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PubMed2001

Patient-centred medicine through student-centred teaching: a student perspective on the key impacts of community- based learning in undergraduate medical education.

CONTEXT: The UK General Medical Council has proposed that increased use of community settings is essential to enhancement of medical education. However, such curriculum developments have been directed by educationalists and clinical faculty; there is to date little to show whether student perspectives accord with such expectations. AIM: To examine student views on whether community-based learning during a UK undergraduate medical education course results in new learning in the areas expected, and to elucidate any process factors which enhance attainment of learning objectives. METHOD: Nominal group technique, to develop consensus on important learning outcomes and process factors, and questionnaire survey, developed from the views of the nominal groups. RESULTS: 89 students participated (response rate 70% for the nominal groups, and 88% for questionnaire). Students perceived increased learning in many of the areas expected. In particular, students reported significant learning from: witnessing the impact of a longer term and more personal relationship with patients; the visible impact of social environment on health; the importance of dealing with people rather than diseases, and the use of the whole team for care. In addition, they emphasized that tutor, staff and patient enthusiasm for student presence and learning greatly enhanced the student learning experience. CONCLUSIONS: Community settings appear to achieve the expected attitudinal adaptation of students. The role of the committed tutor and team is seen as pivotal to learning. The conclusions support an increased emphasis in contemporary medical education and related research activity on the key impact of relationships in the learning environment.

Community Medicine↗
PubMed2000

Hippocampal participation in navigational map learning in young homing pigeons is dependent on training experience.

The homing pigeon navigational map is perhaps one of the most striking examples of a naturally occurring spatial representation of the environment used to guide navigation. In a previous study, it was found that hippocampal lesions thoroughly disrupt the ability of young homing pigeons held in an outdoor aviary to learn a navigational map. However, since that study an accumulation of anecdotal data has hinted that hippocampal-lesioned young pigeons allowed to fly during their first summer could learn a navigational map. In the present study, young control and hippocampal-lesioned homing pigeons were either held in an outdoor aviary or allowed to fly during the time of navigational map learning. At the end of their first summer, the birds were experimentally released to test for navigational map learning. Independent of training experience, control pigeons oriented homeward during the experimental releases demonstrating that they learned a navigational map. Surprisingly, while the aviary-held hippocampal-lesioned pigeons failed to learn a navigational map as reported previously, hippocampal-lesioned birds allowed flight experience learned a navigational map indistinguishable from the two control groups. A subsequent experiment revealed that the navigational map learned by the three groups was based on atmospheric odours. The results demonstrate that hippocampal participation in navigational map learning depends on the type of experience a young bird pigeon has, and presumably, the type of navigational map learned.

Animals↗
PubMed1999

Seven years on: distance learning courses for first level registered nurses and midwives.

There is a recognized need to increase the accessibility and flexibility of post-registration course provision for first level registered nurses and midwives. Distance learning courses were developed and implemented at the University of Dundee in response to this need. The courses provide a range of learning opportunities from single module certificate courses to Bachelor, Honours and Masters level studies. The courses are well received by nurses and midwives and experience, over the last 7 years, has highlighted important aspects for distance learning education for both professional groups. Different educational strategies such as Work-based Learning and Problem-based Learning are incorporated into distance learning course design to facilitate the integration of theory and practice and develop cognitive and meta-cognitive skills. The relationship between course assessment and clinical environment is also a key feature of course design, with assessment methods built around work-based learning opportunities in clinical practice. Experience has shown that students require support throughout the learning process. This is achieved through text-based study guides and a range of other support strategies. It is concluded that distance learning can be individualized to meet the professional and personal needs of students and provide quality, flexible learning opportunities for nurses and midwives, facilitating practice development and benefiting patient care.

Education, Distance↗
PubMed2005

Independent perceptual learning in monocular and binocular motion systems.

Eye-transfer tests, external noise manipulations, and observer models were used to systematically characterize learning mechanisms in judging motion direction of moving objects in visual periphery (Experiment 1) and fovea (Experiment 2) and to investigate the degree of transfer of the learning mechanisms from trained to untrained eyes. Perceptual learning in one eye was measured over 10 practice sessions. Subsequent learning in the untrained eye was assessed in five transfer sessions. We characterized the magnitude of transfer of each learning mechanism to the untrained eye by separately analyzing the magnitude of subsequent learning in low and high external noise conditions. In both experiments, we found that learning in the trained eye reduced contrast thresholds uniformly across all of the external noise levels: 47 +/- 10% and 62 +/- 8% in experiments 1 and 2, respectively. Two mechanisms, stimulus enhancement and template retuning, accounted for the observed performance improvements. The degree of transfer to the untrained eye depended on the amount of external noise added to the signal stimuli: In high external noise conditions, learning transferred completely to the untrained eye in both experiments. In low external noise conditions, there was only partial transfer of learning: 63% in experiment 1 and 54% in experiment 2. The results suggest that template retuning, which is effective in high external noise conditions, is mostly binocular, whereas stimulus enhancement, which is effective in low external noise displays, is largely monocular. The two independent mechanisms underlie perceptual learning of motion direction identification in monocular and binocular motion systems.

