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PubMed2006

A case for learning-centered curricula.

Nurses must be able to anticipate and manage the care of patients with complex conditions in a rapidly changing, highly technological health care environment. Yet many of today's nursing programs are failing to provide curricula to meet the changing needs of students who will work in that environment. Typical teacher-centered programs are content heavy and focus on what faculty want to teach, not what students need to learn. Learning-centered education shifts the focus from teaching to student learning. Learning-centered programs identify student learning outcomes that are reflective of current nursing practice, use authentic assessment, and provide learning experiences that move students toward the achievement of outcomes. This article describes the major benefits of a learning-centered curriculum, and a model depicts the dynamic relationship among learning experiences, assessment, and student learning outcomes. We also offer suggestions for nursing faculty who are considering the move from teacher-centered to learning-centered curricula.

Adult↗
PubMed2006

[Knowledge and learning needs related to cancer treatment in gynecological cancer patients].

PURPOSE: This study was to investigate the knowledge and learning needs of chemotherapy in gynecological cancer patients. METHOD: The subjects consisted of 103 gynecological cancer patients receiving chemotherapy from April 2005 to August 2005. Data was collected using a questionnaire about knowledge and learning needs of chemotherapy. The data was analyzed by t-test, ANOVA, Scheffe test, and Pearson's correlation coefficient using SAS. RESULT: Average scores of knowledge and learning needs of general treatment and care were 2.74, and 3.30 respectively. Average score of knowledge and learning needs of chemotherapy were 2.54, and 3.23 respectively. Learning needs of general treatment and care and of chemotherapy were significantly different in relation to marital status, educational level, family support, the operation, and the amount of chemotherapy received. Items with the highest level of learning needs were the symptoms of recurring illness of general treatment, and minimizing side effects of chemotherapy. There were a negative correlation between knowledge and learning needs on general treatment and a positive correlation between knowledge and learning needs on chemotherapy but there were not significant statistically. CONCLUSION: The level of learning needs related to cancer treatment was high, whereas, that of knowledge was low. Therefore, when designing an educational program for gynecological cancer patients, understanding of learning needs is necessary. Also, consideration of a patient's characteristics, and a systematic and detailed educational program should be provided.

Adult↗
PubMedDate not supplied

Building a learning organization.

Continuous improvement programs are proliferating as corporations seek to better themselves and gain an edge. Unfortunately, however, failed programs far outnumber successes, and improvement rates remain low. That's because most companies have failed to grasp a basic truth. Before people and companies can improve, they first must learn. And to do this, they need to look beyond rhetoric and high philosophy and focus on the fundamentals. Three critical issues must be addressed before a company can truly become a learning organization, writes HBS Professor David Garvin. First is the question of meaning: a well-grounded, easy-to-apply definition of a learning organization. Second comes management: clearer operational guidelines for practice. Finally, better tools for measurement can assess an organization's rate and level of learning. Using these "three Ms" as a framework, Garvin defines learning organizations as skilled at five main activities: systematic problem solving, experimentation with new approaches, learning from past experience, learning from the best practices of others, and transferring knowledge quickly and efficiently throughout the organization. And since you can't manage something if you can't measure it, a complete learning audit is a must. That includes measuring cognitive and behavioral changes as well as tangible improvements in results. No learning organization is built overnight. Success comes from carefully cultivated attitudes, commitments, and management processes that accrue slowly and steadily. The first step is to foster an environment conducive to learning. Analog Devices, Chaparral Steel, Xerox, GE, and other companies provide enlightened examples.

Diffusion of Innovation↗
PubMed1999

Modulation of learning and anxiety by corticotropin-releasing factor (CRF) and stress: differential roles of CRF receptors 1 and 2.

