Prescribing of psychotropic medication to the intellectually disabled by community paediatricians – a survey

Background Children with intellectual disability are often managed by community paediatricians and have a high prevalence of mental disorder. We do not know whether community paediatricians feel adequately trained to treat this group although we know that paediatricians contribute significantly to psychotropic prescribing for children. Methods Psychotropic medication prescribing by community paediatricians to the intellectually disabled in the north‐west and northern regions, community paediatricians' perceived training needs in this area and the availability of specialized psychiatric services were surveyed. Postal questionnaires were sent to all members of the British Association of Community Child Health in the north and north western regions (n= 155), between summer 2004 and autumn 2005. Results A total of 70.1% (n= 110) of questionnaires were returned of which 66 were completed. The most common reason for non‐completion was that the respondent did not look after the intellectually disabled. A total of 54.5% of respondents did not have access to specialist psychiatry services for children and adolescents with an intellectual disability. Community paediatricians were most likely to prescribe for sleep disorders and attention deficit hyperactivity disorder (ADHD). There was a significant relationship between perceived adequacy of training and paediatrics prescribing for ADHD, but there was no such relationship for sleep disorders. The vast majority of community paediatricians did not feel adequately trained to prescribe for challenging behaviour or depression, although a small minority did prescribe. Conclusions Community paediatricians play a substantial role in prescribing psychotropic medications for this group. A substantial minority of community paediatricians do not feel that they have enough training to prescribe for ADHD and sleep disorders, and perceived competency is more likely to inform prescribing for ADHD than for sleep disorders. This may have implications for training. Although these children pose complex difficulties, access to specialist mental health services for children and adolescents with intellectual disability remains patchy, especially in the north‐west, and further development of these services is needed.     

313例ADHD儿童注意力测评结果分析

目的:利用IVA-CPT注意力测评软件检测ADHD儿童,了解ADHD儿童各种类型听视觉注意力和控制能力受损的程度,有针对性的制定干预计划,促进ADHD儿童的早日康复。方法:选择IVA-CPT注意力测评软件检测阳性、符合DSM-Ⅳ的诊断标准、智力正常的313例儿童进行各种类型听视觉注意力和控制能力受损的程度相关方面的t检验和方差分析。结果:ADHD儿童患病男女比例为3.17∶1,各型之间男女患病比例无统计学意义,多动型的患儿听觉控制能力好于视觉控制能力,P值<0.001,两者存在显著的统计学意义,注意力缺陷型的患儿视觉注意力好于听觉注意力,P值<0.001,两者存在显著的统计学意义,混合型的患儿注意力受损大于控制能力,P值<0.001,两者存在显著的统计学意义。结论:IVA-CPT注意力测评是评价注意力多动障碍的一种客观指标,与DSM-Ⅳ主观诊断指标相结合,使ADHD的诊断可靠,提高可信度。多动型的患儿建议采用视觉控制训练为主,听觉控制训练为辅的方案;注意力缺陷型的患儿应强化听觉注意力训练;混合型的患儿应采用加大注意力方面的训练为主,控制训练为辅的方案。     

体验式教学在失能老人护理员培训中的应用研究

目的探讨体验式教学在失能老人护理员培训中的应用效果。方法设计若干个照顾失能老人的模拟情景,应用体验式教学法对老年照护学习班27名学员进行培训,采用一般自我效能感量表、学业自我效能量表分别于培训前后进行测评,采用技能评定表在培训结束后对学员进行考核,并用于学习过程的自评和互评。结果培训后学员的一般自我效能、学业自我效能感均显著高于培训前（P〈0.05）,且学员的一般自我效能和学业自我效能感与其考试成绩呈中高度正相关关系（P〈0.05）。结论体验式教学法适合于失能老人护理员的培训,可提高学员的自我效果感和照护技能学习效果。     