Fixation, Ocular↗
PubMed1999

Glutamate infused posttraining into the hippocampus or caudate-putamen differentially strengthens place and response learning.

A cross-maze task that can be acquired through either place or response learning was used to examine the hypothesis that posttraining neurochemical manipulation of the hippocampus or caudate-putamen can bias an animal toward the use of a specific memory system. Male Long-Evans rats received four trials per day for 7 days, a probe trial on day 8, further training on days 9-15, and an additional probe trial on day 16. Training occurred in a cross-maze task in which rats started from a consistent start-box (south), and obtained food from a consistent goal-arm (west). On days 4-6 of training, rats received posttraining intrahippocampal (1 microgram/0.5 microliter) or intracaudate (2 microgram/0.5 microliter) injections of either glutamate or saline (0.5 microliter). On days 8 and 16, a probe trial was given in which rats were placed in a novel start-box (north). Rats selecting the west goal-arm were designated "place" learners, and those selecting the east goal-arm were designated "response" learners. Saline-treated rats predominantly displayed place learning on day 8 and response learning on day 16, indicating a shift in control of learned behavior with extended training. Rats receiving intrahippocampal injections of glutamate predominantly displayed place learning on days 8 and 16, indicating that manipulation of the hippocampus produced a blockade of the shift to response learning. Rats receiving intracaudate injections of glutamate displayed response learning on days 8 and 16, indicating an accelerated shift to response learning. The findings suggest that posttraining intracerebral glutamate infusions can (i) modulate the distinct memory processes mediated by the hippocampus and caudate-putamen and (ii) bias the brain toward the use of a specific memory system to control learned behavior and thereby influence the timing of the switch from the use of cognitive memory to habit learning to guide behavior.

Animals↗
PubMed2004

The vestibulo-ocular reflex as a model system for motor learning: what is the role of the cerebellum?

Motor systems are under a continuous adaptive process to maintain behavior throughout developmental changes and disease, a process called motor learning. Simple behaviors with easily measurable inputs and outputs are best suited to understand the neuronal signals that contribute to the required motor learning. Considering simple behaviors, the vestibulo-ocular reflex (VOR) allows quantification of its input and motor output and its neural circuitry is among the best documented. The main candidates for plastic change are the cerebellum and its target neurons in the brainstem. This review focuses on recent data regarding the involvement of the cerebellum in VOR motor learning. Learning can be divided into that acutely acquired over a period of hours and that chronically acquired over longer periods. Both acute and chronic learning have three phases named acquisition, consolidation, and retention. The cerebellar role in retention is disputed, but there is a consensus on the need of an intact cerebellum for acquisition. Data from neuronal recording, lesion studies and transgenic mouse experiments is complex but suggests that the signal representation in the cerebellum contains aspects of both motor output and sensory input. The cerebellum apparently uses different mechanisms for acute and chronic learning as well as for increases and decreases in VOR gain. Recent studies also suggest that the signal content in the cerebellum changes following learning and that the mechanisms used for chronic adaptation involve not only changes in a head velocity component but also in the efference copy of an eye movement command signal reaching Purkinje cells. This data leads to a new conceptual framework having implications for developing theories on the role of the cerebellum in motor learning and in the search for plastic elements within the VOR circuitry. For chronic learning we hypothesize that changes in the head velocity information traveling through the circuitry occur in parallel with changes in the integrator pathway and the efference copy pathway. We further propose that these changes are necessary to maintain the broadband characteristics of the learned behavior.

Animals↗
PubMed2005

Scene perception, gaze behavior, and perceptual learning in virtual environments.

More and more immersive environments are developed to provide support for learning or training purposes. Ecological validity of such environments is usually based on learning performance comparisons between virtual environments and their genuine counterparts. Little is known about learning processes occurring in immersive environments. A new technique is proposed for testing perceptual learning during virtual immersion. This methodology relies upon eye-tracking technologies to analyze gaze behavior recorded in relation to virtual objects' features and tasks' requirements. It is proposed that perceptual learning mechanisms engaged could be detected through eye movements. In this study, nine subjects performed perceptual learning tasks in virtual immersion. Results obtained indicated that perceptual learning influences gaze behavior dynamics. More precisely, analysis revealed that fixation number and variability in fixation duration varied with perceptual learning level. Such findings could contribute in shedding light on learning mechanisms as well as providing additional support for validating virtual learning environments.

