We are continually receiving and giving feedback. Whether explicit through oral or written language, or implicit in gestures or tone of voice, feedback conveys information about behaviors and offers an evaluation of the quality of those behaviors. Feedback received from our students and feedback given to our students is important to a successful teaching experience. Here are some tips on receiving feedback and next week on giving it...
*****************************************
Receiving Feedback Effectively
• Listen to the feedback given. This means not interrupting. Hear the person out, and listen to what they are really saying, not what you assume they will say. You can absorb more information if you are concentrating on listening and understanding rather than being defensive and focusing on your response.
• Be aware of your responses. Your body language and tone of voice often speak louder than words. Try to avoid putting up barriers. If you look distracted and bored, that sends a negative message as well. Attentiveness, on the other hand, indicates that you value what someone has to say and puts both of you at ease.
• Be open. This means being receptive to new ideas and different opinions. Often, there is more than one way of doing something and others may have a completely different viewpoint on a given topic. You may learn something worthwhile.
• Understand the message. Make sure you understand what is being said to you, especially before responding to the feedback. Ask questions for clarification if necessary. Listen actively by repeating key points so that you know you have interpreted the feedback correctly. In a group environment, ask for others’ feedback before responding. As well, when possible, be explicit as to what kind of feedback you are seeking beforehand so you are not taken by surprise.
• Reflect and decide what to do. Assess the value of the feedback, the consequences of using it or ignoring it, and then decide what to do because of it. Your response is your choice. If you disagree with the feedback, consider asking for a second opinion from someone else.
• Follow up. There are many ways to follow up on feedback. Sometimes, your follow-up will simply involve implementing the suggestions given to you. In other situations, you might want to set up another meeting to discuss the feedback or to re-submit the revised work.
http://www.cte.uwaterloo.ca/teaching_resources/teaching_tips/tips_challenges/receiving_and_giving_effective_feedback.pdf
*****************************************
Monday, November 30, 2009
Clinical Skills Pearl Vol 2 (#14): Incidental brain findings on MRI c/o of Dr. Klimek
Why does CSF leak? (How does one measure CSF pressure?)
(Magnaes B. Body position and cerebrospinal fluid pressure. Part 2: Clinical studies on orthostatic pressure and the hydrostatic indifferent point .J. Neurosurg 1976;44:698-705)
There is conceptually a position in the body in which measured CSF pressure does not change during the transition from lateral decubitus to sitting upright.
Imagine that a person is lying down. The opening CSF pressure is the same along the entire length of the spinal canal. With tilting into a vertical posture the pressure of the column of CSF must (like a manometer tube) be proportional to the height of the column (greater at the bottom, less at the top).
In a control group of 72 normal patients, spinal taps were undertaken and the pressure measured as the patient was tilted from lying to sitting upright.
The normal lying CSF pressure measured ranged from 50 to 180 mm H2O. The CSF pressure in the sitting position ranged from 320 to 630 mm (H2O) with a mean of 490 mm. During continued sitting the CSF pressure rose 20 to 60 mm over one hour and returned to normal after lying for 5 minutes.
The occipital prominence is the palpable anatomical landmark beyond which 71 out of 72 normal patients had zero CSF pressure. In other words, maximal CSF pressure measured within 15 minutes of sitting was less than the height of the occipital prominence.
Thus, if one were to measure the opening pressure in the sitting position, it is not higher than the occipital prominence if measured before the increase pressure adaptation occurred.
Therefore a CSF leak above this level would not be accentuated by standing and walking about. However, the possibility of air entering the CSF would be a consideration.
(Magnaes B. Body position and cerebrospinal fluid pressure. Part 2: Clinical studies on orthostatic pressure and the hydrostatic indifferent point .J. Neurosurg 1976;44:698-705)
There is conceptually a position in the body in which measured CSF pressure does not change during the transition from lateral decubitus to sitting upright.
Imagine that a person is lying down. The opening CSF pressure is the same along the entire length of the spinal canal. With tilting into a vertical posture the pressure of the column of CSF must (like a manometer tube) be proportional to the height of the column (greater at the bottom, less at the top).
In a control group of 72 normal patients, spinal taps were undertaken and the pressure measured as the patient was tilted from lying to sitting upright.
The normal lying CSF pressure measured ranged from 50 to 180 mm H2O. The CSF pressure in the sitting position ranged from 320 to 630 mm (H2O) with a mean of 490 mm. During continued sitting the CSF pressure rose 20 to 60 mm over one hour and returned to normal after lying for 5 minutes.
