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PubMed1997

The acceptability of personal learning plans in vocational training.

Personal learning plans have been advocated as a means of introducing the principles of adult learning into general practice vocational training. The aim of this study was to investigate attitudes amongst general practice trainers and registrars to the introduction and use of personal learning plans. A questionnaire was sent to general practice trainers and registrars in one vocational training scheme prior to the introduction of personal learning plans. Overall, doctors in the training scheme were positive to the idea of personal learning plans. Trainers were significantly more positive towards introducing learning plans than their registrars. Registrars in their final general practice posts were significantly more positive towards the idea of learning plans than their hospital counterparts. Doctors who had completed membership of the Royal College of General Practitioners, usually trainers or final year registrars, were also more positive in their attitude. This pilot study suggests that most trainers and registrars were positive in their attitude towards personal learning plans prior to their introduction in the Lincoln vocational training scheme. The study cautiously suggests a wider use and evaluation of personal learning plans in vocational training.

Adult↗
PubMed1995

Factor structure of the California Verbal Learning Test in moderate and severe closed-head injury.

A factor analysis with principal components extraction and varimax rotation was performed on 19 California Verbal Learning Test age-uncorrected scores from a sample of 75 moderate and severe closed-head-injured patients. A 6-factor solution was obtained that accounted for 80% of the total variance and was similar to those reported previously. The factors were labeled General Verbal Learning, Response Discrimination, Learning Strategy, Proactive Effect, Self-monitoring, and Serial Position. Factor scores were derived and correlated with other neuropsychological measures. The General Verbal Learning factor scores were significantly correlated with those on measures of memory, complex attention, and strategy induction.

Adult↗
PubMed1998

[Nursing students' perceptions of the factors in the field of general clinical experience which facilitate learning].

Learning through clinical experience forms an integral part of student nurses' academic and professional foundation. The extent to which learning is facilitated for student nurses is determined by the structuring of the field of clinical experience as well as by student nurses' perception of the field of clinical experience. The purpose of this study is to determine student nurses' perception of factors in the field of general clinical experience which facilitate learning. Literature pertaining to factors in the field of general clinical experience which impact on the learning by students was studied. A descriptive, exploratory survey was done through the medium of a questionnaire completed by B.Cur-students. The results of this study indicate, despite the fact that student nurses experience some aspects pertaining to learning in the general clinical field negatively, their overall impression is positive and favourable. Factors restraining learning were identified. Recommendations are made to counter the restraining factors.

Attitude of Health Personnel↗
PubMed2003

Learned dynamics of reaching movements generalize from dominant to nondominant arm.

Accurate performance of reaching movements depends on adaptable neural circuitry that learns to predict forces and compensate for limb dynamics. In earlier experiments, we quantified generalization from training at one arm position to another position. The generalization patterns suggested that neural elements learning to predict forces coded a limb's state in an intrinsic, muscle-like coordinate system. Here, we test the sensitivity of these elements to the other arm by quantifying inter-arm generalization. We considered two possible coordinate systems: an intrinsic (joint) representation should generalize with mirror symmetry reflecting the joint's symmetry and an extrinsic representation should preserve the task's structure in extrinsic coordinates. Both coordinate systems of generalization were compared with a naïve control group. We tested transfer in right-handed subjects both from dominant to nondominant arm (D-->ND) and vice versa (ND-->D). This led to a 2 x 3 experimental design matrix: transfer direction (D-->ND/ND-->D) by coordinate system (extrinsic, intrinsic, control). Generalization occurred only from dominant to nondominant arm and only in extrinsic coordinates. To assess the dependence of generalization on callosal inter-hemispheric communication, we tested commissurotomy patient JW. JW showed generalization from dominant to nondominant arm in extrinsic coordinates. The results suggest that when the dominant right arm is used in learning dynamics, the information could be represented in the left hemisphere with neural elements tuned to both the right arm and the left arm. In contrast, learning with the nondominant arm seems to rely on the elements in the nondominant hemisphere tuned only to movements of that arm.

Adolescent↗
PubMed1983

The application of psychodynamic principles to the learning objectives in a general practice vocational training scheme in the setting of a small group.

This paper is the result of 12 years' work and describes the application of psychodynamic principles to the structuring and conducting of a course for general practitioners in the Ipswich Vocational Training Scheme. The overall aims are to release the potential of each trainee for life-long self-motivated study and for emotional sensitivity through self-awareness. We have attempted to integrate the emotional and factual learning of the trainee by applying the procedures found valuable in psychoanalytic therapy to the learning process, thus enabling him to go through some of the integrative experience present in therapy. This will help him to use the doctor/patient relationship more creatively. A secondary aim is to provide him with the necessary skills to enable him to become a better partner, trainer and educationist. The course to which this was applied started 12 years ago with a unique feature. It was constructed so as to have 8 members who worked together throughout the 3 years of their training; the first 2 years being spent in rotating hospital posts and the last in general practice. Throughout the 3 years the 8 members came together with two staff for weekly sessions in a small group setting. Since the beginning of the scheme we have had six cohorts of 8 members, with 2 'drop-outs' and 'drop-ins', making a total of 50 doctors.