Emotion,cognitive load and learning outcomes during simulation training

Medical Education 2012: 46 : 1055–1062 CONTEXT Simulation training has emerged as an effective way to complement clinical training of medical students. Yet outcomes from simulation training must be considered suboptimal when 25–30% of students fail to recognise a cardiac murmur on which they were trained 1 hour previously. There are several possible explanations for failure to improve following simulation training, which include the impact of heightened emotions on learning and cognitive overload caused by interactivity with high‐fidelity simulators. This study was conducted to assess emotion during simulation training and to explore the relationships between emotion and cognitive load, and diagnostic performance. METHODS We trained 84 Year 1 medical students on a scenario of chest pain caused by symptomatic aortic stenosis. After training, students were asked to rate their emotional state and cognitive load. We then provided training on a dyspnoea scenario before asking participants to diagnose the murmur in which they had been trained (aortic stenosis) and a novel murmur (mitral regurgitation). We used factor analysis to identify the principal components of emotion, and then studied the associations between these components of emotion and cognitive load and diagnostic performance. RESULTS We identified two principal components of emotion, which we felt represented invigoration and tranquillity. Both of these were associated with cognitive load with adjusted regression coefficients of 0.63 (95% confidence interval [CI] 0.28–0.99; p = 0.001) and ? 0.44 (95% CI ? 0.77 to ? 0.10; p = 0.009), respectively. We found a significant negative association between cognitive load and the odds of subsequently identifying the trained murmur (odds ratio 0.27, 95% CI 0.11–0.67; p = 0.004). CONCLUSIONS We found that increased invigoration and reduced tranquillity during simulation training were associated with increased cognitive load, and that the likelihood of correctly identifying a trained murmur declined with increasing cognitive load. Further studies are needed to evaluate the impact on performance of strategies to alter emotion and cognitive load during simulation training.     

Do prior knowledge,personality and visual perceptual ability predict student performance in microscopic pathology?

Medical Education 2010: 44: 621–629 Objectives There has been long‐standing controversy regarding aptitude testing and selection for medical education. Visual perception is considered particularly important for detecting signs of disease as part of diagnostic procedures in, for example, microscopic pathology, radiology and dermatology and as a component of perceptual motor skills in medical procedures such as surgery. In 1968 the Perceptual Ability Test (PAT) was introduced in dental education. The aim of the present pilot study was to explore possible predictors of performance in diagnostic classification based on microscopic observation in the context of an undergraduate pathology course. Methods A pre‐ and post‐test of diagnostic classification performance, test of visual perceptual skill (Test of Visual Perceptual Skills, 3rd edition [TVPS‐3]) and a self‐report instrument of personality (Big Five Personality Inventory) were administered. In addition, data on academic performance (performance in histology and cell biology, a compulsory course taken the previous year, in addition to performance on the microscopy examination and final examination) were collected. Results The results indicated that one personality factor (Conscientiousness) and one element of visual perceptual ability (spatial relationship awareness) predicted performance on the pre‐test. The only factor to predict performance on the post‐test was performance on the pre‐test. Similarly, the microscopy examination score was predicted by the pre‐test score, in addition to the histology and cell biology grade. The course examination score was predicted by two personality factors (Conscientiousness and lack of Openness) and the histology and cell biology grade. Conclusions Visual spatial ability may be related to performance in the initial phase of training in microscopic pathology. However, from a practical point of view, medical students are able to learn basic microscopic pathology using worked‐out examples, independently of measures of personality or visual perceptual ability. This finding should reassure students about their abilities to improve with training independently of their scores on tests on basic abilities and personality.     

Does chess training affect conceptual development of six-year-old children in Turkey?

