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Benefiting from clinical experience: the influence of learning style and clinical experience on performance in an undergraduate objective structured clinical examination.

OBJECTIVE: To assess the relationship between clinical experience, learning style and performance in an objective structured clinical examination (OSCE) in medical students at the end of their first clinical year. DESIGN: Prospective study of undergraduate students taking an OSCE examination at the end of their first clinical year. SUBJECTS: 194 undergraduate medical students (95 male). MAIN OUTCOME MEASURES: Performance in the OSCE examination, the Entwhistle Learning Style Inventory1 and a composite self-reported score of clinical activity during the students first clinical year. RESULTS: Performance in the OSCE examination was related to well-organized study methods but not to clinical experience. A significant relationship between clinical experience and organized deep-learning styles suggests that knowledge gained from clinical experience is related to learning style. CONCLUSIONS: The relationship between clinical experience and student performance is complex. Well-organized and strategic learning styles appear to influence the benefits of increased clinical exposure. Further work is required to elucidate the most beneficial aspects of clinical teaching.

Adult↗

Integrating the philosophy and psychology of aesthetic experience: development of the aesthetic experience scale.

This study assessed the dynamic relationship between person and object in aesthetic experience. Patterns of the structure of aesthetic experience were derived from a conceptual model based on philosophical and psychological ideas. These patterns were further informed by interviewing individuals with extensive involvement in aesthetic activities and 25 secondary students. Accordingly, patterns were tested by developing a large pool of items attempting to identify measurable structural components of aesthetic experience. Refined first in a pilot study, the 36-item questionnaire was administered to 652 Greek students, aged from 13 to 15 years. Correlation matrices and exploratory factor analyses on principal components were used to examine internal structural relationships. The obliquely rotated five-factor solution of the refined instrument accounted for the 44.1% of the total variance and was combatible with the conceptual model of aesthetic experience, indicating the plausibility of both. The internal consistency of the items was adequate and external correlational analysis offered preliminary support for subsequent development of a self-report measure that serves to operationalize the major constructs of aesthetic experience in the general adolescent population. The results also raise theoretical issues for those interested in empirical aesthetics, suggesting that in experiential functioning, expressive perception and affect may play a more constructive role in cognitive processes than is generally acknowledged.

Adolescent↗

[Situations and cognitive appraisals in 'agari' experiences: feature analyses of 'agari' experiences].

The purpose of this study was to examine the 'agari' experiences in everyday life. 'Agari' is a Japanese noun (the verb form is 'agaru'), referring to broad experiences including stage-fright, choking under pressure, social anxiety, and so on. Based upon the self-reports of 452 subjects, we constructed, in Study 1, a 52-items Features of 'Agari' Experience Questionnaire (FAEQ). In Study 2, another sample of 364 completed the FAEQ, and factor analysis was performed. The analysis found six primary factors: Self insufficiency, physical insufficiency, trembling, pressure, physiological response, and awareness of others. A second-order factor analysis was performed on them, and two factors emerged: Self-reflection and awareness of self-importance. It may be therefore concluded that looking at the self leads to an 'agari' experience. In addition, hierarchical cluster analysis divided twelve 'agari' situations into four clusters. The clusters were differentiated by two factors of FAEQ. It is suggested that eliciting situations and associated cognitive appraisals differentiated 'agari' experiences.

Adolescent↗

Minding experience: An exploration of the concept of "experience" in the early French anthropology of Durkheim, Lévy-Bruhl, and Lévi-Strauss.

In line with the growing concern with the unexamined reliance upon the concept of "experience" in anthropology, this article explores in some detail the various usages and definitions of the concept in the work of three of early French anthropology's most influential theorists: Emile Durkheim (1858-1918), Lucien Lévy-Bruhl (1857-1939), and Claude Lévi-Strauss (1908-). With its important influence on both British and American anthropology, the early French anthropological tradition, as epitomized in the writings of these three thinkers, has indeed played a pivotal role in shaping many current taken-for-granted understandings of the concept of experience in the discipline of anthropology as a whole. In the process of exploring how experience is viewed by these three scholars, this paper will thus take some initial steps toward the historical contextualization of many of the unquestioned assumptions underpinning current understandings of experience in the discipline of anthropology and the social sciences more generally.