Adult↗
PubMed1999

Non-motor associative learning in patients with isolated degenerative cerebellar disease.

In recent decades it has become clear that the cerebellum is involved in associative motor learning, but its exact role in motor learning as such is still controversial. Recently, a contribution of the cerebellum to different cognitive abilities has also been considered, but it remains unclear whether the cerebellum contributes to cognitive associative learning. We compared nine patients with an isolated cerebellar degenerative disease in a cognitive associative learning task with 10 controls. Patients and controls were matched for age, sex, handedness, level of education, intelligence and capabilities of visual memory. The subjects were asked to learn the association between six pairs of colours and numerals by trial and error. Additionally, a simple reaction time and a visual scanning test were conducted in order to control for the influence of motor performance deficits in cerebellar patients. In comparison with the controls, it took the patients significantly longer to learn the correct associations between colours and numerals, and they were impaired in recognizing them later on. Two patients showed no associative learning effect at all. Neither the simple reaction time nor the visual scanning time correlated substantially with the results of associative learning. Therefore, motor-associated disabilities are unlikely to be the reason for the learning deficit in cerebellar patients. Our results suggest that the cerebellum might contribute to motor-independent processes that are generally involved in associative learning.

Aged↗
PubMed2001

The role of the dorsolateral prefrontal cortex during sequence learning is specific for spatial information.

Many studies have implicated the dorsolateral prefrontal cortex in the acquisition of skill, including procedural sequence learning. However, the specific role it performs in sequence learning has remained uncertain. This type of skill has been intensively studied using the serial reaction time task. We used three versions of this task: a standard task where the position of the stimulus cued the response; a non-standard task where the color of the stimulus was related to the correct response; and a combined task where both the color and position simultaneously cued the response. We refer to each of these tasks based upon the cues available for guiding learning as position, color and combined tasks. The combined task usually shows an enhancement of skill acquisition, a result of being driven by two simultaneous and congruent cues. Prior to the performance of each of these tasks the function of the dorsolateral prefrontal cortex was disrupted using repetitive transcranial magnetic stimulation. This completely prevented learning within the position task, while sequence learning occurred to a similar extent in both the color and combined tasks. So, following prefrontal stimulation the expected learning enhancement in the combined task was lost, consistent with only a color cue being available to guide sequence learning in the combined task. Neither of these effects was observed following stimulation at the parietal cortex. Hence the critical role played by the dorsolateral prefrontal cortex in sequence learning is related exclusively to spatial cues. We suggest that the dorsolateral prefrontal cortex operates over the short term to retain and manipulate spatial information to allow cortical and subcortical structures to learn a predictable sequence of actions. Such functions may emerge from the broader role the dorsolateral prefrontal cortex has in spatial working memory. These results argue against the dorsolateral prefrontal cortex constituting part of the neuronal substrate responsible for general aspects of implicit or explicit sequence learning.

Adult↗
PubMedDate not supplied

Learning by selection in the trion model of cortical organization.

The basic issue of whether mammalian learning in cortex proceeds via a selection principle, as stressed by Edelman, versus an instructional one is of major importance. We present here a realization of selection learning in the trion model, which is based on the Mountcastle columnar organizational principle of cortex. We suggest that mammalian cortex starts out with an a priori connectivity between minicolumns that is highly structured in time and in space, competing between excitation and inhibition. This provides a "naive" repertoire of spatial-temporal firing patterns that stimuli and internal processing map onto. These patterns can be learned with small modifications to the connectivity strengths determined by a Hebbian learning rule. As various patterns are learned, the repertoire changes somewhat in order to respond properly to various stimuli, but the majority of all possible stimuli still map onto spatial-temporal firing patterns of the original repertoire. In order to show that the example presented here is showing true selectivity and is not an artifact of more stimuli evolving into the learned pattern, we develop a selectivity measure. We suggest that some form of instructional learning (in which connectivities are finely tuned) is present for difficult tasks requiring many trials, whereas very rapid learning involves selectional learning. Both types of learning must be considered to understand behavior.

Animals↗
PubMed2004

On the benefits of not trying: brain activity and connectivity reflecting the interactions of explicit and implicit sequence learning.

