Journal of Advances in Medical Education & Professionalism

Beyond what we expect: The basics and pedagogical implications of test-enhanced learning in contemporary medical education

R RAJPRASATH.; MAGI MURGAN; DINESH KUMAR. V

Volume 10, Issue 2 , April 2022, , Pages 131-132

https://doi.org/10.30476/jamp.2020.86165.1233

Abstract

Hands-on brain slicing activity based on Gagné’s instructional model: A novel pedagogy for mastering neuroanatomical cross sections

RAJASEKHAR S.S.S.N; DINESH KUMAR. V

Volume 10, Issue 1 , January 2022, , Pages 64-65

https://doi.org/10.30476/jamp.2020.86497.1242

Abstract

Comprehending the cross sectional anatomy of brain is one of the ultimate objective of neuroanatomy teaching. We cannot deny the fact that any physician or radiologist or surgeon who ... Read More

Multiple facets of learning a skill – Amalgamation of learning theories in cadaveric surgical skill lab

DINESH KUMAR. V; S.S.S.N RAJASEKHAR

Volume 9, Issue 3 , July 2021, , Pages 183-184

https://doi.org/10.30476/jamp.2020.84959.1155

Abstract

Psychomotor skills training includes three stages of learning. In the cognitive stage, there is a creation of awareness regarding the items to be learned; in the associative ... Read More Psychomotor skills training includes three stages of learning. In the cognitive stage, there is a creation of awareness regarding the items to be learned; in the associative stage, the refining of skills takes place, and in the autonomous stage, the proficiency in the skills is developed (1). One of the ways by which novice surgeons acquire mastery standards, before proceeding to perform surgical skills independently, is by practicing in cadavers. In contrast to the conventional pattern of learning,i.e. apprenticeship model whereby the trainees learn by ‘see one, do one and teach one’ adage,cadaveric skill lab ascertains the transformation/change of individual abilities in a structuredenvironment in pursuit of a task goal. The above statement could be substantiated by the study conducted by Zendejas et al. (2), where residents trained under simulated settings were able to complete the task goal, i.e. total extraperitoneal repair in lesser time and with reduced intra-operative and post-operative complications compared to the traditional training group.When we mean acquiring mastery standards, it means that all learners should attain the prescribedcompetency standards required for deliberate practice without much variation in the definedoutcomes. Nevertheless, it is well known that each individual does not necessarily have the samemotor learning dynamics, and they need not learn the same pattern even in similar task conditions(3). Notably, the surgical skill can be deciphered as a sequential motor skill learning, involving acombination of explicit and implicit processes, operating in a schema in order to accomplish thetask (4). Besides, this should be complemented by proprioceptive feedback, which harnessesthe motor accuracy and enables making quick adjustments in the authentic environment. In thiscontext, we wish to throw light upon two pertinent learning theories which medical educators shallreconcile while planning surgical skill programs.Let us consider the sequence of learning taking place while learning a surgical skill, for example, arthrocentesis in the cadaveric knee model. Comparing the Kovacs’ steps for procedural skill training (5), we could envisage that skill acquisition passes through four distinct stages. In the first step, the novice gains the cognitive knowledge required for the procedure (‘learn’ step). Secondly, he/she visualizes and contextualizes the procedure by observing while being performed by an expert (‘see’ step).Thirdly, the step of imitation begins where the participant performs the movements required for the skill with a certain degree of confidence, and this could be considered as trial and error (‘practice’ step). Finally, upon multiple cycles of practice, the trainee would master the movement patterns, tailor it according to tricky situations, and, if needed, create a new pattern of movements(‘do’ step). Subsequently, we shall reiterate upon two theories, which could be attributed to motor learning in the cadaveric skill lab.Schmidt’s schema theory is an open-loop controlled method of motor learning which does not involve feedback mechanism (6). It postulates the mechanism by which a novice learns a specific motor task which he or she has not performed previously. During the ‘learn’ and ‘see’ phase, a trainee observes a lot of co-ordinated movement patterns that get stored as schemas in a short memory system. When they practice, they learn by committing multiple errors, which also gets coded as schemas. For example, while performing laparoscopic procedures in cadavers, a surgeon needs to learn how to anticipate where and how far the instrument will pass through employing perceptual decisions made on the moment-moment basis. From short term memory, the information goes to a recall schema, where the specific response is selected, and then the recognition schema, where the response willbe evaluated, errors are realized, and followed by the generation of information on the correctresponse. This process helps in deciding a critical move or use a certain degree of force in specific situations for a co-ordinated motor pattern. This can be analogized to a cricketer who recalls the mistakes after the innings, interprets the sequence of movements, and corrects his future performances. Besides, schema theory emphasizes the value of variability in practice conditions for honing the learned skills in simulated settings. Thus, schema theory could still be considered to have a significant role in skill learning despite the criticism placed on it.Another major theory that has been posited for motor skill acquisition is Adam’s theory of learning, which is essentially a closed-loop method relying upon the sensory/perceptual feedback on the ongoing sequence of skilled movements (7).It involves a stimulus (input) that generates a perception of input resulting in a memory trace todecide as to which movement should be initiated. This will be followed by a perception trace, whichis an amalgamation of sensory consequences of previous similar movements and, finally, a motoraction (output). This can be compared with gaining experience of driving a car in crowded placeswhere the driver learns negotiation and adjustment abilities in stimulus-response reacting manner.The crux of this theory that supports the need for formative feedback in ‘practice’ sessions wherebymaking the learners know about the results is that it facilitates the identification/rectification of errors. To exemplify, a workshop where the placement of the endotracheal tube in cadaver bythe novice is confirmed by visualizing using the ultrasound transducer, the learners could assess theend-point by themselves and rectify accordingly.Performing the prescribed movement repetitively enables the learners to gain the correct perceptualtrace over time with the actual accomplishment of end-point, similar to hitting the bull’s eye duringshooting practice. Nevertheless, this motor theory of learning does not take into consideration thesalience of variability in practice while mastering a procedure.With the advent of soft embalming techniques, cadavers are increasingly used for teachingprocedural skills owing to their relatively higher fidelity, haptic parameters, and life-likesimulation compared to mannequins and virtual reality simulator. On the flip side, many cadaverbased workshops suffer a lack of structuring and sophisticated feedback. Feedback from cadaveric skill workshops should be structured to provide feedback regarding the knowledge of results and knowledge of performance to aid the mastery of standards. In this context, we emphasize the importance of knowledge about the theories involved in motor learning, which ideally shouldbe incorporated while designing surgical skill cadaveric workshops and in the absence of whichprocedural skill training might not effectively translate to the clinical environment. Supplementingthe established framework with learning theories will suffice the long-term outcomes of the skilltraining sessions, which is reaching mastery standards in performing that particular procedure.

