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PubMed1999

Teaching self-awareness enhances learning about patient-centered interviewing.

PURPOSE: To evaluate the effect of intensive attitudinal training on residents' learning the patient-centered interviewing skills required to establish a healthy provider-patient relationship and to communicate effectively. METHOD: While teaching 53 residents patient-centered interviewing skills, the authors also trained them to recognize previously unrecognized, negative attitudes that interfered with learning the skills. The authors, using an iterative, consensus-building process based on the residents' performances and personality data, identified a spectrum of responses to the educational intervention. Barriers to and facilitators of mastery of skills were analyzed and this information was used to help residents overcome skill deficits. RESULTS: To varying degrees, 44 residents became aware of previously unrecognized attitudes to the extent that they improved their patient-centered interviewing skills. Six residents failed to develop awareness of negative attitudes and showed little learning and clinical use of the interviewing skills being taught. Three residents who rapidly developed superb interviewing skills showed no negative attitude towards using them. CONCLUSIONS: Pending a confirmatory hypothesis-testing study, the authors believe that, as residents learn how to conduct patient-centered interviews, training in awareness of interfering attitudes should accompany training in skills.

Attitude of Health Personnel↗

PubMed1991

Cumulative versus rapid introduction of new information.

This study investigated the way new information is presented to students. Subjects were 60 elementary and middle school students, most with learning disabilities. Students used two versions of a specially designed computer-assisted instruction (CAI) program. One version rapidly presented students with seven pieces of information (rapid-introduction group); the other cumulatively presented smaller "chunks" of information (cumulative-introduction group). Both groups worked to mastery level successfully but students in the cumulative group spent one-third the time, required fewer responses, showed less frustration, and made fewer errors in the process. Results suggest that students with learning disabilities need much more practice than most commercial CAI programs supply.

Child↗

PubMed2003

Current issues in medical education.

Medical education has witnessed recently an accelerated and worldwide trend of change. The race is on for curricula that are relevant, appropriate and accountable. One of the consequences of this is the need for a drastic reassessment of how we devise curricula, and of what models, approaches, and strategies to adopt. Outcomes-based education is currently offered as an alternative to the content-based approach, which has been criticized by many educational experts in the past. Although this new approach has its detractors, it holds some promise of being able to improve on a current situation that is in deadlock with itself. There has been a great deal of interest in educational strategies in the last decade. This has been associated with the development of new concepts such as "problem-based learning", "student-centered learning", and "integrated teaching". Each school has to assess each of these strategies and adopt what ever will serve the aims of the curriculum. Similarly, the considerable progress that has taken place in the design and development of instructional materials and instructional technology should be appreciated. This includes, development in computer assisted learning, virtual reality, the use of simulated subjects, e learning, and the new concept of Reusable Learning Objects (RLO's). Finally, it was realized, with the rapid development in medical education that medical education requires professional training. The assumption that any good medical practitioner has the ability to teach no longer holds and professional training is required.

Computer-Assisted Instruction↗

PubMedDate not supplied

Predictive regulation of associative learning in a neural network by reinforcement and attentive feedback.

At least four types of learning processes are relevant in the present paper: learning of conditioned reinforcement, incentive motivation, sensory expectancy, and motor command. These several types of learning processes, which operate on a slow time scale, regulate and are regulated by rapidly fluctuating limited capacity STM representations of sensory events. The theory suggest how nonlinear feedback interactions among these fast information processing mechanisms and slow learning mechanisms participate in different conditioning paradigms, and actively regulate learning and memory to generate predictive internal representations of external environmental contingencies.

Animals↗

PubMed2004

Molecular determinants mediating effects of acute stress on hippocampus-dependent synaptic plasticity and learning.

The understanding of the molecular events underlying the neuroendocrine and behavioral sequelae of the response to stress has advanced rapidly over recent years. The hippocampus is a target of stress hormones, and we are beginning to dissect the molecular players in the modulation of synaptic plasticity and learning and memory involving this region of the brain. Given the wealth of data obtained from electrophysiological and behavioral experiments and in view of the importance to use identical experimental protocols in order to correlate the results obtained under both experimental conditions, this review focuses primarily on those contributions, which combine both approaches. From these studies it is evident that a single stressful event elicits responses in the hippocampus with different time-spans ranging from rapid changes in glutamatergic neurotransmission (i.e., N-methyl-d-aspartate receptor signaling), activation of second messenger cascades by corticotropin-releasing factor to long-lasting transcriptional changes of acetylcholinesterase. The relative contribution of these molecular targets to the stress response, the relation to hippocampal synaptic plasticity and memory formation, and the possible interaction of the underlying processes are discussed.