Under certain circumstances, implicit, automatic learning may be attenuated by explicit memory processes. We explored the brain basis of this phenomenon in a functional magnetic resonance imaging (fMRI) study of motor sequence learning. Using a factorial design that crossed subjective intention to learn (explicit versus implicit) with sequence difficulty (a standard versus a more complex alternating sequence), we show that explicit attempts to learn the difficult sequence produce a failure of implicit learning and, in a follow-up behavioural experiment, that this failure represents a suppression of learning itself rather than of the expression of learning. This suppression is associated with sustained right frontal activation and attenuation of learning-related changes in the medial temporal lobe and the thalamus. Furthermore, this condition is characterized by a reversal of the fronto-thalamic connectivity observed with unimpaired implicit learning. The findings demonstrate a neural basis for a well-known behavioural effect: the deleterious impact of an explicit search upon implicit learning.

Adult↗
PubMed2004

Prefrontal-hippocampal dynamics involved in learning regularities across episodes.

Using functional magnetic resonance imaging, the neural correlates of context-specific memories and invariant memories about regularities across episodes were investigated. Volunteers had to learn conjunctions between objects and positions. In an invariant learning condition, positions were held constant, enabling subjects to learn regularities across trials. By contrast, in a context-specific condition object-position conjunctions were trial unique. Performance increase in the invariant learning condition was paralleled by a learning-related increase of inferior frontal gyrus activation and ventral striatal activation and a decrease of hippocampus activation. Conversely, in the context-specific condition hippocampal activation was constant across trials. We argue that the learning-related hippocampal activation pattern might be due to reduced relational binding requirements once regularities are extracted. Furthermore, we propose that the learning-related prefrontal modulation reflects the requirement to extract and maintain regularities across trials and the adjustment of object-position conjunctions on the basis of the extracted knowledge. Finally, our data suggest that the ventral striatum encodes the increased predictability of spatial features as a function of learning. Taken together, these results indicate a transition of the relative roles of distinct brain regions during learning regularities across multiple episodes: regularity learning is characterized by a shift from a hippocampal to a prefrontal-striatal brain system.

Adult↗
PubMed2000

Nitric oxide synthetase inhibition hinders facilitation of active avoidance learning by nicotine in rats.

Nicotine produces dose-dependent enhancement of performance in an active avoidance test, and also increases the levels of NO2- and NO3-, which are stable metabolites of nitric oxide (NO), in various brain regions of rats. On the basis of these two observations, we hypothesized that the beneficial effect of nicotine on learning could result from increased NO in relevant brain regions. We therefore tested active avoidance performance in rats given L-Nomega-nitroarginine (L-NA) to inhibit NO synthetase (NOS) prior to nicotine administration. Male Sprague-Dawley rats received L-NA (30 or 50 mg/kg), nicotine (0.4 mg/kg), saline or combinations of these treatments before learning trials. Rats were also tested on the inclined plane, to assess the possible effects due to impairment of motor function by drug treatments on active avoidance learning. L-NA treatment impaired the acquisition of active avoidance learning, and this defect was partially overcome by the co-administration of nicotine. Nicotine facilitated learning and significantly increased the number of correct responses. The threshold for the effect of NOS inhibition on performance exceeded 30 mg/kg L-NA, whereas 50 mg/kg impaired learning and also eliminated the nicotine-induced enhancement of learning. On the fifth day of learning trials, no facilitation of learning by nicotine was observed in rats receiving either dose of L-NA. Our results suggest that NO is involved in the facilitation of active avoidance learning by nicotine.

Animals↗
PubMed2004

Perceptual learning in detoxified alcoholic men: contributions from explicit memory, executive function, and age.

BACKGROUND: Visuospatial and visuoperceptual deficits have consistently been observed in detoxified alcoholics; however, the severity of impairment varies with test and task type. Identifying the component processes and factors that underlie a particular deficit may reveal why some visuospatial and visuoperceptual tasks are more compromised than others and may lead to the specification of neural systems that are particularly vulnerable in alcoholism. METHODS: We examined visuoperception and perceptual learning with a picture fragment identification task in 51 recently detoxified nonamnesic alcoholic men (aged 29-66 years) compared with 63 normal control men (aged 21-70 years). Executive function and explicit declarative memory were also assessed. RESULTS: Despite deficits in the primary components of visuoperception and explicit memory for visuospatial stimuli, the alcoholics showed normal perceptual learning. Although the alcoholics and controls performed at comparable levels on the perceptual learning task, multiple regression analyses indicated that the factors accounting for perceptual learning variance differed between and within groups. Visuoperceptual abilities consistently predicted perceptual learning in the control subjects but not the alcoholic subjects. Explicit memory contributed to perceptual learning performance in both the alcoholic and control groups. Frontal executive ability consistently predicted perceptual learning in the alcoholic subjects, but it had predictive ability only in the control subjects as time elapsed. Age was significantly correlated with perceptual learning performance in both groups. Lifetime alcohol consumption, but not alcoholism duration, was an independent predictor of 1-hr perceptual learning. CONCLUSIONS: These correlational analyses suggest that controls invoke basic visuospatial processes to perform a perceptual learning task, whereas alcoholics invoke higher-order cognitive processes (i.e., frontal executive systems) to perform the same task at normal levels. Use of more demanding cognitive systems by the alcoholics may be less efficient and more costly to processing capacity than those invoked by controls.