Curriculum↗
PubMed2006

The neurocognitive effects of aripiprazole: an open-label comparison with olanzapine.

RATIONALE: Cognitive deficits are a core feature of schizophrenia. As a target of intervention, improvements in cognition may lead to improvements in functional outcome. OBJECTIVES: The present paper is the first report, to our knowledge, on the neurocognitive effects of aripiprazole. Unlike other second-generation antipsychotics, aripiprazole is a D(2) and D(3) receptor partial agonist. It is unknown what effects this unusual pharmacological profile may yield on neurocognition. MATERIALS AND METHODS: The present open-label study included data on 169 patients with schizophrenia or schizoaffective disorder who were randomly treated with aripiprazole or olanzapine. Subjects received a neurocognitive battery at baseline, week 8, and 26. RESULTS: The aripiprazole group had a significantly greater dropout rate than the olanzapine group. Neurocognitive data were reduced through a principal components analysis that yielded a three-factor solution. The factors were general cognitive functioning, executive functioning, and verbal learning. For general cognitive functioning, both groups improved from baseline and the effects were relatively stable over the 26-week protocol. There were no differential treatment effects. For executive functioning, neither group improved significantly from baseline. For verbal learning, the aripiprazole group improved significantly from baseline to the 8th and 26th week of assessment, and there was a between-group effect favoring aripiprazole over olanzapine that was largely attributable to the differences in performance within the 8th week. Separate analyses were conducted for a measure of sustained attention (Continuous Performance Test-Identical Pairs). There were no differential treatment effects on this measure. CONCLUSIONS: The findings from this open-label study suggest that the neurocognitive effects of aripiprazole are at least as good as those of olanzapine.

Adult↗
PubMed2003

Long-term memory deficits in schizophrenia: primary or secondary dysfunction?

Long-term memory impairment is often found in schizophrenia. The question remains whether this is caused by other cognitive deficits. One hundred eighteen first-episode patients were compared with 45 control participants on several memory tasks. The role of processing speed and central executive functions on memory performance was examined with regression analysis for all participants and for patients separately. Deficits were found in general verbal learning performance and retrieval in episodic memory and semantic memory. Processing speed reduced disease-related variance in all memory variables. Coordination, organization of information, and speed of processing were the best predictors for long-term memory deficits in patients. The amount of explained variance, however, is small, especially in general verbal learning performance.

Adult↗
PubMed2000

Perceptual learning in visual search generalizes over tasks, locations, and eyes.

In a visual search task, targets containing elementary features are detected in parallel, while a serial search is necessary for the detection of a target without a feature, or for targets containing conjunctions of features. In this study, we re-investigated the role of practice in visual search tasks, using an uncued visual search paradigm. Under some circumstances, initially serial tasks can become parallel with practice. Perceptual learning of feature search tasks is rapid (a few hundreds of trials are sufficient to transform serial into parallel search), long-lasting (a learned task is retained over several months), but far less specific than learning of other visual tasks (see also Sireteanu & Rettenbach, 1995a [Vision Research, 35, 2037-2043]). Learning transfers from one task to another, from one location in the visual field to another, and between the two eyes of a given subject, even if the subject has reduced stereopsis. Search for a conjunction of orientation and colour becomes more efficient, suggesting that a different search strategy emerges after prolonged practice. These results suggest that learning of visual search tasks modifies neural structures located at a high level in the visual pathway, involving different, presumably more central neural circuits, than the learning of visual discriminations and hyperacuity.

Analysis of Variance↗
PubMed2005

Lectures in problem-based learning--why, when and how? An example of interactive lecturing that stimulates meaningful learning.

Even though opinions differ as to whether lecturing is compatible with problem-based learning (PBL) or not, lectures are still a common form of instruction in PBL curricula. This paper discusses the lecture in the framework of theories of learning in general and the medical problem-based learning tradition in particular. An example of how theories of learning can be implemented in the lecture hall is presented. Theories that underpin PBL as an educational philosophy rather than as a method of instruction are reviewed. A lecture form, organized in introductory, in depth and application lectures, that responds to important factors for stimulating deep processing of knowledge and meaningful learning is discussed. Examples of and practical points about how to renew and restructure lectures in a way that counteracts surface approaches to learning, teacher centering and student passivity are presented. We argue that, with proper awareness of possible drawbacks of the large format, lectures can be used as valuable tools for learning also in a PBL curriculum.

Education, Medical↗
PubMed2026

Machine learning vs. traditional methods for predicting postoperative cardiac complications after non-cardiac surgery: a systematic review and Bayesian network meta-analysis.