Anthropology↗

Accordion BIRD-HMBC experiments: improved one-bond correlation suppression in accordion heteronuclear multiple-bond correlation-type experiments.

Modifications of the BIRD-HMBC experiment, in which the accordion principle and a constant time period have been introduced, are presented. With the simple accordion BIRD-HMBC, the use of a BIRD(r, X) element in the middle of the variable long-range couplings evolution period efficiently eliminates unwanted (1)J(CH) signals and samples a broad range of long-range heteronuclear couplings. While the accordion BIRD-HMBC experiment shows reduced F(1) modulation, superior suppression of unwanted (1)J(CH) signals and sensitivity comparable to the ACCORD-HMBC, the addition of another constant time period suppresses F(1) modulation due to (1)H-(1)H coupling, while preserving the excellent suppression of unwanted (1)J(CH) signals. The constant-time (CT) accordion BIRD-HMBC experiment combines sensitivity similar to the CIGAR-HMBC and superior suppression of unwanted (1)J(CH) signals. Results of identically optimized ACCORD-HMBC, accordion BIRD-HMBC, CT accordion BIRD-HMBC and CIGAR-HMBC experiments performed on a sample of strychnine are compared and discussed.

Journal Article↗

Interpreting large-scale experiments on effects of trawling on benthic fauna: an empirical test of the potential effects of spatial confounding in experiments without replicated control and trawled areas.

Disturbances due to trawling and dredging is a serious threat to assemblages of benthic marine animals. We tested hypotheses about effects of trawling on benthic assemblages in a manipulative field experiment, using gear and intensities relevant to future management of trawling in a Swedish fjord. Three trawled and three control sites were sampled at several times before and after trawling was initiated. This paper describes how conclusions about effects of trawling might differ between experiments involving replicate sites and experiments using only one trawled and one control site, as in several recent studies. Analyses of selected taxa showed that abundances of many species changed differently among control sites. Differences in temporal change between pairs of single trawled and control sites were also frequent. Neither the quantitative nor the qualitative nature of differences between treatments could, however, be coherently interpreted among the different combinations of trawled and control sites. This is consistent with results obtained from analyses using all sites, which showed no consistent effects of trawling on any of these taxa. These results provide empirical evidence that spatial confounding may cause serious problems to formal interpretation of experiments, which use only one control and one trawled area. Such potential problems can best be solved by ensuring that the study incorporates more than one control site.

Journal Article↗

Natural experiments to study the effects of early experience: progress and limitations.

Questions concerning the long-term effects of early experience on psychological development in humans continue to stir up controversy. There are, at present, great diversity and contradictions among extant conceptual models and inadequate data to resolve these differences. Limited opportunities to use experimental approaches and the inherent restrictions of observational approaches in research on humans implies that alternative research designs are needed. This article examines the use of "natural experiments" as a method for testing hypotheses concerning the effects of early experience on psychological development. The benefits and limitations of using natural experiments are reviewed and several case illustrations are considered.

Adult↗

Intersensory experience and early perceptual development: postnatal experience with multimodal maternal cues affects intersensory responsiveness in bobwhite quail chicks.

Unlike the other sensory modalities of precocial infants, the visual modality does not normally become functional until after birth or hatching. Despite this unique developmental status, the role of emerging visual experience on postnatal perceptual organization remains unclear. In this study, bobwhite quail hatchlings were reared in conditions that manipulated postnatal experience with maternal visual cues, either alone or in conjunction with maternal auditory cues. Results revealed that bobwhite chicks require postnatal exposure to both maternal auditory and visual cues following hatching to demonstrate species-specific perceptual preferences. Chicks that received temporally disparate maternal auditory and visual cues or experience with only maternal visual or maternal auditory cues failed to show species-typical perceptual responsiveness. These results suggest that developmental mechanisms involving both visual and auditory sensory experience underlie the emergence of early intersensory integration.