Acute Disease↗

PubMedDate not supplied

Computer-assisted learning: cyberPatient--a step in the future of surgical education.

Computer-assisted learning is a hot topic and is evolving parallel with the rapidly growing computer technology. Today, modern computers with sophisticated software are able to create a new dimension in the application of many important pedagogical principles and philosophies. Modern computers with excellent multimedia applications are capable of simulating a realistic situation that enriches the educational environment, improves the learning process, and brings new challenges to the process of "learning by doing." The use of computers in medical industry and in medical education lags far behind other applications in the industrial world. Although a great many computer-assisted learning programs have been developed in the last decade and patient simulation has been attempted, there are no computer programs in the market that are capable of simulating the realism of the patient-doctor relationship. cyberActive Technology Ltd. has been able to complete this mission. The computer software cyberPatient developed by cyberActive Technology Ltd. is able to realize this long-term dream of medical students and educators. The discrepancy between theoretical and practical medical knowledge in the classical medical education was greater than in any other aspect of science. In classical medical education, diseases were taught beginning with etiology and pathogenesis to signs and symptoms. In practice, the patient comes to the doctor with complaints, and the doctor has to think backward to find out about the etiology and pathogenesis. This discrepancy created enormous difficulties for interns and young doctors with respect to the application of theoretical medicine to medical practice. This was one of the reasons why medical schools turned to a new problem-based learning curriculum. The new curriculum, however, has brought new challenges and problems of its own. Some of the problems include patient availability, increased demands for teachers, and, in turn, significant increases in the costs of medical education. Intensive use of computers may be a solution for problem-based learning. The aim of this article is to give an overview of computer-based learning and its place in the future of medical education.

Computer-Assisted Instruction↗

PubMedDate not supplied

Neuropathological studies on strains of senescence-accelerated mice (SAM) with age-related deficits in learning and memory.

In a series of inbred Senescence-Accelerated mice (SAM) strains, accelerated-senescence prone SAMP substrains show early onset and rapid advancement of senescence. SAMP8 and SAMP10, in particular, exhibit a significant age-related deterioration in memory and learning for passive and active avoidance tasks with, respectively, a low and high incidence of systemic senile amyloidosis. In the brains of both SAMP8 and SAMP10 strains, we have found numerous morphological alterations. Here we review the changes seen in both neuronal or glial components in SAMP8/P10 brains. They may serve as markers of the neuronal degeneration leading to the deficits in learning and memory.

Aging↗

PubMed1999

Preparing for the workplace: fostering generic attributes in allied health education programs.

Allied health curricula need to extend beyond the learning of discipline-specific skills to encompass broader learning goals. In particular, the acquisition of generic skills is necessary to enable graduates to function more competently and confidently within their rapidly changing work, professional, and societal environments. In health sciences education particularly, the rate of change in practice and education is rapid and unprecedented. If educators focus on components of the curriculum rather than the entire learning experience, they are likely to significantly limit the students' acquisition of such generic skills. To achieve the desired generic skills outcomes, an overarching, integrated, and consistently applied curriculum strategy is advocated. This article considers a number of such strategies relevant to allied health education.

Allied Health Personnel↗

PubMed2005

A cellular correlate of learning-induced metaplasticity in the hippocampus.

Metaplasticity, the plasticity of synaptic plasticity, is thought to have a pivotal role in activity-dependent modulation of synaptic connectivity, which underlies learning and memory. Metaplasticity is usually attributed to modifications in glutamate receptor-mediated synaptic transmission. However, experimental evidence and theoretical considerations suggest that learning reduces the predisposition for further synaptic strengthening, while behavioral studies show that learning capability is enhanced by prior learning. Here we show that enhanced neuronal excitability in CA1 pyramidal neurons, but not enhanced synaptic transmission, occurs prior to rule learning of an olfactory discrimination task. This transient enhancement lasts for 1 day after rule learning, is apparent throughout the cell population and results from reduction in the medium and slow after-hyperpolarizations that control spike frequency adaptation. Such olfactory learning-induced increased excitability in hippocampal neurons enhances the rats' learning capability in another hippocampus-dependent task, the Morris water maze. Once olfactory discrimination rule learning is acquired, its maintenance is not dependent on the reduced post-burst AHP in hippocampal neurons. However, the enhanced spatial learning capability of olfactory-trained rats in the water maze is diminished once the post burst AHP in CA1 pyramidal cells resumes its initial value. We suggest that enhanced excitability of CA1 neurons may serve as a mechanism for generalized enhancement of hippocampus-dependent learning capability. In the presence of such enhanced neuronal excitability, the hippocampal network enters into a 'learning mode' in which a variety of hippocampus-dependent skills are acquired rapidly and efficiently.

