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Pathology in the new medical curriculum: what has replaced the subject courses?

In line with the UK General Medical Council recommendations, the traditional, taught curriculum at Liverpool was replaced from 1996 by a new one using problem-based learning (PBL) as its principal method of information transfer. There is integration of clinical and preclinical studies, coupled with a reduction in the factual knowledge content and the disappearance of identifiable separate subject courses. Learning is now student-centred. This requires a new approach to the acquisition of pathology knowledge. 1. Pathology is included in all relevant PBL case scenarios by pathology representation on module planning and review committees. 2. Special study modules (SSMs) allow students to observe the practice of pathology including surgical and autopsy work, carry out a detailed study and write a dissertation. Career selectives are provided for individual students in the final year. 3. Clinicopathological (CPC) teaching meetings are held, with the discussion of case examples, clinicians and students contributing. 4. Assessments include the input of appropriate pathology content, integrated with other subjects. 5. A pathology teaching website is provided, containing images, notes, self-assessment questions, handouts, timetables and information. Although the 1996 intake have not yet completed their studies, the results of in-course assessments have been encouraging. The response to the pathology SSMs has been very positive, and the level of presentations and dissertations reached is of a high standard. With the disappearance of a separate subject course in pathology, the subject is being learned by other routes, and the students will complete their undergraduate course with a sound basis for proceeding with their further studies.

Curriculum↗

Learning helpers: how they facilitated improvement and improved facilitation--lessons from a hospital-wide quality improvement initiative.

Quality improvement is a leading approach to the difficult yet inevitable task of managing organizational change. The literature suggests that facilitators can help organizations apply improvement principles and tools but it is unclear how facilitators actually do this and how they develop their own skills. Using a case study design we therefore examined how facilitators worked with 93 improvement projects in over 1000 sessions at one Swedish university hospital where systematic process improvement was successfully established over a 5-year period. They facilitated improvement by providing a framework and methods' support for improvement efforts--relying on experiential learning rather than didactic teaching--while letting clinical teams and managers maintain control over the content of improvement projects. They developed extensive experience that they documented and could transfer between teams, so that each team could benefit from lessons learned elsewhere. They improved facilitation through participant feedback and systematic review and reflection regarding their own practice. We suggest that facilitators can help organizations manage change by assuming responsibility for demanding tasks related to improvement work, developing specialized skill and extensive experience regarding improvement, and transferring insights across the organization, while using a learning approach throughout including to their own work.

Hospitals, University↗

Sensation seeking, paired associate learning and brain catecholamines.

Paired associate learning performance and strategies were analyzed in terms of learning situations (training vs. 'contextual' and 'noncontextual' transfer), personality factors [Thrill and adventure seeking (TAS) and disinhibition (Dis)] and catecholamine enzyme activity [dopamine-beta-hydroxylase (DBH) and monoamine-oxydase (MAO)]. Performance was better in transfer situations, in high MAO-high DBH subjects (high catecholamine turnover rate?), and as a negative function of DBH (preponderance of dopaminergic activity?). Error patterns of response selection (high omission and low intrusion error rate) were found to be a positive function of contextual transfer, TAS and DBH (high response-contingent noradrenergic activity?).

Adult↗

Neural plasticity in adults with amblyopia.

Amblyopia is a neuronal abnormality of vision that is often considered irreversible in adults. We found strong and significant improvement of Vernier acuity in human adults with naturally occurring amblyopia following practice. Learning was strongest at the trained orientation and did not transfer to an untrained task (detection), but it did transfer partially to the untrained eye (primarily at the trained orientation). We conclude that this perceptual learning reflects alterations in early neural processes that are localized beyond the site of convergence of the two eyes. Our results suggest a significant degree of plasticity in the visual system of adults with amblyopia.

Adult↗

Transvaginal embryo transfer during the zygote intrafallopian tube transfer procedure.

OBJECTIVE: Our purpose was to evaluate a tactile non-ultrasonographically directed approach to transvaginal tubal cannulation and embryo transfer during the zygote intrafallopian tube transfer procedure. STUDY DESIGN: We studied the application of the tactile approach to transvaginal tubal cannulation and embryo transfer in 68 consecutive zygote intrafallopian tube transfer cycles. RESULTS: The tactile approach to transvaginal tubal cannulation and subsequent embryo transfer was successful in 93% of couples. Pregnancy occurred in 16 of the 63 (25%) women undergoing a successful transvaginal embryo transfer. CONCLUSION: The tactile approach to transvaginal tubal cannulation was found to be easily learned and provided a safe and convenient method of tubal embryo transfer. This low-cost approach, which has application to transfer of both embryos and gametes, deserves further study.

Catheterization↗

Isotope effects in the study of enzymatic phosphoryl transfer reactions.