The differential modulation of learning and anxiety by corticotropin-releasing factor (CRF) through CRF receptor subtypes 1 (CRFR1) and 2 (CRFR2) is demonstrated. As learning paradigm, context- and tone-dependent fear conditioning of the mouse was used. Injection of CRF into the dorsal hippocampus before training enhanced learning through CRFR1 as demonstrated by the finding that this effect was prevented by the local injection of the unselective CRFR antagonist astressin, but not by the CRFR2-specific antagonist antisauvagine-30 (anti-Svg-30). In contrast, injection of CRF into the lateral intermediate septum impaired learning through CRFR2, as demonstrated by the ability of antisauvagine-30 to block this effect. When antisauvagine-30 was injected alone into the lateral intermediate septum, learning was enhanced. Such tonic control of learning was not observed when astressin or antisauvagine-30 was injected into the dorsal hippocampus. Injection of CRF after the training into the dorsal hippocampus and the lateral intermediate septum also enhanced and impaired learning, respectively. Thus, it was indicated that CRF acted on memory consolidation. It was concluded that the observed effects reflected changes of associative learning and not arousal, attention, or motivation. Although a dose of 20 pmol human/rat CRF was sufficient to affect learning significantly, a fivefold higher dose was required to induce anxiety by injection into the septum. Immobilization for 1 hr generated a stress response that included the induction of anxiety through septal CRFR2 and the subsequent enhancement of learning through hippocampal CRFR1. The involvement of either receptor subtype was demonstrated by region-specific injections of astressin and antisauvagine-30.

Acoustic Stimulation↗
PubMed1999

Development of topography within song control circuitry of zebra finches during the sensitive period for song learning.

Refinement of topographic maps during sensitive periods of development is a characteristic feature of diverse sensory and motor circuits in the nervous system. Within the neural system that controls vocal learning and behavior in zebra finches, axonal connections of the cortical nucleus lMAN demonstrate striking functional and morphological changes during vocal development in juvenile males. These circuits are uniquely important for song production during the sensitive period for vocal learning, and the overall size of these brain regions and their patterns of axonal connectivity undergo dramatic growth and regression during this time. Axonal connections to and from lMAN are topographically organized in adult males that have already learned song. We wondered whether the large-scale changes seen in lMAN circuitry during the time that vocal behavior is being learned and refined could be accompanied by the emergence of topographic mapping. However, results presented herein demonstrate that most of these song-control circuits show the same broad patterns of axonal connectivity between subregions of individual nuclei at the onset of song learning as seen in adult birds. Thus, coarse topographic organization is not dependent on the types of experience that are crucial for vocal learning. Furthermore, this maintenance of topographic organization throughout the period of song learning is clearly not achieved by maintenance of static axonal arbors. In fact, because the volumes of song-control nuclei are growing (or regressing), topography must be maintained by active remodeling of axonal arbors to adapt to the changes in overall size of postsynaptic targets. A salient exception to this pattern of conserved topography is the projection from lMAN to the motor cortical region RA: this pathway is diffusely organized at the onset of song learning but undergoes substantial refinement during early stages of song learning, suggesting that remodeling of axonal connections within this projection during the period of vocal learning may signify the production of increasingly refined vocal utterances.

Aging↗
PubMed1999

Learning organizations: an introduction.

Many believe that successful companies beyond the year 2000 will all need to operate as learning organizations. Stimulating this vision have been Dr. Peter Senge of the Massachusetts Institute of Technology and Dr. James Milojkovic of Stanford University. As a learning organization, all members of a company will learn more about other parts of the organization and more about essential processes such as: helping each other learn, sharing, cooperating, leading, and participating in organizational decisions. This learning together will change existing stratifications, such as "bosses make decisions and employees implement the decisions without being consulted." A learning organization is a group of very different people who work together closely; bosses learn to treat each person as a responsible adult and hourly employees learn to participate in decisions. Learning organizations have a strong commitment to continual change. Each participant is expected to personally learn and grow. Everyone is expected to be open and share information, all while being tactful. The question that is continually before everyone in the company is "how can we do better?"

Decision Making, Organizational↗
PubMedDate not supplied

Procedural learning in schizophrenia: further consideration on the deleterious effect of neuroleptics.

