisition of strategies involves direct, explicit teaching and requires time for modeling, practice, and discussion. Using a cognitive strategy model is critical because it supports the later use and generalization of strategies, but it is important to explore various models for strategy instruction and to work collaboratively with students and teachers. The SLP can provide direct instruction, consultation, or training, or can facilitate a collaborative model among professionals. In so doing, her impact may reach throughout a life, because learning strategies are life strategies, and if learned they are tools forever.

Adolescent↗
PubMed1997

Effectiveness of elevator service signs: measurement of perceived understandability, willingness to comply and behaviour.

This research examines the effectiveness of four elevator service signs. The signs' purpose is to reduce delays for longer distance riders by dissuading people from using the elevator when they are only going up one floor or down two floors. Three of the four signs were described in Chapanis' (1965, Human Factors 7, 1-17) seminal treatise entitled 'Words, words, words ...': an original sign and two others that he suggested as possibly being better. The fourth was an enhanced sign incorporating human factor principles that were derived from research since Chapanis' article. The enhancements involved the use of colour, a signal word panel, icons/pictorial, and direct, explicit wording of the required behaviour. In Experiment 1, participants rated the understandability of each sign and their willingness to obey its instructions. The pattern of the means was the same for both questions. The original sign was rated lowest and the enhanced sign was rated highest, with the two other signs receiving intermediate ratings. In Experiment 2, the signs were placed on each floor of six multi-story buildings adjacent to the elevator call buttons. People's use of the elevators during the posting of each sign and during no-sign (control) periods was measured. The experimenter rode the elevators and counted the total number of passengers using the elevators as well as the number who rode up only one floor or down one or two floors (noncompliers). The new enhanced sign increased compliance compared to the other three signs and the no-sign period. These results suggest that design principles derived from recent research can help to promote comprehension, motivation and compliance behaviour to signs.

Adolescent↗
PubMedDate not supplied

When labels hurt but novelty helps: children's perseveration and flexibility in a card-sorting task.

Children often perseverate, repeating prior behaviors when inappropriate. This work tested the roles of verbal labels and stimulus novelty in such perseveration. Three-year-old children sorted cards by one rule and were then instructed to switch to a second rule. In a basic condition, cards had familiar shapes and colors and both rules were stated explicitly. In an uninformative-label condition, cards had familiar shapes and colors, but the first rule was not stated explicitly. In a novel-stimuli condition, both rules were stated explicitly but stimuli were novel on the first sorting dimension. More children switched to the second rule in the uninformative-label and novel-stimuli conditions than in the basic condition. Implications for theories of cognitive flexibility are discussed.

Child, Preschool↗
PubMed2002

Explorations in the social contagion of memory.

Four experiments examined social influence on the development of false memories. We employed the social contagion paradigm: A subject and a confederate see scenes and then later take turns recalling items from the scenes, with the confederate erroneously reporting some items that were not present in the scenes; on a final test, the subject reports these suggested items when instructed to recall only items from the scenes. The first two experiments showed that the social contagion effect persisted when subjects were explicitly warned about the possibility that confederates' responses might induce false memories and when they were tested via source-monitoring tests that explicitly gave the choice of attributing suggested items to the other person. Levels of false recall and recognition increased with the number of times the misleading information was suggested (Experiment 3), and subjects were more likely to incorporate the erroneous responses of an actual confederate on a recognition/source test as compared with those of a simulated confederate (Experiment 4). Collectively, the data support the claim that false memories may be transmitted between people and reveal critical factors that modulate the social contagion of memories.

Humans↗
PubMed1995

Effects of learning contexts on implicit and explicit learning.

Two parallel tasks involving rule learning were identified in Experiment 1A and were used to assess implicit and explicit learning. In both tasks, subjects had to input numbers in order to reach the target values of outputs. The relationship between inputs and outputs was either simple (in the simple task) or complex (in the complex task), and the way in which target values were presented could be in the form of either numbers (in the simple task) or lines (in the complex task). Experiment 1B examined the validity of the explicit measure in the complex task. Experiments 2-4 investigated the interaction between learning contexts and the simple/complex learning tasks. Verbalization and instructions to search for the rules facilitated the simple-task learning and hurt or have no effect on the complex-task learning. In the observational-learning condition, no learning occurred for the simple task, and the complex task learning was impaired. These results suggest that the complex task and simple task involve two distinct learning systems. Other implications are also discussed.

Adolescent↗
PubMed1989

The effect of analytic versus holistic encoding instructions on hemispheric superiority.