Adult↗
PubMed2001

Explaining social learning of food preferences without aversions: an evolutionary simulation model of Norway rats.

Norway rats (Rattus norvegicus) transmit preferences for novel foods socially by smelling each other's breath. However, rats fail to learn aversions, acquiring a preference even if the rat whose breath they smell has been poisoned. Rats can distinguish between sick and healthy conspecifics and social learning of both preferences and aversions is present in other species - hence it is unclear why rats cannot learn aversions socially. We constructed an evolutionary simulation in which a population of rats foraged from a central location, exploiting food sites that could contain edible or toxic foodstuffs. We examined the relationship between toxin lethality and selection for individual versus social learning and discrimination between sick and healthy conspecifics in order to allow learning of both preferences and aversions. At low lethality levels individual learning was selected for and at intermediate levels we found social learning of both preferences and aversions. Finally, given high lethality levels the simulated rats would employ social learning but failed to learn aversions, matching the behaviour of real rats. We argue that Norway rats do not learn aversions socially because their environment may contain only highly lethal toxins which make interaction with a sick conspecific an extremely rare event.

Animals↗
PubMed2006

Developmental learning with behavioral mode tuning by carrier-frequency modulation in coherent neural networks.

We propose a developmental learning architecture with which a motion-control system learns multiple tasks similar to each other or advanced ones incrementally and efficiently by tuning its behavioral mode. The system is based on a coherent neural network whose carrier frequency works as a mode-tuning parameter. In our experiments, we consider two tasks related to bicycle riding. The first is to ride as temporally long as the system can before it falls down (task 1). The second is an advanced one, i.e., to ride as far as possible in a certain direction (task 2). We compare developmental learning to learn task 2 after task 1 with the direct learning of task 2. We also examine the effect of the mode tuning by comparing variable-mode learning (VML), where the carrier frequency is set free to move, with fixed-mode learning (FML), where the frequency is unchanged. We find that VML developmental learning results in the most efficient learning among the possible combinations. We discuss the effects of the incremental task assignment as well as the behavioral mode tuning in developmental learning.

Adaptation, Physiological↗
PubMed2006

Robust and fast learning for fuzzy cerebellar model articulation controllers.

In this paper, the online learning capability and the robust property for the learning algorithms of cerebellar model articulation controllers (CMAC) are discussed. Both the traditional CMAC and fuzzy CMAC are considered. In the study, we find a way of embeding the idea of M-estimators into the CMAC learning algorithms to provide the robust property against outliers existing in training data. An annealing schedule is also adopted for the learning constant to fulfill robust learning. In the study, we also extend our previous work of adopting the credit assignment idea into CMAC learning to provide fast learning for fuzzy CMAC. From demonstrated examples, it is clearly evident that the proposed algorithm indeed has faster and more robust learning. In our study, we then employ the proposed CMAC for an online learning control scheme used in the literature. In the implementation, we also propose to use a tuning parameter instead of a fixed constant to achieve both online learning and fine-tuning effects. The simulation results indeed show the effectiveness of the proposed approaches.

Algorithms↗
PubMed1992

Learning from experience in the community: an ethnographic study of district nurse students.

This study seeks to gain an understanding of the learning experiences of district nurse students in the learning environment of the community, and to examine learning in the practice setting from the perspective of the student. Since the research depends upon the changing and differing interpretations of the individuals involved in the natural setting of the community, an ethnographic approach has been adopted. The experiences of students are monitored throughout the taught practice element of the district nurse course in both inner city and rural/urban locations. Data, collected through interview and observations, are analysed in the context of theory relating to adult learning and learning from experience. Three major categories are identified. Examples from these categories are identified and discussed. The categories are sequential and represent the learning process experienced by the students in the practice setting as they learn to fit into a new environment, test out their own ideas and compare the unreality of college with the reality of practice. Attention is drawn to the difficulties for students of fitting into new settings and trying out change, to the detrimental effect on learning of rigid practice routines and to the powerlessness of community practice teachers to exert a major influence on the learning environment. These issues are discussed in the context of changes in nurse education and evaluation of the community learning environment.

Community Health Services↗