INTRODUCTION: Accurate prediction of peri-operative cardiac complications is critical to optimise pre-operative decision-making. Traditional risk prediction scores, such as the Revised Cardiac Risk Index, show only modest discrimination. Machine learning can model complex, non-linear relationships but their predictive performance compared with traditional scores remains unclear. METHODS: We performed a systematic review and Bayesian network meta-analysis. The primary outcome was postoperative adverse cardiac events following non-cardiac surgery. Prediction models were assessed relative to the Revised Cardiac Risk Index. As many studies evaluated multiple versions of each model type, the highest performing ('best version') and lowest performing ('worst version') results were analysed. Models were ranked using the surface under the cumulative ranking curve (SUCRA). RESULTS: Thirteen studies evaluating 54 models and 927,113 patients were included. Machine learning approaches generally outperformed traditional risk scores. Automated machine learning ranked highest (SUCRA 96.6) showed the greatest improvement in the best version analysis (mean difference (MD) 0.28 (95%CrI 0.16-0.40)) and remained superior in the sensitivity analysis (MD 0.30 (95%CrI 0.14-0.45)). Gradient boosting models showed superior performance over the Revised Cardiac Risk Index across analysis (best version: MD 0.20 (95%CrI 0.14-0.26), worst version: MD 0.18 (95%CrI 0.12-0.25), SUCRA 82.4). The Gupta Perioperative Risk for Myocardial Infarction or Cardiac Arrest score outperformed the Revised Cardiac Risk Index in the best version analysis (MD 0.16 (95%CrI 0.01-0.32)). Between-study heterogeneity was low. None of the included studies externally validated their machine learning models and only six were judged to be at low risk of bias. DISCUSSION: Most machine learning models showed better discrimination than traditional risk scores, with automated machine learning and gradient boosting models ranking highest. However, study quality, calibration reporting and absence of external validation limit immediate clinical adoption. Prospective, multicentre evaluation is required before integration of these models into peri-operative practice.

Humans↗
PubMed1997

Portfolio-based learning: continuing medical education for general practitioners--a mid-point evaluation.

In October 1994 a project was initiated by the General Practice Continuing Medical Education Tutors in the Department of General Practice at Sheffield University. The project sought to evaluate the efficiency (effort expended) and effectiveness (distance travelled) of a model of continuing professional development for general practitioners through individual portfolio-based learning in co-mentoring groups. Learning demonstrated through the portfolio was accredited for the postgraduate education allowance of participants. This paper addresses the process of portfolio development at the mid-point of a year-long trial to ascertain the strengths, weaknesses and possible future development of such a process within the context of continuing medical education.

Family Practice↗
PubMed2006

Primate errors in transitive 'inference': a two-tier learning model.

Transitive performance (TP) is a learning-based behaviour exhibited by a wide range of species, where if a subject has been taught to prefer A when presented with the pair AB but to prefer B when presented with the pair BC, then the subject will also prefer A when presented with the novel pair AC. Most explanations of TP assume that subjects recognize and learn an underlying sequence from observing the training pairs. However, data from squirrel monkeys (Saimiri sciureus) and young children contradict this, showing that when three different items (a triad) are drawn from the sequence, subjects' performance degrades systematically (McGonigle and Chalmers, Nature 267:694-696, 1977; Chalmers and McGonigle, Journal of Experimental Child Psychology 37:355-377, 1984; Harris and McGonigle, The Quarterly Journal of Experimental Psychology 47B:319-348, 1994). We present here the two-tier model, the first learning model of TP which accounts for this systematic performance degradation. Our model assumes primate TP is based on a general-purpose task learning system rather than a special-purpose sequence-learning system. It supports the hypothesis of Heckers et al. (Hippocampus 14:153-162, 2004) that TP is an expression of two separate general learning elements: one for associating actions and contexts, another for prioritising associations when more than one context is present. The two-tier model also provides explanations for why phased training is important for helping subjects learn the initial training pairs and why some subjects fail to do so. It also supports the Harris and McGonigle (The Quarterly Journal of Experimental Psychology 47B:319-348, 1994) explanation of why, once the training pairs have been acquired, subjects perform transitive choice automatically on two-item diads, but not when exposed to triads from the same sequence.

Animals↗
PubMed1994

[Relaxation training for children--a review of the literature].

The results of a literature survey for the use of relaxation methods can be summarized to the following essential points: Children are able to learn relaxation training--generally better and faster than adults. However, they need more external instructions for doing it. The kind of instructions seem not to be of so much importance. At least younger children proceed from a more heterosuggestive procedure and using of identification figures for the experience of relaxation reaction. According to the children's age and the surrounding conditions, stories of fantasy can be used. The significance of surrounding activities (e.g. games to introduce the training) should not be undervalued for the motivation of children and thus for learning and use of the training. Generally learning of the training in a group should be preferred to individual training. Children should explicitly be trained in transferring of the learned to every-day situations.

Adolescent↗