Protein-tyrosine phosphatases and serine/threonine protein phosphatases utilize very different catalytic machinery to catalyze phosphoryl transfer reactions. Tyrosine is a better leaving group than serine or threonine, having a pK(a) more than three units lower. Has the difference in the catalytic machinery used by these enzyme families evolved as a result of the difference in the lability of their substrates? Are the transition states for phosphoryl transfer similar for the two classes of enzymes? This review summarizes what has been learned from kinetic isotope effects about the nature of enzymatic phosphoryl transfer, and how the enzymatic mechanisms compare to uncatalyzed phosphoryl transfer reactions.

Animals↗

Timing light and tone signals in pigeons.

Pigeons' ability to time light and tone stimuli was examined in four experiments. In Experiment 1, two groups of pigeons were trained to discriminate between 2- and 8-s durations of lights or tones and then were transferred to reversal or nonreversal discriminations in the alternate modality. Pigeons learned the light discrimination faster than the tone discrimination and showed immediate positive intermodal transfer from tone to light but not from light to tone. In Experiments 2-4, the peak procedure was used to study birds' timing of 15- and 30-s fixed-interval light and tone signals. Peak times on empty trials under baseline conditions closely approximated the length of fixed-interval signals. When pigeons were tested with time-outs and intermodal switches introduced midway through an empty trial, they tended to reset the timing mechanism and begin timing again from 0 s. With both estimation and production procedures, pigeons were less accurate when timing the tone stimuli than when timing the light stimuli. A comparison of these data with data from timing experiments with rats suggests several possible differences in timing processes between pigeons and rats.

Animals↗

Adoptive transfer of experimental autoimmune uveoretinitis in rats. Immunopathogenic mechanisms and histologic features.

In order to learn about the immunopathogenic mechanisms of experimental autoimmune uveoretinitis (EAU), the capacity of lymphocytes to transfer the disease was studied. EAU was transferred to naive syngeneic rats by intraperitoneal injection of spleen or lymph node (LN) cells from S-antigen immunized rats, following their incubation in culture with either S-antigen or concanavalin A (Con A). In contrast, the same cells did not cause inflammatory changes in the recipient eyes when injected intravitreally. The identity of the lymphocytes that transfer EAU was determined by using monoclonal antibody enriched subsets of lymphocytes. EAU was transferred by the subset of helper/inducer T-cells, but not by T-cells of the suppressor/cytotoxic subset. Recipient rats of spleen or LN cells cultured with S-antigen exhibited both humoral and cellular immune responses to S-antigen. On the other hand, recipients of spleen cells cultured with Con A developed only cellular immune response to S-antigen. Yet, both groups of recipients fully developed EAU. The clinical and histologic changes in recipient rats closely resembled those in rats in which EAU was induced by active immunization. Severe tissue damage occurred at the photoreceptor cell layer, but inflammatory infiltration also was found in other ocular tissues. Involvement of polymorphonuclear leukocytes (PMNs) was noted throughout ocular tissues even in the eyes of recipients with no detectable antibodies to S-antigen, suggesting that the ocular PMNs infiltration in rats is not necessarily the result of an Arthus-like inflammatory process.

Animals↗

Influence of antidepressant drugs on learning and memory paradigms in mice.

Effect of antidepressant drugs (amitriptyline, imipramine and fluoxetine) on cognitive functions, impaired by the muscarinic antagonist scopolamine were investigated in mice. The changes in learning and memory tasks were studied using transfer latency on elevated plus maze and employing number of descents in passive avoidance paradigms. Amitriptyline and imipramine showed significant memory impairment. They also potentiated scopolamine-induced memory deficit in a significant way. Amitriptyline and imipramine impair cognitive function possibly due to their anticholinergic properties. Fluoxetine, a newer antidepressant, however showed no effect on learning and memory. It significantly reversed the scopolamine-induced memory impairment in both the tests. Fluoxetine with no anticholinergic property may prove to be a better drug in endogenous depression in elderly patients.

Aged↗

Planning and evaluation of cross-cultural health education activities.

This paper was written to assist health professionals who are or who are planning to undertake health education activities with people of a different culture. The focus is on the educative function of health promotion. A short summary of relevant learning theory is presented. Some obstacles (pitfalls) encountered in cross-cultural transfer of information, knowledge and skills are presented and the effects of this learning process on the learner and teacher are explored. Examples of possible conflict situations drawn from the author's experiences and research are presented. Variables which influence planning and implementation of health education in cross-cultural settings are examined. A cyclical model which identifies critical questions to be asked and decisions to be made in a four-phased process of assessment, planning, implementation and evaluation is described for the use of health educators in transcultural settings. The need for systematic cultural assessment prior to planning is stressed to ensure relevancy, acceptance and positive outcome of programmes. Cooperative efforts of health educators with existing systems and traditional teachers and involvement of clients during all phases of the decision making process are suggested.