Animals↗

Factorial structure of the hallucinatory experience: continuity of experience in psychotic and normal individuals.

Examination of the distribution of the hallucinatory experience may aide in the determination of their continuity and the psychological mechanisms that mediate their occurrence. Past investigators have found that hallucinatory experiences are not limited to disordered individuals and can be induced in the laboratory and occur naturally in the general population. Few reports to date, however, have directly investigated the continuity of the experience by comparing hallucinatory behavior of psychotic patients with a nonclinical sample. In the present study, we examined the architecture of the hallucinatory experience by comparing the factorial structure of the Launay-Slade Hallucination Scale using psychotic patients with active hallucinations, psychotic inpatients without hallucinations, and a group of university students. In support of the continuum model of psychosis, a very similar factor-analytic solution was obtained for all three groups. Discriminant function analysis, however, revealed that all groups achieved a high classified rate by their item responses. These results are consistent with the notion that expression of hallucinatory behavior exists along a continuum, but at a certain level of symptom severity beyond a critical threshold, the behavior becomes discontinuous and dysfunctional.

Adult↗

Extramural study experience and practical experience of final year veterinary students of nine European schools.

Arrangements for extramural education including "seeing practice" experience in nine European veterinary schools (Bristol, Glasgow, Liverpool, Helsinki, Stockholm, Hannover, Ghent, Toulouse and Vienna) are described. Considerable differences existed between three UK schools, and between them and the Continental schools, where arrangements were usually voluntary. The amount of extramural experience in different types of work was quantified by student questionnaires. An average of 12 weeks' experience in farm practice was gained by 83 per cent of the 339 students, six weeks' small animal work by 48 per cent, four weeks in an abattoir by 43 per cent and other periods in specialised practices, laboratories and veterinary faculties. Practice abroad was experienced by 10 per cent. The total experience of different medical and surgical conditions varied considerably between schools as a result of disease eradication (eg, swine fever in UK), non-occurrence (canine leptospirosis in Sweden and Finland) or the availability of surgical or reproductive material, as well as on other factors.

Curriculum↗

The varieties of ecstatic experience: an exploration of the subjective experiences of ecstasy.

Previous investigations of the subjective effects of MDMA (material sold as ecstasy) have conducted interviews and surveys of various groups of ecstasy users within particular sub-populations. This study examined subjective drug effects reported by different sub-populations of ecstasy users and explored whether the function or purpose served by using ecstasy influenced the nature of the drug experience. Drawing on previous measures of alterations in consciousness, psychedelic drugs and cannabis, and informal interviews with ecstasy users and MDMA researchers, a 130-item survey assessing subjective effects of ecstasy/MDMA was developed. Principal components analysis of responses of ecstasy users revealed six components; perceptual alterations, entactogenic effects, prosocial effects, aesthetic effects, negative effects and sexual effects. The derived scale was used to predict ecstasy use behaviours, and functions and experiences of use. A variety of component scores were related to ecstasy use parameters; in particular, heavier users expected fewer negative, perceptual and aesthetic effects from taking the drug. The reasons given for using ecstasy (use function) also influenced reported drug effects. Abstainers expected greater negative, perceptual, aesthetic and sexual effects than users. These data indicate that the subjective ecstasy experience is influenced by a variety of extra-psychopharmacological factors. Drug intervention strategies may be made more effective by targeting particular user groups defined by reasons given for substance use, as it is likely that their experiences of ecstasy effects will differ. Future research into ecstasy may be improved by recognizing user diversity.

Adolescent↗

The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon's experience, institutional experience, body mass index and fellowship training.