Animals↗

PubMed1992

Ultrasonic vocalization as an indicator of emotional state during active avoidance learning in rats.

Adult male rats subjected to a two-way avoidance task emitted ultrasonic vocalizations (20-30 kHz) both during the presentation of the conditioned stimulus and the intertrial interval. The rate of ultrasonic calling decreased during the 75-trial session indicating that acquisition of the conditioned avoidance response (CAR) was inversely correlated with the rate of vocalization. The rate of acquisition of the CAR was most rapid in those rats that did not emit any vocalization during learning. These data suggest that ultrasonic calling during stressful situations may be sensitive indicator of underlying emotional states that interfere with the acquisition of a complex task.

Animals↗

PubMed1998

Inquiry-based learning and critical thinking in an advanced practice psychiatric nursing program.

The advanced practice psychiatric nurse must be prepared to meet the changing demands being placed on the nursing profession. Some changes are the product of health care reforms, especially managed care. Others are more fundamental, because continuing scientific advances drive rapid changes in the knowledge base required of mental health nurses. Curricular reforms initiated earlier this decade were intended to equip nurses with the problem-solving and critical-thinking skills required to deal with novel and complex situations in a rapidly changing healthcare system. This article describes how the Inquiry-Based Learning tutorial method attends to the mental processes of graduate students and fosters critical-thinking skills.

Clinical Competence↗

PubMed1999

Motor-learning-related changes in piano players and non-musicians revealed by functional magnetic-resonance signals.

In this study, we investigated blood-flow-related magnetic-resonance (MR) signal changes and the time course underlying short-term motor learning of the dominant right hand in ten piano players (PPs) and 23 non-musicians (NMs), using a complex finger-tapping task. The activation patterns were analyzed for selected regions of interest (ROIs) within the two examined groups and were related to the subjects' performance. A functional learning profile, based on the regional blood-oxygenation-level-dependent (BOLD) signal changes, was assessed in both groups. All subjects achieved significant increases in tapping frequency during the training session of 35 min in the scanner. PPs, however, performed significantly better than NMs and showed increasing activation in the contralateral primary motor cortex throughout motor learning in the scanner. At the same time, involvement of secondary motor areas, such as bilateral supplementary motor area, premotor, and cerebellar areas, diminished relative to the NMs throughout the training session. Extended activation of primary and secondary motor areas in the initial training stage (7-14 min) and rapid attenuation were the main functional patterns underlying short-term learning in the NM group; attenuation was particularly marked in the primary motor cortices as compared with the PPs. When tapping of the rehearsed sequence was performed with the left hand, transfer effects of motor learning were evident in both groups. Involvement of all relevant motor components was smaller than after initial training with the right hand. Ipsilateral premotor and primary motor contributions, however, showed slight increases of activation, indicating that dominant cortices influence complex sequence learning of the non-dominant hand. In summary, the involvement of primary and secondary motor cortices in motor learning is dependent on experience. Interhemispheric transfer effects are present.

Adult↗

PubMed1975

The role of orosensory stimuli from ethanol and blood-alcohol levels in producing conditioned taste aversion in the rat.

A taste-aversion paradigm was used to demonstrate that aversive consequences accompany the rapid oral ingestion of 5% (v/v) ethanol solutions. The learned taste aversion resulted from five 10-min self-administrations of alcohol mixed with an originally preferred flavor at a dosage of 1.69 g alcohol/kg body weight/day. In contrast, when the consumption of the alcohol solution was distributed throughout the day, a conditioned aversion was not obtained. This outcome was observed even though the distributed drinking animals were exposed to more orosensory stimuli and ingested more g/kg than the 10-min animals. The observation that those animals that drank their daily fluid in 10 min demonstrated higher peak blood-alcohol levels than the distributed animals supports the conclusion that a centrally mediated aversive state of inebriation must be present to produce a conditioned aversion.

Alcohol Drinking↗

PubMed1984

Generality in the verbal tacting of autistic children as a function of "naturalness" in antecedent control.

Two autistic children were taught to emit verbal tacts under two conditions--one employing verbal antecedent stimuli in the training process and the other employing so-called naturalistic antecedent stimuli. Although acquisition was more rapid when verbal antecedents were used, the generality of learning was substantially better for language taught under naturalistic stimulus control. Implications of these findings for the instruction of autistic children are considered in the context of current information on stimulus control.

Autistic Disorder↗

PubMed1994

The percutaneous dilatational subcricoid tracheostomy.