Deficits in procedural learning remain a controversial issue in schizophrenia. This may be related to the nature of the neuroleptic treatment of schizophrenic patients as conventional neuroleptics may be more deleterious than new atypical neuroleptics. However, there is no comparative study on the effect of specific neuroleptics on procedural learning. In this study, three groups of patients treated with different neuroleptics were compared to normal controls on two procedural learning tasks. In a visuo-motor task, patients and controls showed similar learning rates, although schizophrenic patients showed generally lower performances than normal controls. However, patients treated with a conventional neuroleptic, but not those treated with the atypical neuroleptics, showed many fluctuations during the initial learning phase. In a problem-solving task, all groups were comparable in performance and learning fluctuations, but learning rates were lower in patients treated with the neuroleptic showing the higher incidence of extrapyramidal symptoms. This suggests that procedural learning abilities may be significantly affected by neuroleptics in schizophrenia, although the effect may differ between tasks and the specific neuroleptics. Fluctuations in the initial learning phase of the visuo-motor task probably results from a frontal dysfunction while reduced learning rates, such as those observed in the problem solving task, may be attributed to a striatal dysfunction. This is concordant with the differential pharmacological actions of the conventional and atypical neuroleptics in these two cerebral areas.

Adult↗
PubMed2006

Students' perceptions of effective learning experiences in dental school: a qualitative study using a critical incident technique.

Students' views of their educational experience can be an important source of information for curriculum assessment. Although quantitative methods, particularly surveys, are frequently used to gather such data, fewer studies have employed qualitative methods to examine students' dental education experiences. The purpose of this study is to explore characteristics of effective learning experiences in dental school using a qualitative method. All third-year (seventy) and fourth-year (seventy) dental students enrolled in one midwestern dental school were invited to participate. Fifty-three dental students (thirty-five male and eighteen female; thirty-two third-year and twenty-one fourth-year) were interviewed using a critical incident interview technique. Each student was asked to describe a specific, particularly effective learning incident that he or she had experienced in dental school and a specific, particularly ineffective learning incident, for comparison. Each interview was audiotaped. Students were assured that only the interviewer and one additional researcher would have access to the tapes. Data analysis resulted in identification of key themes in the data describing characteristics of effective learning experiences. The following characteristics of effective learning experiences were identified: 1) instructor characteristics (personal qualities, "checking-in" with students, and an interactive style); 2) characteristics of the learning process (focus on the "big picture," modeling and demonstrations, opportunities to apply new knowledge, high-quality feedback, focus, specificity and relevance, and peer interactions); and 3) learning environment (culture of the learning environment, technology). Common themes emerged across a wide variety of learning incidents. Although additional research is needed, the characteristics of effective learning experiences identified in this study may have implications for individual course design and for the dental school curriculum as a whole.

Attitude of Health Personnel↗
PubMedDate not supplied

Cognitive, affective, and transfer of learning consequences of computer-assisted instruction.

The effect of computer-assisted instruction (CAI) versus lecture-discussion (LD) on cognitive learning, transfer of learning, and affective behaviors of nurse practitioner students was tested by the following hypotheses: The experimental (E) group will learn, transfer, and demonstrate affective behaviors significantly more than the control (C1 group. Subjects were 31 nurse practioner students at the graduate level. Content taught was the nursing and medical management of hypertensive patients. The 14 E group subjects were taught by means of CAI. The 17 C group subjects were taught by means of LD. Pre- and posttests were done to obtain meassures on cognitive learning and transfer of learning. Demographic data and affective measures were obtained only at the posttest. The hypotheses were tested by means of t test. Pearson's r and MCNemar's Test for Symmetry were done to test the relationship between the variables. Results showed no significant differences between the groups in congitive learning, transfer of learning, or affective behaviors. There were, however, significant differences between the groups in three posttest scores on cognitive learning and transfer of learning, with the E group scoring better. Both groups learned significantly, but only the E group transferred significantly. Implications were made for education of nurse practitioners and staff.

Adult↗
PubMed1993

The neurophysiological basis of learning: attention and memory implications for SCI nurses.