A modification of the tachistoscopic letter detection task employed by Neisser (1963) was utilized to examine hemispheric differences in employing analytic and holistic processing strategies. Stimulus arrays designed to elicit either serial or parallel processing sets were presented to the right hemisphere-left visual field (RH-LVF) or to the left hemisphere-right visual field (LH-RVF). Subjects were explicitly directed to perform an analytic or holistic encoding process on both types of stimulus arrays. The serial array produced longer reaction times than the parallel array for both hemispheres. A RH-LVF reaction time advantage was found across both stimulus sets and instructions. In addition, an overall reaction time advantage was found for holistic instructions relative to analytic instructions, but this superiority was not effected by hemisphere or contextual stimuli.

Adult↗
PubMed2003

Detecting neuropsychological malingering: effects of coaching and information.

Concerns that patients presenting for neuropsychological assessment may not be putting forth maximum effort during testing has prompted the development of measures designed to detect malingering and incomplete effort. Two of these measures are the Computerized Assessment of Response Bias-97 (CARB-97) and Word Memory Test (WMT). Despite widespread use of these instruments, no study has been published determining the vulnerability of neuropsychological malingering measures to explicit coaching or brain injury information. The present study, using analog participants, found that the CARB-97 and WMT differentiate "normal" from "malingered" instructional sets, and show little difference between nai;ve and coached malingering efforts. There was also little difference between providing brain injury information and a no-information condition, but when effects were present, the information group generally scored worse. Further, it was found that response times (RTs), in addition to items correct, may also be effective in detecting those who are not giving their full effort.

Adolescent↗
PubMed1995

Jones on ice: psychoanalysis and figure skating.

This paper rescues Ernest Jones's largely-unknown book, 'The Elements of Figure Skating' (1931/1952), from relative obscurity and argues for its place in the psychoanalytic literature. In the first section, the authors situate Jones's passion for figure skating by turning to various historical and biographical sources, and to personal correspondence with Jones's son, Mervyn Jones. In the second section, they offer the first textual reading of Jones and skating within a psychoanalytic framework. This approach, they argue, is long overdue since Jones explicitly claimed that the 'Elements' was motivated by his interest in the 'psychological' problems of the beginning skater, and with the task of instruction therein. The authors rely heavily on passages from the 'Elements', in part because the book is out-of-print and unavailable to most readers, but also because Jones's own words are an exemplary instance of his intense transference to psychoanalytic theory during his extra-professional time as a skater. They conclude the paper by arguing that Jones ultimately advocates a position beyond psychology when he idealistically embraces 'exact knowledge' as the royal road to masterful skating.

Humans↗
PubMed2006

Instruction in mastery goal orientation: developing problem solving and persistence for clinical settings.

Individuals with a mastery orientation are more motivated to persist and increase their competence. Although studies have demonstrated the usefulness of explicitly teaching mastery goal orientation, no interventions have been used in nursing education. The purpose of this study was to determine whether mastery goal orientation could be rapidly acquired by nursing students via a short-term educational intervention. Nursing students from five programs participated in a 3-week intervention. Participants were matched by demographic profile and pretest goal orientation scores before being randomly assigned to experimental and control groups. Goal orientation was measured before and after the intervention. Students in the experimental group increased their mastery orientation significantly, while reducing their performance orientation somewhat. They persisted to solve problems, while students in the control group gave up more easily when faced with a difficult task. Early development of mastery goal orientation that promotes problem solving and persistence for clinical settings can be a powerful adjunct to undergraduate nursing education.

Adaptation, Psychological↗
PubMed2005

Methodology of studies evaluating death certificate accuracy were flawed.

BACKGROUND AND OBJECTIVE: Statistics on causes of death are important for epidemiologic research. Studies that evaluate the source data often give conflicting results, which raise questions about comparability and validity of methods. METHODS: For 44 recent evaluation studies we examined the methods employed and assessed the reproducibility. RESULTS: Thirty studies stated who reviewed the source data. Six studies reported reliability tests. Twelve studies included all causes of death, but none specified criteria for identifying the underlying cause when several, etiologically independent conditions were present. We assessed these as not reproducible. Of 32 studies that focussed on a specific condition, 21 provided diagnostic criteria such that the verification of the focal diagnosis is reproducible. Of 16 that discussed the difference between dying "with" and "from" a condition, eight described how competing causes had been handled. For these eight, the selection of a principal cause is reproducible, but in three the selection strategy conflicts with the international instructions issued by the World Health Organization. CONCLUSION: Methods and criteria are often insufficiently described. When described, they sometimes disagree with the international standard. Explicit descriptions of methods and criteria would contribute to methodologic improvement and would allow readers to assess the generalizability of the conclusions.

Cause of Death↗