BACKGROUND: Surgeons must overcome a substantial learning curve before mastering laparoscopic Roux-en-Y gastric bypass (LRYGBP). This learning curve can be defined in terms of mortality, morbidity or length of surgery. The aim of this study was to compare the learning curves in terms of surgical time for the first 3 surgeons performing LRYGBP in our hospital with the length of surgery for open gastric bypass (CONTROLS). METHODS: We compared 494 primary LRYGBPs performed by 3 surgeons (393 by 1st SURGEON, 57 by 2nd SURGEON and 44 by 3rd SURGEON) to 159 open vertical banded gastroplasty-Roux-en-Y gastric bypasses (CONTROLS). Data for LRYGBP patients were prospectively obtained. Factors that significantly affected the length of surgery were identified by univariate and multivariate linear regression analysis. RESULTS: LRYGBP and CONTROL patients were similar in age, height, weight and BMI, although more CONTROLS were male. Median time for the 1st SURGEON performing LRYGBP dropped for each subsequent 100 operations: 1st 100 - 190 min, 2nd 100 - 135 min, 3rd 100 - 110 min and 4th 100 - 100 min. Median time for 2nd SURGEON performing LRYGBP was 120 min, 3rd SURGEON 173 min and CONTROLS 64 min. Length of surgery significantly correlated with surgical experience in terms of numbers of operations and BMI of patient. Times for 2nd SURGEON, a fellowship trained laparoscopic surgeon, started significantly faster than 1st SURGEON's, but did not significantly improve with experience. 3rd SURGEON's initial times were similar to 1st SURGEON's, but his times improved more rapidly with experience. Times for CONTROLS were significantly faster than all laparoscopic groups and did not correlate with operation number or patient BMI. CONCLUSIONS: The length of surgery for LRYGBPs continued to shorten beyond 400 operations for the first surgeon performing LRYGBP in our hospital. Previous fellowship training in LRYGBP shortened surgical times during initial clinical experience as an attending for the second surgeon. The learning curve was truncated because of the already established LRYGBP program.

Adult↗

Cross-cultural measurement of experience: Taiwanese and Americans' peak performance, peak experience, misery, failure, sport, and average events.

To compare Taiwanese and Americans on selected experiential personality dimensions, the Experience Questionnaire was translated and tested with 27 Taiwanese in an American university. Descriptions by 129 Taiwanese of peak performance, peak experience, misery, failure, sport, and average events were compared with those made by 123 Americans. Analysis of variance with repeated measures of factors indicated that both samples uniformly characterized processes of peak performance as full focus with clarity of self in process. The Taiwanese considered failure more significant than the Americans who denied clarity of self in misery and failure and more generally endorsed peak experience than the Taiwanese. The study extends the credibility of experience: experiential events can simultaneously have cross-cultural generality and inner processes that are culturally sensitive.

Adult↗

Is subjective word familiarity a meter of ambient language? A natural experiment on effects of perceptual experience.

The present study examined the sensitivity of a subjective familiarity measure to differences in word exposure within and between populations that differ dramatically in their perceptual experience. Descriptive measures of language ability and subjective familiarity ratings for 450 words were collected from a group of college-educated adults with normal hearing and a group of college-educated deaf adults. The results demonstrate the sensitivity of subjective familiarity ratings to both between- and within-group differences in word experience. Specifically, the deaf participants consistently rated words as less familiar than did hearing participants. Furthermore, item-level correlations within a participant group were higher than ones between groups. Within groups, mean familiarity ratings were correlated with descriptive measures of language ability. The results are discussed in relation to a simple sampling model of word experience and the language experience of the participant groups.

Adolescent↗

[Christian responsibility and experimental medicine. Experiments with and on humans, experiments on animals].

The Jewish-Christian convictions that man was created as the image of God founded the "ethics of unavailability" which contrast with the utilitarian "ethics of interests." As man s nature is imperfect according to biblical understanding, those responsible in the field of experimental medicine should counteract all tendencies in society which promote an utopian definition of health and an eugenic mentality (idea of the "perfection of mankind"). Consequently, scientists must reflect their own image of man and the effects of their actions on this image. The goals of experimental medicine must also be examined under the aspect of fairness: do they only benefit a minority in the rich industrial nations? As in research on humans, the ethical evaluation of animal experiments must consider the question of the underlying image of humanity and the responsibility of mankind connected to it. Because of changes in society's values, the validity of traditional anthropocentrism is increasingly questioned. However, this does not affect the view of the special position of man as the bearer of responsibility. Even though there are different biblical statements on the relationship between man and animal, the Christian maxim to minimise violence towards animals can be derived from them. In the case of animal experiments this means: experiments which cause the animals severe suffering must be avoided by waiving the potential gain of knowledge from them. In general: in an ethical discussion on medical experiments using humans or animals, the public must be informed completely and involved effectively. A moratorium must be possible before plans become facts. Thinking about ethical problems in the area of experimental medicine should not be separated from the far-reaching questions about changes in our lifestyle and consumer behaviour.