The occipital prominence is the palpable anatomical landmark beyond which 71 out of 72 normal patients had zero CSF pressure. In other words, maximal CSF pressure measured within 15 minutes of sitting was less than the height of the occipital prominence.
Thus, if one were to measure the opening pressure in the sitting position, it is not higher than the occipital prominence if measured before the increase pressure adaptation occurred.
Therefore a CSF leak above this level would not be accentuated by standing and walking about. However, the possibility of air entering the CSF would be a consideration.
Tuesday, November 24, 2009
PBL Pearl Vol 2 (#13): Giving Negative Feedback
Please click here for a webpage on giving negative feedback from the London Metropolitan University.
Remember you are not alone. If you have concerns about any of your students please ask me, Karl or Kathy....we are always available to help.
Maynard Luterman MD
Remember you are not alone. If you have concerns about any of your students please ask me, Karl or Kathy....we are always available to help.
Maynard Luterman MD
Clinical Skills Pearl Vol 2 (#13): Dysphagia
Dysphagia, defined as difficulty in swallowing, can vary in severity, with symptoms ranging from mild throat discomfort to an inability to eat (Galvan, 2001). Perry (2001) described findings of dysphagia that included drooling, difficulty chewing, food pocketing, slow swallowing,coughing, choking, wet-sounding voice, food sticking in the throat,weight loss, heartburn, nasal regurgitation, and aspiration pneumonia.
Dysphagia is a condition that is associated with numerous neurological and neuromuscular diseases. Kayser-Jones and Pengilly (1999) identified stroke, Huntington's chorea, medications with anticholinergic effects (e.g., antidepressants and antihistamines), phenothiazines, and poor dentition as being associated with dysphagia. Myasthenia gravis, cerebral palsy, poliomyelitis, toxic or inflammatory encephalopathy, amyotrophic lateral sclerosis, injury from radiation or surgical procedures for head and neck cancer, and cleft palate also have been identified as contributing to dysphagia (Galvan, 2001). Alzheimer's disease, traumatic brain injury, Guillain- Barre syndrome, tonsillitis, dental caries, xerostomia, and chronic gastroesophageal reflux are other conditions that contribute to dysphagia (Perry, 2001).
It is difficult to comprehend the full extent of this major health problem. Doggett et al. (2001) estimated there are 300,000–600,000 new dysphagia cases each year. The reported mortality rates due to aspiration pneumonia are as high as 6% in the first year after a stroke. (Teasell, McRae, Marchuk, Hillel, & Finestone, 1996). This is a noteworthy finding, considering that nearly half of all stroke patients experience dysphagia (Smithard et al., 1996). According to Galvan (2001), 30%–60% of persons with stroke history have dysphagia. The incidence of dysphagia in Parkinson's disease may be as high as 50% (Galvan, 2001).
Nurses have an important role in identifying dysphagia patients. According to Travers (1999), nurses are the professionals who most often are present at the bedside, particularly at mealtime, and are the first members of the healthcare team to observe signs and symptoms of dysphagia. By recognizing dysphagia early, nurses can help to prevent complications and decrease the number of deaths associated with dysphagia in those who have had a stroke (Travers, 1999).
According to the Canadian Stroke Guidelines all patients diagnosed with a CVA should recieve a swallowing assessment before being fed.
Reference
Dysphagia is a condition that is associated with numerous neurological and neuromuscular diseases. Kayser-Jones and Pengilly (1999) identified stroke, Huntington's chorea, medications with anticholinergic effects (e.g., antidepressants and antihistamines), phenothiazines, and poor dentition as being associated with dysphagia. Myasthenia gravis, cerebral palsy, poliomyelitis, toxic or inflammatory encephalopathy, amyotrophic lateral sclerosis, injury from radiation or surgical procedures for head and neck cancer, and cleft palate also have been identified as contributing to dysphagia (Galvan, 2001). Alzheimer's disease, traumatic brain injury, Guillain- Barre syndrome, tonsillitis, dental caries, xerostomia, and chronic gastroesophageal reflux are other conditions that contribute to dysphagia (Perry, 2001).