Does management reasoning constitute the backbone of the clinical learning environment?: Conceptual analysis of the existing notions

DINESH KUMAR V; ANEESH BASHEER

Volume 9, Issue 1 , January 2021, , Pages 54-58

https://doi.org/10.30476/jamp.2020.84431.1138

Abstract

Management reasoning is a paradigm whereby learning occurs in a context bound fashion on analysing the biophysical factors existing in the clinical learning environment. In ... Read More

Professionalism in practice: Exploring the ethical perplexity of involving students in Medical Education Research

DINESH KUMAR V; MAGI MURUGAN

Volume 8, Issue 4 , October 2020, , Pages 200-203

https://doi.org/10.30476/jamp.2020.74921.0

Abstract

With the worldwide increase in the number of medical education researches, few ethical quagmires have emerged regarding the recruitment and inclusion of students in research ... Read More

Being a departmental head – what does it mean? Emphasizing the salience and shades in medical academia

S.S.S.N RAJASEKHAR; DINESH KUMAR. V

Volume 8, Issue 2 , April 2020, , Pages 105-106

https://doi.org/10.30476/jamp.2019.81476.1009

Abstract

Dear Editor, When an academician or clinician assumes the chair of department, multiple responsibilities dawn upon the chair that requires appropriate analysis and effective decision-making ... Read More

Too much but less effective: Managing the cognitive load while designing the distanced learning instructional formats

DINESH KUMAR. V; S.S.S.N RAJASEKHAR

Volume 8, Issue 2 , April 2020, , Pages 107-108

https://doi.org/10.30476/jamp.2020.85990.1208

Abstract

In the light of educational disruptions due to COVID-19 outbreak, most, if not all institutions have adopted distanced online based learning methodologies. But, most educators seem ... Read More

Intangibility of the invisible hand – Analysing the micro-dynamics of novice mentoring program based upon one institutional experience

DINESH KUMAR. V; ANEESH BASHEER

Volume 7, Issue 4 , October 2019, , Pages 220-223

https://doi.org/10.30476/jamp.2019.81615.1025

Abstract

Although mentoring has been regarded as an essential component in the developmental phase of medical students, it is the nature of hierarchical relationship and the quality ... Read More

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Author = DINESH KUMAR. V

Beyond what we expect: The basics and pedagogical implications of test-enhanced learning in contemporary medical education

Abstract

Hands-on brain slicing activity based on Gagné’s instructional model: A novel pedagogy for mastering neuroanatomical cross sections

Abstract

Multiple facets of learning a skill – Amalgamation of learning theories in cadaveric surgical skill lab

Abstract

Does management reasoning constitute the backbone of the clinical learning environment?: Conceptual analysis of the existing notions

Abstract

Professionalism in practice: Exploring the ethical perplexity of involving students in Medical Education Research

Abstract

Being a departmental head – what does it mean? Emphasizing the salience and shades in medical academia

Abstract

Too much but less effective: Managing the cognitive load while designing the distanced learning instructional formats

Abstract

Intangibility of the invisible hand – Analysing the micro-dynamics of novice mentoring program based upon one institutional experience

Abstract