Understanding the neurophysiological basis of learning enables nurses working with individuals with spinal cord injury to astutely assess potential for learning. This is particularly relevant when head injury or drug effects influence neurological systems relevant to learning. The neuroanatomical and neurophysiological bases of learning are related to attention, memory, concept formation/abstraction, reasoning, and executive systems. Attention and memory are discussed as they relate to learning in this article. This information is incorporated into an expanded assessment (Ciminaro, Calhoun, & Adams, 1977; Gazzaniga 1979; Lezak, 1983: Mesulam, 1985). More in-depth nursing assessment related to cognitive systems necessary for learning enables nurses to identify intact and impaired cognitive systems and to quantify deficits. Astute assessment is fundamental to planning effective teaching and learning strategies for spinal cord injured persons especially when learning deficits exist, e.g., in head injured persons who have sustained a spinal cord injury. Implications for client and family education derive from an understanding of the normal neurophysiological basis of learning and normal and abnormal assessment findings. Learning is dependent on several cognitive systems--attention systems, memory systems, concept formation/abstraction and reasoning systems, and the "executive" system. Attention and memory systems are discussed in this article, the remainder will be discussed in the next issue. The neuroanatomy and neurophysiology, clinical findings associated with normal and abnormal function, and nursing implications for the nurse working with individuals with spinal cord injury will be explored.

Attention↗
PubMed1994

Sun compass-based spatial learning impaired in homing pigeons with hippocampal lesions.

The hippocampal formation is known to be critical for spatial cognition, for example, regulating the learning of environmental maps. But how is a spatial map learned, and what is the role of the hippocampal formation in the learning process? The sun compass is perhaps the most ubiquitous, naturally occurring spatial orientation mechanism found in the animal kingdom. The sun compass may also serve as a directional reference that supports spatial learning. We report that homing pigeons with hippocampal lesions were unable to use the sun compass to learn the directional location of food in an outdoor, experimental arena. Homing pigeons with lesions of the caudal neostriatum readily learned the same task, and showed appropriately shifted directional responses following a clock-shift manipulation demonstrating that they were indeed using the sun compass to learn the task. Finally, both hippocampal and control lesioned birds quickly learned a procedurally similar task where a color cue identified the location of food in the same experimental arena. The results indicate that hippocampal lesions impair sun compass use in the context of learning. As such, the results support the hypothesis that the importance of the hippocampal formation in spatial cognition may be related to its participation in a neural process in which information from a directional reference, in this case the sun compass, is used to learn the directional relationship among stimuli in space.

Animals↗
PubMed1994

Learning styles of nurse anesthesia students related to level in a master of science in nursing program.

To alleviate the shortage of anesthetists, nurse anesthesia programs are expanding and new programs are being developed while they simultaneously move into the master's degree framework. Students' learning style preferences can provide valuable information for educators engaged in facilitating and enhancing learning. This study identified the learning styles of nurse anesthesia students enrolled in 12 programs that confer a master of science in Nursing degree in relation to the students' gender and level in an anesthesia program. Learning profiles were determined by scores on the Learning Style Inventory (Kolb, 1985). A personal data sheet was used to elicit the students' demographic characteristics. Surveys were administered to a sample of 264 nurse anesthesia students, with 164 usable responses (62.8%). Results indicated a preference for the assimilator learning style (37.2%). A statistically significant relationship between learning style and level in an anesthesia program was found (chi-square = 11.14, df = 3, P < .05). Whereas students who had completed fewer than 12 months in an anesthesia program showed no dominant preference for a learning style, students who had completed more than 12 months were predominantly distributed in two learning style categories: assimilators (40.0%) and convergers (38.8%). No statistically significant relationships were identified between learning styles and gender.

Adult↗
PubMed1998

Robot-aided functional imaging: application to a motor learning study.