Many studies propose that chess is a game requiring cognitive skills and has positive effects on mental development. In recent years, chess training has also been emphasised as important during the early childhood period. However, no studies have been done with six-year-old children. The purpose of this study was to investigate whether or not chess training for six-year-old children would affect the development of spatial concepts such as forward–backward, between–next to, in front–behind, diagonal, far–near, corner, pattern and symmetry and whether or not there are differences according to child gender. Subjects were 50 children who had previously taken chess courses and 50 children who had not taken chess courses. A group of 100 six-year-old children was given a concept test. A test containing the concepts used in chess instruction and a chess board to be used in applying the test were developed by the researcher. After the obtained data were analysed, K-R 20?=?0.92 was found for the concept test. The Mann–Whitney U test, based on the children's scores t from the concept test, revealed a statistically meaningful difference in all concepts in favour of the children who took chess courses, but showed no meaningful gender differences for any of the concepts.     

How to measure critical health competences: development and validation of the Critical Health Competence Test (CHC Test)

Consumers’ autonomy regarding health increasingly requires competences to critically appraise health information. Critical health literacy refers to the concept of evidence-based medicine. Instruments to measure these competences in curriculum evaluation and surveys are lacking. We aimed to develop and validate an instrument to measure critical health competences (CHC test). Development and testing of the questionnaire covered three phases: (1) test construction (and feasibility, (2) first field test of scalability and items revision (3) second field test to validate the instrument. Model fit analyses were performed for both field tests for Rasch-, Mixed Rasch- and Hybrid model. Participants were secondary school and university students with and without prior training in evidence-based medicine (1. field test n = 322; with training n = 87; 2. field test n = 107; with training n = 13). The second field test resulted in Rasch scalability of all items in one person class. Mean values (±SD) of person parameters were 716.14 (±53.74) for trained students and 470.11 (±59.63) for untrained students. Reliability of the instrument was 0.91 (WINMIRA ANOVA). In conclusion the CHC instrument is a feasible, reliable and valid instrument to measure critical health literacy. The generalizability of the instrument is to be explored in ongoing studies in different educational settings.     

The Effect of Task Goal on Cross-Transfer in a Supination and Pronation Task

The aim of this study was to determine whether the motor performance in a cross-transfer training design was influenced by having a goal associated with the training task. In this pre-test, training (unilateral), post-test design, 60 right-handed participants 18–62 years old were randomly assigned to a practice or a control group. The task involved cranking resistive wing nuts in and out of a test device. Participants who trained their left limbs had a greater pre-test post-test difference than participants in the control group (p<0.0001). A significant cross-transfer effect was detected in the left crank-in practice group (p=0.0090 for) but not in the left crank-out practice group, (p=0.3676). The practice groups’ pre- and post-test difference in the untrained limb's performance was significant depending on the goal of the task (p=0.0214 for left crank-in practice group, p=0.0034 for left crank-out practice group). This study supports the occupational therapy core belief that participating in goal-oriented occupations can enhance motor performance. Cross-transfer effects were not bound to the contralateral homologous trained muscle groups, rather, it was the untrained muscle groups associated with the goal of the task that demonstrated the best performance in the time task.     

What does ‘disability’ mean for medical students? An exploration of the words medical students associate with the term ‘disability’

CONTEXT: Disability teaching is a core theme in undergraduate medical education. Medical students bring a range of experiences of disability to their medical training. AIM: The principal aim of this study was to explore the words that medical students associate with the term "disability" and to consider how the resulting information could inform teaching. A secondary aim was to see if a short disability course changed the word associations. METHODS: Students were asked to write down 2 words that came to mind when they heard the word "disability", before and after a 4-day course in disability. Words from 4 cohorts were analysed by frequency and the following word dichotomies: visual icons/personal attributes; loss/enabling, and medical model/social model. A random sample of students took part in focus groups at the beginning and end of the course. RESULTS: A total of 381 students provided 667 before-course words and 189 students provided 336 after-course words. Before the course, words denoting visual icons of disability, and loss were prominent, accounting for 85% of the words, and 74% of the words describing personal attributes were negative. Focus group responses at this stage reflected an eagerness to help but patronising terms were prominent, along with concern about political correctness. Students also expressed nervousness about encountering disabled people. In response, teaching was adapted to make it more learner-focused, to offer a safe environment in which students can test out their language, to build on the positive associations and to develop a range of pre-course creative activities with disabled people. After the course a considerable and significant shift in emphasis was observed, with a reduction in the use of visual icon words, an increase in words denoting enablement, and an increase in words relating to the social model of disability and to positive personal attributes (P < 0.001). Focus group participants at this stage reported greater confidence in approaching disabled people but continued to question political correctness. CONCLUSIONS: Medical students associate disability predominantly with depersonalised or negative words. A short disability course appears to change these associations. Reasons for this and implications for teaching are discussed.     