Animal Welfare↗

The Rochester practice-based experience. An experiment in medical education.

BACKGROUND: Recent changes in the organization and financing of medical practice have resulted in a shift of patient care from the hospital to ambulatory locations and dramatically changed the mix and severity of the inpatient population. Medical educators are concerned that hospitalized patients are not truly representative of the practice of internal medicine and may be unsuitable for the education of third-year medical students. The University of Rochester (NY) Department of Medicine recently established a "practice-based" component to complement the inpatient segment of the third-year medicine clerkship. METHODS: Participating students work with a practicing internist for the second half of the 12-week clerkship. Students evaluate office and hospital patients in the internist's practice and attend didactic conferences. We used a multi-measurement curriculum evaluation system to assess the new program and compare it with the established hospital experience. Evaluation components included the following: logs in which students profiled their clinical activities; questionnaires that assessed opinions and satisfaction about the clerkship; group interviews with students; and visits to practice-based sites to interview both preceptor and student. RESULTS: Practice-based students saw many more patients with a broader range of illnesses and had more observation and supervision from faculty than hospital-based students. Practice-based students discussed all of their patients with their preceptors, who were perceived as being excellent teachers. Hospital-based students, although generally positive, were also generally less enthusiastic about the amount and quality of teaching, observation, and supervision. Practice-based and hospital-based students achieved similar grades on the final examination and received a similar number of honors grades. Preceptors were enthusiastic in their endorsement of the practice-based experience and patient acceptance of students was high. CONCLUSION: The practice-based experience is feasible and of equal academic rigor to the hospital experience. This realistic immersion into the daily activities of an internist provides an enriching balance to the traditional hospital-based clerkship.

Ambulatory Care↗

Saturation transfer difference (STD) 1H-NMR experiments and in silico docking experiments to probe the binding of N-acetylneuraminic acid and derivatives to Vibrio cholerae sialidase.

Saturation transfer difference (STD) (1)H NMR experiments were used to probe the epitope binding characteristics of the sialidase [EC 3.2.1.18] from the bacterium Vibrio cholerae, the causative agent of cholera. Binding preferences were investigated for N-acetylneuraminic acid (Neu5Ac, 1), the product of the sialidase catalytic reaction, for the known sialidase inhibitor 5-acetamido-2,6-anhydro-3,5-dideoxy-D-glycero-D-galacto-non-2-enoic acid (Neu5Ac2en, 2), and for the uronic acid-based Neu5Ac2en mimetic iso-propyl 2-acetamido-2,4-dideoxy-alpha-L-threo-hex-4-enopyranosiduronic acid (3), in which the native glycerol side-chain of Neu5Ac2en is replaced with an O-iso-propyl ether. The STD experiments provided evidence, supporting previous studies, that Neu5Ac (1) binds to the sialidase as the alpha-anomer. Docking experiments using DOCK (version 4.0.1) revealed further information regarding the binding characteristics of the enzyme active site in complex with Neu5Ac2en (2) and the Neu5Ac2en mimetic (3), indicating an expected dominant interaction of the acetamide moiety with the protein.

Acetamides↗

Multiplicity-Selective Coherence Transfer Steps for the Design of Amino Acid-Selective Experiments-A Triple-Resonance Experiment Selective for Asn and Gln

A multiplicity-selective coherence transfer step is discussed, that can replace the normal INEPT transfer in triple-resonance experiments. Depending on the pulse sequence in which they are implemented, amino acid-selective experiments will be created. Two experiments selective for Asn and Gln are proposed. Copyright 1998 Academic Press.

Journal Article↗