The purpose of this study was to examine the neural activity underlying an implicit motor learning task. In particular, our goals were to determine whether initial phases of procedural learning of a motor task involve areas of the brain distinct from those involved in later phases of learning the task, and what changes in neural activity coincide with performance improvement. We describe a novel integration of robotic technology with functional brain imaging and its use in this study of implicit motor learning. A portable robotic device was used to generate forces that disturbed the subjects' arm movements, thereby generating a "virtual mechanical environment" that the subjects learned to manipulate. Positron emission tomography (PET) was used to measure indices of neural activity underlying learning of the motor task. Eight health, right-handed male subjects participated in the study. Results support the hypothesis that different stages of implicit learning (early and late implicit learning) occur in an orderly fashion, and that distinct neural structures may be involved in these different stages. In particular, neuroimaging results indicate that the cortico-striatal loop may play a significant role during early learning, and that the cortico-cerebellar loop may play a significant role during late learning.

Adult↗
PubMed2006

Tonic dopaminergic stimulation impairs associative learning in healthy subjects.

Endogenous dopamine plays a central role in salience coding during associative learning. Administration of the dopamine precursor levodopa enhances learning in healthy subjects and stroke patients. Because levodopa increases both phasic and tonic dopaminergic neurotransmission, the critical mechanism mediating the enhancement of learning is unresolved. We here probed how selective tonic dopaminergic stimulation affects associative learning. Forty healthy subjects were trained in a novel vocabulary of 45 concrete nouns over the course of 5 consecutive training days in a prospective, randomized, double-blind, placebo-controlled design. Subjects received the tonically stimulating dopamine-receptor agonist pergolide (0.1 mg) vs placebo 120 min before training on each training day. The dopamine agonist significantly impaired novel word learning compared to placebo. This learning decrement persisted up to the last follow-up 4 weeks post-training. Subjects treated with pergolide also showed restricted emotional responses compared to the PLACEBO group. The extent of 'flattened' affect with pergolide was related to the degree of learning inhibition. These findings suggest that tonic occupation of dopamine receptors impairs learning by competition with phasic dopamine signals. Thus, phasic signaling seems to be the critical mechanism by which dopamine enhances associative learning in healthy subjects and stroke patients.

Adult↗
PubMed2006

Increased expression of 5-HT6 receptors in the rat dorsomedial striatum impairs instrumental learning.

A number of studies have shown that systemic 5-HT(6) receptor antagonists can improve learning and memory, but the mechanism for these observations is not known. As striatum normally expresses 5-HT(6) receptors abundantly and is important in consolidating stimulus-response learning, we used targeted gene delivery to further increase the expression of 5-HT(6) receptors in rat striatum and then examined learning. Increased 5-HT(6) expression had no effect on performance in the Morris water maze, a hippocampal-dependent learning paradigm, and did not alter the latency to approach or consume sucrose tablets. However, rats with increased 5-HT(6) expression failed to acquire a reward-based instrumental learning task, a striatum-dependent learning model, during 3 days of successive sessions as compared to sham surgery or GFP-expressing control rats. This behavioral deficit was observed in rats overexpressing 5-HT(6) receptors in the dorsomedial striatum, but not in rats with increased dorsocentral striatal expression. The 5-HT(6) receptor-associated deficit was reversed by administration of a 5-HT(6) antagonist, SB-258585, before each training session. When animals learned the instrumental learning task before gene transfer, increased 5-HT(6) receptor expression had no effect on long-term recall or performance of the task or on extinction of operant responding. Thus, 5-HT(6) receptor activity in rat striatum disrupts acquisition of new instrumental learning but does not impair memory or performance of reward-motivated behavior once established.