It is difficult to comprehend the full extent of this major health problem. Doggett et al. (2001) estimated there are 300,000–600,000 new dysphagia cases each year. The reported mortality rates due to aspiration pneumonia are as high as 6% in the first year after a stroke. (Teasell, McRae, Marchuk, Hillel, & Finestone, 1996). This is a noteworthy finding, considering that nearly half of all stroke patients experience dysphagia (Smithard et al., 1996). According to Galvan (2001), 30%–60% of persons with stroke history have dysphagia. The incidence of dysphagia in Parkinson's disease may be as high as 50% (Galvan, 2001).
Nurses have an important role in identifying dysphagia patients. According to Travers (1999), nurses are the professionals who most often are present at the bedside, particularly at mealtime, and are the first members of the healthcare team to observe signs and symptoms of dysphagia. By recognizing dysphagia early, nurses can help to prevent complications and decrease the number of deaths associated with dysphagia in those who have had a stroke (Travers, 1999).
According to the Canadian Stroke Guidelines all patients diagnosed with a CVA should recieve a swallowing assessment before being fed.
Reference
Monday, November 16, 2009
PBL Pearl Vol 2 (#12): Instilling curiosity Part 2
Some practical tips to foster curiosity in learners . . . courtesy of Marilyn P. Arnone.
Most educators would agree that fostering the scholarly attribute of curiosity in learners is an important task. Providing students with adequate guidance while affording them the opportunities for exploration, however, is probably easier stated than accomplished. As mentioned earlier, not all students are highly curious and what might stimulate curiosity in some students might result in anxiety for others. It becomes the job of the educator and/or instructional designer to recognize these differences and control the classroom or other learning environment to accommodate all learners. With this caveat in mind, the following are ten instructional design strategies for fostering curiosity.
Strategy #1: Curiosity as a Hook
Use curiosity as a primary motivator at the beginning of a lesson by starting, for example, with a thought-provoking question or surprising statement (Small & Arnone, 2000).
Strategy #2: Conceptual Conflict
Introduce a conceptual conflict when possible. Learners will feel compelled to explore the conflict until it is resolved. When the student has resolved the conceptual conflict, he/she will sense a feeling of satisfaction.
Strategy #3: An Atmosphere for Questions
Create an atmosphere where students feel comfortable about raising questions and where they can test their own hypotheses through discussion and brainstorming. Not only does this foster curiosity but it also helps to build confidence.
Strategy #4: Time
Allow adequate time for exploration of a topic. If the teacher has been successful in stimulating curiosity, then learners will want to persist in that exploration.
Strategy #5: Choices
Give students the opportunity for choosing topics within a subject area. For example, in a writing class, the student can explore a topic of his/her interest while accomplishing the goals of the writing task. Being allowed to choose a topic that is intrinsically motivating will help sustain curiosity.
Strategy #6: Curiosity-Arousing Elements
Introduce one or more of the following elements into a lesson to arouse curiosity:
--Incongruity
--Contradictions
--Novelty
--Surprise
--Complexity
--Uncertainty
Learners will desire to explore the source of the incongruity, contradiction, novelty, uncertainty, etc., and the resulting information will satisfy their curiosity.
Strategy #7: The Right Amount of Stimulation
Be aware of the degree of stimulation that is being entered into the learning situation. Remember, there are individual differences when it comes to curiosity. Some learners will become anxious if the stimulus is too complex, too uncertain, too novel, etc. (Gorlitz, 1987). They may quickly leave what Day (1982) refers to as the Zone of Curiosity and enter the Zone of Anxiety.
Strategy # 8: Exploration
Encourage students to learn through active exploration.
Strategy #9: Rewards
Allow the exploration and discovery to be its own reward. "Exploration is self-rewarding (Day, 1982, p.19)." Use external rewards judiciously as some studies have shown that extrinsic rewards given for a task that a learner finds intrinsically motivating may dampen future interest in the activity.<
Strategy #10: Modeling
Model curiosity. Ask questions. Engage in specific exploration to resolve a question posed, and demonstrate enthusiasm.
Conclusion
To instill curiosity in students is to encourage their disposition to learn. To ignore its importance is to risk diminishing, if not losing, the endowment of curiosity conferred upon all at birth.
Dr. Maynard Luterman
Most educators would agree that fostering the scholarly attribute of curiosity in learners is an important task. Providing students with adequate guidance while affording them the opportunities for exploration, however, is probably easier stated than accomplished. As mentioned earlier, not all students are highly curious and what might stimulate curiosity in some students might result in anxiety for others. It becomes the job of the educator and/or instructional designer to recognize these differences and control the classroom or other learning environment to accommodate all learners. With this caveat in mind, the following are ten instructional design strategies for fostering curiosity.