Directed self-regulated learning versus instructor-regulated learning in simulation training

Medical Education 2012: 46: 648–656 Objectives Simulation training offers opportunities for unsupervised, self‐regulated learning, yet little evidence is available to indicate the efficacy of this approach in the learning of procedural skills. We evaluated the effectiveness of directed self‐regulated learning (DSRL) and instructor‐regulated learning (IRL), respectively, for teaching lumbar puncture (LP) using simulation. Methods We randomly assigned internal medicine residents in postgraduate year 1 to either DSRL (‘directed’ to progress from easy to difficult LP simulators during self‐regulated learning) or IRL (in groups of four led by an instructor). All participants practised for up to 50 minutes and completed a pre‐test, post‐test and delayed (by 3 months) retention test on the simulator. Pairs of blinded trained experts independently rated all videotaped performances using a validated global rating scale and a modified version of a validated checklist. Participants provided measures of LP experience and self‐reported confidence. We analysed the pre–post (n = 42) and pre–post–retention performance scores (n = 23) using two separate repeated‐measures analyses of variance (anova s) and computed Pearson correlation coefficients between participants’ confidence and performance scores. Results Inter‐rater agreement was strong for both performance measures (intra‐class correlation coefficient > 0.81). The groups achieved similar pre‐test and post‐test scores (p > 0.05) and scores in both groups improved significantly from the pre‐ to the post‐test (p < 0.05). On retention, a significant interaction (F_2,42 = 3.92, p = 0.03) suggests the DSRL group maintained its post‐test performance, whereas that in the IRL group dropped significantly (p < 0.05). Correlations between self‐reported confidence and post‐test performance were positive and significant for the DSRL group, and negative and non‐significant for the IRL group. Conclusions Both IRL and DSRL led to improved LP performance immediately after practice. Whereas the IRL group’s skills declined after 3 months, the DSRL group’s performance was maintained, suggesting a potential long‐term benefit of this training. Participants in the DSRL group also developed a more accurate relationship between confidence and competence following practice. Further research is needed to clarify the mechanisms of self‐regulated learning and its role in simulation contexts.     

Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality

This study reports an analysis of factors associated with home care use in a setting in which long‐term care services are provided within a publicly financed welfare system. We considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long‐term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. Furthermore, we found a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, we also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. Our analysis showed that routinely collected data capture important predictors of home care use and thus facilitate both short‐term budgeting and long‐term planning of home care services.     

Preparing Child Care Health Consultants to Address Childhood Overweight: A Randomized Controlled Trial Comparing Web to In-Person Training

Objectives Child care centers have recently become targets for overweight prevention efforts directed at young children. Child Care Health Consultants (CCHCs), who provide consultation to these centers, receive little training on the basic nutrition and physical activity principles important for the promotion of child healthy weight. Traditional approaches, such as in-person training, are limited in their ability to disseminate health information to a geographically diverse population of health professionals. The purpose of this study was to determine if web-based training is as effective as in-person training. Methods A randomized controlled trial was conducted between August 2005 and June 2006 with 50 CCHCs. Web-based and in-person trained CCHCs were compared to each other and to controls. The main outcome of this study was performance on a test of nutrition knowledge related to childhood overweight measured by a 28-item multiple choice test administered pre- and post-training. Results Results from the ANCOVA model suggest that web trained CCHCs performed similarly to in-person trained CCHCs on the knowledge test (P < .0001). Additionally, both training groups improved significantly compared to controls (P < .0001 for each group). Conclusions This study found no significant differences in post-training knowledge between in-person and web trained Child Care Health Consultants. Scores on the post-training knowledge test were within 0.5 points for the in-person and web trained groups. These results demonstrate that web-based instruction is as effective as in-person training on improving basic nutrition and physical activity knowledge for promoting healthy weight in preschool children.     