Animals↗
PubMed1997

Transfer and Complexity in Artificial Grammar Learning

Implicit and explicit learning are sensitive to various degrees of complexity and abstractness, ranging from knowledge of first-order dependencies and specific surface structure to second-order dependencies and transfer. Three experiments addressed whether implicit learning is sensitive to this entire range of information or whether explicit knowledge becomes an important factor in cases of more complex learning. Experiment 1 used recognition and prediction to assess deliberate access to knowledge of letter patterns in an artificial grammar learning paradigm. Experiment 2 manipulated stimulus presentation and response in a sequence-based grammar learning paradigm. Learning can occur without awareness in cases of lesser complexity (such as learning first-order dependencies). However, more complex learning, such as that involved in learning second-order dependencies or in transfer to stimuli with the same underlying syntax but new surface features is linked to explicit knowledge. In contrast to Experiments 1 and 2 which assessed deliberate access to knowledge of the acquisition stimuli, Experiment 3 assessed deliberate access to knowledge of the transfer stimuli. Knowledge of initial trigrams in the transfer stimuli appears to play an important role in transfer. These findings are evaluated in terms of postulated implicit learning mechanisms.

Journal Article↗
PubMed1988

Heterosis and resistance to DFP effects on spatial learning in C57BL X DBA hybrids.

The inbred mouse strains C57BL/6Ibg and DBA/2Ibg differ in their ability to exhibit spatial learning in the Morris water task. C57BL mice learn the task well and show impairment of spatial learning following disruption of cholinergic function. DBA mice show rudimentary spatial learning ability, and are not further impaired when cholinergic function is decreased. These mice may carry genes regulating a noncholinergic spatial learning system. To test this hypothesis, first generation (F1) hybrids between DBA and C57BL mice were tested for spatial learning in the Morris water task. The hybrids performed better than either parental strain, suggesting that both parents contributed genes for spatial learning ability. Chronic treatment with diisopropylfluorophosphate (DFP), which abolished spatial learning ability in C57BL mice, produced only minor impairments in the hybrids. The behavioral resistance to DFP occurred despite significant reductions in hippocampal and cortical muscarinic binding. The results suggest either that the hybrids inherited a noncholinergic neurochemical system influencing spatial learning from their DBA parents or that the DFP treatment did not disrupt cholinergic function to a sufficient degree to impair the superior learning abilities of the F1 hybrids.

Acetylcholinesterase↗
PubMed2005

An incremental EM-based learning approach for on-line prediction of hospital resource utilization.

OBJECTIVE: Inpatient length of stay (LOS) is an important measure of hospital activity, health care resource consumption, and patient acuity. This research work aims at developing an incremental expectation maximization (EM) based learning approach on mixture of experts (ME) system for on-line prediction of LOS. The use of a batch-mode learning process in most existing artificial neural networks to predict LOS is unrealistic, as the data become available over time and their pattern change dynamically. In contrast, an on-line process is capable of providing an output whenever a new datum becomes available. This on-the-spot information is therefore more useful and practical for making decisions, especially when one deals with a tremendous amount of data. METHODS AND MATERIAL: The proposed approach is illustrated using a real example of gastroenteritis LOS data. The data set was extracted from a retrospective cohort study on all infants born in 1995-1997 and their subsequent admissions for gastroenteritis. The total number of admissions in this data set was n = 692. Linked hospitalization records of the cohort were retrieved retrospectively to derive the outcome measure, patient demographics, and associated co-morbidities information. A comparative study of the incremental learning and the batch-mode learning algorithms is considered. The performances of the learning algorithms are compared based on the mean absolute difference (MAD) between the predictions and the actual LOS, and the proportion of predictions with MAD < or = 1 day (Prop(MAD < or = 1)). The significance of the comparison is assessed through a regression analysis. RESULTS: The incremental learning algorithm provides better on-line prediction of LOS when the system has gained sufficient training from more examples (MAD = 1.77 days and Prop(MAD < or = 1) = 54.3%), compared to that using the batch-mode learning. The regression analysis indicates a significant decrease of MAD (p-value = 0.063) and a significant (p-value = 0.044) increase of Prop(MAD < or = 1) with the incremental learning algorithm. CONCLUSIONS: The incremental learning feature and the self-adaptive model-selection ability of the ME network enhance its effective adaptation to non-stationary LOS data. It is demonstrated that the incremental learning algorithm outperforms the batch-mode algorithm in the on-line prediction of LOS.

Algorithms↗