Canada↗

Technology transfer of neuroprosthetic devices.

Despite long development periods for neuroprosthetic devices, the numbers in clinical use or clinical trials are rising, with an estimated 3,000 systems in use today. As they gain experience with the regulatory approval process, developers are learning to conduct research to best prepare for transfer of technology to industry. The track record of the first motor prosthesis to be approved by the United States Food and Drug Administration contains important lessons for a company planning to undergo the regulatory process. Throughout the development of a neuroprosthesis, the capabilities and preferences of the customers who will use it (physicians, surgeons, therapists, and end-users) should be sought out and used in device design. When a device has reached clinical application, particular attention is needed to maximize both the population who will use it and each individual's degree of use (optimal, partial, reluctant). Identification of person-technology mismatches can help to select training strategies and other interventions that can be applied to ensure a good rehabilitation outcome.

Clinical Trials as Topic↗

Pigeon memory: same/different concept learning, serial probe recognition acquisition, and probe delay effects on the serial-position function.

Two pigeons were trained with sets of 70 pairs of color-slide stimuli in a same/different task to perform at least 88% correct; six different sets were used in successive acquisitions. The subjects transferred same/different performance to novel stimuli with 60% accuracy following their six acquisitions; further training and daily changes in the training stimuli revealed 71% transfer to novel stimuli. Four pigeons were trained (88% criterion) in a serial-probe-recognition task with three list items, and the list length was increased with successive acquisitions to four, five, and six list items. Their serial-position functions changed for different delays between the last list item and the test item revealing a recency effect (last items remembered well) for 0-s delay, recency and primacy effects (first items remembered well) for 1- and 2-s delays, and only a primacy effect for a 10-s delay. These results are discussed in relation to human memory performance and theories of memory processing generally.

Animals↗

Age differences in visual search: target and distractor learning.

Age differences in a semantic category visual search task were investigated to determine whether the age effects were due to target learning deficits, distractor learning deficits, or a combination thereof. Twelve young (mean age 20) and 12 older (mean age 70) adults received 2,400 trials each in consistent and varied versions of the search task. Following training, a series of transfer-reversal manipulations allowed the assessment of target learning and distractor learning both in isolation and in combination. The pattern of data suggests that older adults have a deficit in their ability to increase the attention-attraction strength of targets and to decrease the attention-attraction strength of distractors. The results are interpreted in terms of a strength-based framework of visual search performance.

Adult↗

Influences of prior knowledge on selective weighting of category members.

Three experiments addressed how prior theories affect categorization, comparing the influence of theory-congruent versus theory-incongruent category members. Subjects observed descriptions of persons, some congruent with prior knowledge and some incongruent, then made transfer judgments. In Experiment 1, subjects were given a relatively long time to study each description, whereas in Experiment 2 study time was manipulated between subjects. In Experiment 3, learning was self-paced by each subject. It was found that, with enough study time, prior knowledge had 2 distinct influences. First, prior knowledge provided an initial representation, subsequently revised in light of new observations. Second, incongruent observations had more impact than congruent observations on categorization. In comparison, when study time was more limited, revision proceeded in a Bayesian manner, in that congruent and incongruent observations had equal impacts.

Adult↗

Chunking during serial learning by a pigeon: II. Integrity of a chunk on a new list.

Can a group of items that a pigeon chunks on one list function as such on a second list? In Experiment 1, the ordinal position of the chunk was held constant across both lists. Following training on a list of colors and achromatic geometric forms (A----B----C----D'----E'), the integrity of the color chunk [A----B----C] was maintained on a list of five colors (A----B----C----F----G) even though the basis for establishing that chunk was eliminated. The integrity of the chunk [A----B----C] was also maintained on a new list of colors and forms (A----B----C----D*----E*). In Experiment 2, the ordinal position of a chunk established on list1 (A----B----C'----D') was changed on list 2. As shown by positive transfer between lists 1 and 2, the integrity of the chunks [A----B] and [C'----D'] was maintained on lists X'----A----B----Y' and X'----C'----D'----Y', respectively. Conversely, the heterogeneous list X'----B----C'----Y' took longer to learn than the original list.

Animals↗

Contextual interference: a meta-analytic study.

A meta-analysis of the contextual interference effect produced 139 estimates of effect sizes from 61 studies. The average overall effect size was .38. The effect size for basic research (.57) was significantly different from applied research (.19). Significant differences were also obtained between the effect sizes for adults (.50) and those for younger learners (.10). Power for retention and transfer scores was not significantly different. The overall mean power of the studies reviewed was .43.

Child↗