Impact of Training Bolivian Farmers on Integrated Pest Management and Diffusion of Knowledge to Neighboring Farmers

Teaching farmers integrated pest management (IPM) in farmer field schools (FFS) has led to reduced pesticide use and safer handling. This article evaluates the long-term impact of training farmers on IPM and the diffusion of knowledge from trained farmers to neighboring farmers, a subject of importance to justify training costs and to promote a healthy and sustainable agriculture. Training on IPM of farmers took place from 2002 to 2004 in their villages in La Paz County, Bolivia, whereas dissemination of knowledge from trained farmer to neighboring farmer took place until 2009. To evaluate the impact of the intervention, self-reported knowledge and practice on pesticide handling and IPM among trained farmers (n = 23) and their neighboring farmers (n = 47) were analyzed in a follow-up study and compared in a cross-sectional analysis with a control group of farmers (n = 138) introduced in 2009. Variables were analyzed using χ² test and analysis of variance (ANOVA). Trained farmers improved and performed significantly better in all tested variables than their neighboring farmers, although the latter also improved their performance from 2002 to 2009. Including a control group showed an increasing trend in all variables, with the control farmers having the poorest performance and trained farmers the best. The same was seen in an aggregated variable where trained farmers had a mean score of 16.55 (95% confidence interval [CI]: 15.45–17.65), neighboring farmers a mean score of 11.97 (95% CI: 10.56–13.38), and control farmers a mean score of 9.18 (95% CI: 8.55–9.80). Controlling for age and living altitude did not change these results. Trained farmers and their neighboring farmers improved and maintained knowledge and practice on IPM and pesticide handling. Diffusion of knowledge from trained farmers might explain the better performance of the neighboring farmers compared with the control farmers. Dissemination of knowledge can contribute to justify the cost and convince donors and governments in low-income countries to prioritize farmers training.     

Training and experience of examiners

Variation in the accuracy of examiner judgements is a source of measurement error in performance-based tests. In previous studies using doctor subjects, examiner training yielded marginal or no improvement in the accuracy of examiner judgments. This study reports an experiment on accuracy of scoring in which provision of training and background of examiners are systematically varied. Experienced teaching staff, medical students and lay subjects were randomly assigned to either training or no-training groups. Using detailed behavioural check-lists, they subsequently scored videotaped performance on two clinical cases, and accuracy of their judgments was appraised. Results indicated that the need for and effectiveness of training varied across groups: it was least needed and least effective for the teaching staff group, more needed and effective for medical students, and most needed and effective for the lay group. The accuracy of the lay group after training approached the accuracy of untrained teaching staff. Trained medical students were as accurate as trained teaching staff. For teaching staff and medical students training also influenced the nature of errors made by reducing the number of errors of commission. It was concluded that training varies in effectiveness as a function of medical experience and that trained lay persons can be utilized as examiners in performance-based tests.     

