关于内科临床技能培训教学课程设置的探讨

通过对参加内科临床技能培训的大连医科大学2007级、2009级五年制及七年制临床医学专业学生进行问卷调查及客观结构化临床考试（OSCE）,探讨内科临床技能培训课程的学时及课程内容等设置.100%的学生认为有开设临床技能培训课的必要,50%以上的学生认为在大学4年级开设本课程较合适,50%以上的学生认为12学时的设置较合理,80%以上的学生认为应每4人共用一名模拟人.OSCE证实毕业前12学时培训组成绩优于实习前8学时组.     

Training Motor Sequences: Effects of Speed and Accuracy Instructions

Participants practiced a fixed 3- and a fixed 6-key press sequence for 144 times each. In the speed group, they were instructed to execute their sequences fast without bothering much about errors while the accurate group was instructed to be careful and prevent errors. In the test phase, participants executed series of 3 and 6 responses (a) when all element-specific stimuli were displayed in the familiar order, (b) in response to just the familiar first stimulus, and (c) by responding to random stimuli. The speed instruction yielded stronger sequencing skill while the accuracy instruction developed stronger reaction skill.     

Emotion in man as Tested by the Delta Index of the Electroencephalogram: II. Simultaneous Records from Cortex and from a Region Near the Hypothalamus

Five male undergraduates could earn 4¢ for every 200 knob-pulls. In addition, they could avoid or terminate an aversive tone by pressing a button with a force of 1.5 lbs (nonaggressive response) or by hitting a cushion with at least 20 lbs force (aggressive response). Rates of aggression tended to be higher during sessions where money was taken from the Ss at the rate of 1¢ per 12 seconds than during sessions when taking was not in effect. Rates of nonaggressive responses were constant across conditions.     

The Coding of Location

One prediction of the recent target hypothesis for movement control (MacNeilage, 1970; Russell, 1976) holds that location reproduction is not solely dependent upon stored kinesthetic information. Three experiments were performed to test this prediction by requiring the subject to reproduce the location with the limb opposite to the one used for criterion production. This switched-limb procedure was assumed to force the subject to rely upon more abstract information rather than the kinesthetic cues of the criterion movement. With movement direction invariant, switched-limb reproduction was equal to same-limb reproduction. The alteration of movement direction hampered switched-limb reproduction but same-limb reproduction was not greatly affected. These findings gave some support to the target hypothesis but suggested that the context of the movement may affect the potency of the location code. Implications of the switched-limb technique for future research were briefly discussed.     

Acquisition and Automatization of a Complex Task: An Examination of Three-Ball Cascade Juggling

The learning patterns of 3-ball cascade juggling from acquisition until automaticity were examined in 10 participants. On the basis of outcome measures derived from 26 practice sessions and 4 periodic probe sessions, the authors differentiated participants into 3 distinct learning types: a proficient group, an emerging group, and a single late learner. The proficient group was distinguished by how rapidly they learned and automatized performance. Most interesting, an inverse response cost (i.e., performance boost) on the secondary task was found in the majority of proficient group members during the dual-task condition. The present results are discussed in relation to the P. L. Ackerman model (1987, 1988) of complex skill acquisition as is the significance of the inverse response cost finding.     

Visual and Proprioceptive Determinants of Space Perception and Movement

The present study determined the relationship between perception of the upright in 2-dimensional space and movement accuracy. 161 female Ss were administered the Rod and Frame Test, and 30 Ss, whose scores indicated the greatest and least error in perceptual differentiation, were assigned to 2 experimental groups and measured on accuracy of postural pursuit tracking. The effects of direction of movement and visual field conditions on accuracy of performance were determined by a coordinate postural platform and hybrid computer methods. A direct relationship existed between perception of the vertical in space and accuracy of motor responses and that perceptual integration was affected by the direction of movement and the presence of a stable visual field.     

Relative Phase Alterations during Bimanual Skill Acquisition

The purposes of the research reported here were (a) to examine changes in relative phase during the acquisition of a new coordination pattern and (b) to determine the effect of learning this pattern on the ability to perform other coordination patterns. Ten subjects practiced an upper limb coordination task that required a 90° phase offset and different amplitudes for each arm. A gross approximation of the mean relative phase for the intended coordination pattern occurred quickly, but the attainment of stability occurred much more gradually. These results were accompanied by changes in pattern stability across practice and on various transfer tests. Learning of the new coordination pattern also affected the stability of the anti-phase mode, but this effect was only temporary.     

Variation in Coordination of a Discrete Multiarticular Action as a Function of Skill Level

The authors investigated coordination modes that emerged as a function of the interaction between skill level and task constraints in a multiarticular kicking action. Five skilled, 5 intermediate, and 5 novice participants attempted to satisfy specific height and accuracy constraints in kicking a ball over a barrier. Skilled and intermediate groups demonstrated a functional coordination mode involving less joint involvement at the proximal joints and greater joint involvement at distal joints, mimicking a chip-like action in soccer. Conversely, the novice group tended to produce larger ranges of motion throughout the kicking limb in a driving-like kicking action. Key differences were also found for task outcome scores, joint angle-angle relations, and ball-trajectory plots between the skilled and intermediate groups and the novice group. Findings from this study demonstrated that joint involvement during this discrete multiarticular action is a function of skill level and task constraints rather than a consequence of a global freezing-freeing strategy suggested in some previous research. The authors also highlight the merit of using a model of the acquisition of coordination in examining how coordination modes for multiarticular actions differ as a function of skill.     

Information Processes in Movement Learning

A series of experiments examined motor learning as an information processing activity occurring within a working short-term memory system and where response-produced feedback and knowledge of results (KR) are used to modify the action plan developed from previous attempts at the movement task. Use of interpolated activities in the KR delay interval allowed inferences to be made regarding the capacity and structural characteristics of these information processes. Results indicated no capacity limitations on the learning process but important structural effects were found. The results supported the idea that response-produced feedback is relatively unimportant as a feedback variable early in learning. Rather, the use of KR at a relatively high level of movement planning appears to be the important information processing activity underlying learning. Finally, the results supported the view that these information processes are related to cognitive problem solving activities.