Tracheostomy is frequently required during maxillofacial procedures. The percutaneous technique is described and advocated as a rapid easily mastered procedure, although there is a definite learning curve and it is not without a potential for complications.

Humans↗

PubMed2004

Brain-derived neurotrophic factor acutely enhances tyrosine phosphorylation of the AMPA receptor subunit GluR1 via NMDA receptor-dependent mechanisms.

Brain-derived growth factor (BDNF) acutely regulates synaptic transmission and modulates hippocampal long-term potentiation (LTP) and long-term depression (LTD), cellular models of plasticity associated with learning and memory. Our previous studies revealed that BDNF rapidly increases phosphorylation of NMDA receptor subunits NR1 and NR2B in the postsynaptic density (PSD), potentially linking receptor phosphorylation to synaptic plasticity. To further define molecular mechanisms governing BDNF actions, we examined tyrosine phosphorylation of GluR1, the most well-characterized subunit of AMPA receptors. Initially, we investigated synaptoneurosomes that contain intact pre- and postsynaptic elements. Incubation of synaptoneurosomes with BDNF for 5 min increased tyrosine phosphorylation of GluR1 in a dose-dependent manner, with a maximal, 4-fold enhancement at 10 ng/ml BDNF. NGF had no effects, suggesting the specificity of BDNF actions. Subsequently, we found that BDNF elicited a maximal, 2.5-fold increase in GluR1 phosphorylation in the PSD at 250 ng/ml BDNF within 5 min, suggesting that BDNF enhances the phosphorylation through postsynaptic mechanisms. Activation of trkB receptors was critical as k252-a, an inhibitor of trk receptor tyrosine kinase, blocked the BDNF-activated GluR1 phosphorylation. In addition, AP-5 and MK 801, NMDA receptor antagonists, blocked BDNF enhancement of phosphorylation in synaptoneurosomes or PSDs. Conversely, NMDA, the specific receptor agonist, evoked respective 3.8- and 2-fold increases in phosphorylation in synaptoneurosomes and PSDs within 5 min, mimicking the effects of BDNF. These findings raise the possibility that BDNF modulates GluR1 activity via changes in NMDA receptor function. Moreover, incubation of synaptoneurosomes or PSDs with BDNF and ifenprodil, a specific NR2B antagonist, reproduced the results of AP-5 and MK-801. Finally, coexposure of synaptoneurosomes or PSDs to BDNF and NMDA was not additive, suggesting that BDNF and NMDA activate the same tyrosine phosphorylation site(s) in GluR1. Our findings suggest that BDNF-mediated GluR1 tyrosine phosphorylation potentially regulates synaptic plasticity postsynaptically through NR2B subunits of the NMDA receptor.

Animals↗

PubMed2000

A curriculum for environmental genetics education.

INTRODUCTION: Environmental genetics is a scientific area concerned with interactions between genes and the environment. Progress in this field, coupled with the growth in genetic testing, has great potential for improving human health. There are also ethical, legal, and social concerns surrounding advances in environmental genetics and genetic testing. Because genetic information is rapidly increasing in our society, the public needs to learn more about scientific progress and policy issues in these areas. OBJECTIVE: To describe a curriculum for the public on environmental genetics and genetic testing. PROGRAM: In 1998, the Department of Environmental Health (Center for Environmental Genetics), University of Cincinnati, began an outreach project for the public called Learning Exchange for Genetic and Environmental Disease Solutions (LEGENDS). The project fosters awareness and understanding of environmental genetics and genetic testing with discussion of related policy issues. The curriculum includes brief lectures and discussions based on thematic modules and a set of interactive exercises to be conducted in small groups. More than 100 persons have attended instructional sessions sponsored by LEGENDS at the time of this writing. SIGNIFICANCE: The curriculum appears to be a potentially useful resource for educating the public about environmental genetics, genetic testing, and related policy issues. This project has implications for other organizations working to further genetics education.

Confidentiality↗

PubMed2005

Task switching after cerebellar damage.

The authors of this study investigated task switching following cerebellar damage. The study group consisted of 7 children and adolescents (M age=13.8 years) who underwent surgical removal of a benign posterior fossa tumor. They were tested at a sufficient interval after surgery (M lag=6.13 years) for restoration of normal cognitive skills and intelligence. Although all showed normal learning of the task compared with control participants, when rapid behavioral changes were required (short preparation time), they exhibited behavioral rigidity manifested by enhanced switching cost. These results are in line with another study on serial reaction time with the same patients (A. Berger et al., in press). They have important implications for our understanding of the cognitive sequelae of early cerebellar damage as well as the involvement of the cerebellum in task switching.

Adolescent↗