Applying multimedia design principles enhances learning in medical education

Medical Education 2011: 45 : 818–826 Context The Association of American Medical Colleges’ Institute for Improving Medical Education’s report entitled ‘Effective Use of Educational Technology’ called on researchers to study the effectiveness of multimedia design principles. These principles were empirically shown to result in superior learning when used with college students in laboratory studies, but have not been studied with undergraduate medical students as participants. Methods A pre‐test/post‐test control group design was used, in which the traditional‐learning group received a lecture on shock using traditionally designed slides and the modified‐design group received the same lecture using slides modified in accord with Mayer’s principles of multimedia design. Participants included Year 3 medical students at a private, midwestern medical school progressing through their surgery clerkship during the academic year 2009–2010. The medical school divides students into four groups; each group attends the surgery clerkship during one of the four quarters of the academic year. Students in the second and third quarters served as the modified‐design group (n = 91) and students in the fourth‐quarter clerkship served as the traditional‐design group (n = 39). Results Both student cohorts had similar levels of pre‐lecture knowledge. Both groups showed significant improvements in retention (p < 0.0001), transfer (p < 0.05) and total scores (p < 0.0001) between the pre‐ and post‐tests. Repeated‐measures anova analysis showed statistically significant greater improvements in retention (F = 10.2, p = 0.0016) and total scores (F = 7.13, p = 0.0081) for those students instructed using principles of multimedia design compared with those instructed using the traditional design. Conclusions Multimedia design principles are easy to implement and result in improved short‐term retention among medical students, but empirical research is still needed to determine how these principles affect transfer of learning. Further research on applying the principles of multimedia design to medical education is needed to verify the impact it has on the long‐term learning of medical students, as well as its impact on other forms of multimedia instructional programmes used in the education of medical students.     

The role of collaborative interactivity in the observational practice of clinical skills

Medical Education 2012: 46 : 409–416 Context Video‐based observational practice can extend simulation‐based learning outside the training space. This study explores the value of collaborative feedback provided during observational practice to the acquisition of clinical skills. Methods Nursing students viewed a video demonstrating the proper ventrogluteal injection technique before performing a videotaped pre‐test trial on a simulator. They were then assigned randomly to one of three observational practice groups: a group that observed the expert demonstration (EO group); a group that viewed the expert demonstration, self‐assessed their individual pre‐test and contrasted their self‐assessments with expert feedback (ESO group), and a group that observed the expert demonstration, self‐assessed and contrasted their assessments with those of an expert, and formed a community that engaged in peer‐to‐peer feedback (ESPO group). The observation of all videos, the provision of assessments and all networking occurred via an Internet‐mediated network. After 2 weeks, participants returned for post‐tests and transfer tests. Results The pre‐test–post‐test analyses revealed significant interactions (global rating scale: F_(2,22) = 4.00 [p = 0.033]; checklist: F_(2,22) = 4.31 [p = 0.026]), which indicated that post‐test performance in the ESPO group was significantly better than pre‐test performance. The transfer analyses revealed main effects for both the global rating scale (F_(2,23) = 6.73; p = 0.005) and validated checklist (F_(2,23) = 7.04; p = 0.004) measures. Participants in the ESPO group performed better on the transfer test than those in the EO group. Conclusions The results suggest that video‐based observational practice can be effective in extending simulation‐based learning, but its effectiveness is mediated by the amount of time the learner spends engaged in the practice and the type of learning activities the learner performs in the observational practice environment. We speculate that increasing collaborative interactivity supports observational learning by increasing the extent to which the educational environment can accommodate learners’ specific needs.     

The effects of a sexual issues discussion group on the sexual attitudes and behaviors of physically disabled college students

The purpose of this study was to measure the effects of a sexual issues discussion group on the sexual attitudes and behaviors of physically disabled college students. Research indicated that the disabled have more difficulty adjusting to college than do able-bodied students. Since sexual adjustment is an important component of total adjustment, it was hypothesized that this might be an important function of a college counselor working with disabled students. Twelve physically disabled students at ASU were the subjects for this study. It was determined that while there was no statistically significant difference on test instruments between the experimental and control groups, change was made in the direction of more liberal sexual attitudes and behaviors of the experimental group. Secondly, self-ratings on individual goals of the experimental group did show that participants progressed toward the goals which they had set for themselves prior to treatment. The major conclusion was that the size of the N was a contributing factor in the failure to denote a statistically significant difference between the two groups on the test instruments.This article is based on her dissertation study on sexuality and disability submitted to the University of Arizona in February, 1980.     

案例式立体教学法在腹部提压心肺复苏培训中的应用研究

目的探讨案例式立体教学法在腹部提压心肺复苏培训中的应用效果。 方法选取2018年在南方医科大学附属郑州人民医院进行全科医师规范化培训的60名学员为研究对象，根据学员工号，采用数字奇偶法将其分为实验组和对照组，每组30名。实验组学员采用案例式立体教学法，对照组学员采用传统教学方法，培训结束后采用考核和问卷调查的方法对教学效果进行评估分析。 结果实验组学员理论成绩为(89.83±5.33)分，对照组学员理论成绩为(86.17±6.52)分，差异有统计学意义(P<0.05)。实验组学员技能成绩为(84.17±5.43)分，对照组学员技能成绩为(78.50±5.44)分，差异有统计学意义(P<0.05)。问卷调查结果显示，案例式立体教学法在增强学习兴趣、提高思维能力、深化学习印象、增强思考主动性、强化理论与临床桥接方面的满意度均优于传统教学法，差异均有统计学意义(均P<0.05)。 结论案例式立体教学法应用于全科医师的腹部提压心肺复苏培训，有利于提高学员理论成绩和技能成绩，有利于提高思维能力、增强思考主动性、增加学习兴趣、深化学习印象和强化理论与临床桥接。     

Visual working memory and perception speed of 3- to 6-year-old children tested with a Matrix Film Battery Test

In this study the visual working memory (VWM) and perception speed of 60 children between the ages of three and six years were tested with an age-based, easy-to-handle Matrix Film Battery Test (reliability R?=?.71). It was thereby affirmed that the VWM is age dependent (correlation coefficient r?=?.66***) as expected. Furthermore, a significant gender effect was found (partial correlation coefficient r_p?=?.42***) indicating that boys generally have a better VWM: they are able to memorise more items and they can process visual information faster. Given that the test was repeated during a period of eight months, strong learning effects could be detected which show that the VWM can be trained and that the test itself is also a good training tool.     

Relative effectiveness of high- versus low-fidelity simulation in learning heart sounds

Context Although there are increasing numbers of studies of outcomes of high‐fidelity patient simulators, few contrast their instruction with that provided by equivalent low‐fidelity, inexpensive simulators. Further, examination of decays in learning and application (transfer) to real patient problems is rare. In this study, we compared the effects of training using a high‐fidelity heart sound simulator (Harvey) and a low‐fidelity simulator (a CD) on recognition of both simulated heart sounds and those in actual patients. Methods A pilot study with 10 students was conducted to show the feasibility of the methods and some evidence of modality‐specific learning (the Harvey‐trained group scored 72% correct on Harvey and 36% correct on CD test examples; the CD‐trained group scored 60% correct on both CD and Harvey test examples). A main study was then initiated involving 37 Year 3 medical students from the University of Leeds. They received 1 hour of common instruction, after which one group received 3 hours of specific instruction on Harvey. The second group received 3 hours of instruction using a CD. Six weeks later, both groups were tested blind with real patients with stable heart sounds. Stations were observed by an examiner who scored communication skills and examination skills using 5‐point scales. Results The Harvey‐trained group was slightly but not significantly better than the CD‐trained group at identifying heart sounds (3.11 versus 2.47, respectively; P = 0.06). However, there was no difference between the Harvey and CD‐trained groups in diagnosis (2.94 versus 2.84, respectively), communication skills (18.9 versus 19.6, respectively) or examination skills (17.4 versus 17.5, respectively). Conclusions The study found little evidence that students trained with a high‐fidelity simulator were more able to transfer skills to real patients than a control group. Although there was some suggestion that the Harvey‐trained group was better at recognising heart sounds, there was no difference between groups in diagnostic accuracy or clinical skills.