Strategy #1: Curiosity as a Hook
Use curiosity as a primary motivator at the beginning of a lesson by starting, for example, with a thought-provoking question or surprising statement (Small & Arnone, 2000).
Strategy #2: Conceptual Conflict
Introduce a conceptual conflict when possible. Learners will feel compelled to explore the conflict until it is resolved. When the student has resolved the conceptual conflict, he/she will sense a feeling of satisfaction.
Strategy #3: An Atmosphere for Questions
Create an atmosphere where students feel comfortable about raising questions and where they can test their own hypotheses through discussion and brainstorming. Not only does this foster curiosity but it also helps to build confidence.
Strategy #4: Time
Allow adequate time for exploration of a topic. If the teacher has been successful in stimulating curiosity, then learners will want to persist in that exploration.
Strategy #5: Choices
Give students the opportunity for choosing topics within a subject area. For example, in a writing class, the student can explore a topic of his/her interest while accomplishing the goals of the writing task. Being allowed to choose a topic that is intrinsically motivating will help sustain curiosity.
Strategy #6: Curiosity-Arousing Elements
Introduce one or more of the following elements into a lesson to arouse curiosity:
--Incongruity
--Contradictions
--Novelty
--Surprise
--Complexity
--Uncertainty
Learners will desire to explore the source of the incongruity, contradiction, novelty, uncertainty, etc., and the resulting information will satisfy their curiosity.
Strategy #7: The Right Amount of Stimulation
Be aware of the degree of stimulation that is being entered into the learning situation. Remember, there are individual differences when it comes to curiosity. Some learners will become anxious if the stimulus is too complex, too uncertain, too novel, etc. (Gorlitz, 1987). They may quickly leave what Day (1982) refers to as the Zone of Curiosity and enter the Zone of Anxiety.
Strategy # 8: Exploration
Encourage students to learn through active exploration.
Strategy #9: Rewards
Allow the exploration and discovery to be its own reward. "Exploration is self-rewarding (Day, 1982, p.19)." Use external rewards judiciously as some studies have shown that extrinsic rewards given for a task that a learner finds intrinsically motivating may dampen future interest in the activity.<
Strategy #10: Modeling
Model curiosity. Ask questions. Engage in specific exploration to resolve a question posed, and demonstrate enthusiasm.
Conclusion
To instill curiosity in students is to encourage their disposition to learn. To ignore its importance is to risk diminishing, if not losing, the endowment of curiosity conferred upon all at birth.
Dr. Maynard Luterman
Clinical Skills Pearl Vol 2 (#12): Should I order an amylase or a lipase?
What is a better test for diagnosing pancreatitis...lipase or amylase?
Lipase is produced primarily in the pancreas, with a small amount in the liver, intestine, tongue, and stomach. Amylase is derived primarily from the pancreas and salivary glands; it is also present in the ovaries, small and large intestine, and skeletal muscle. Serum amylase is the most commonly used lab test. Serum lipase is believed to be more specific and will stay elevated for a longer period of time, as hyperlipasemia persists for 7 days and amylase should normalize within 4 days. Becuase lipase stays higher longer it may be more sensitive. However it is agreed that patients should be followed on their clincial improvement not on an absolute value of amylase or lipase.
Normal serum amylase and lipase levels do not exclude acute pancreatitis. In one consecutive series, normal serum amylase was documented in 67 of 352 (19%) of contrast–enhanced CT-proven cases of acute pancreatitis.
What other entities could cause an elevated amylase or lipase?
Disease can occur in other organs that produce amylase/lipase. Transmural absorption in intestinal infarction and transperitoneal absorption with a perforated viscus and peritonitis probably explain the hyperamylasemia/hyperlipasemia in these conditions. There is decreased renal clearance in patients with renal failure. Macroamylasemia is a condition in which amylase is bound to a larger protein moiety that prevents renal excretion. Thus, serum amylase is elevated in absence of pancreatitis. Macroamylasemia is diagnosed by detecting a low renal amylase clearance. Increased amylase and lipase
in cholecystitis is probably due to subclinical or undiagnosed coexistent pancreatitis.
Amylase levels may also be significantly increased in patients with pancreatic duct obstruction, cancer of the pancreas, and gallbladder attacks. Urine and blood amylase levels may also be elevated with a variety of other conditions, such as ovarian cancer, lung cancer, tubal pregnancy, mumps, intestinal obstruction, or perforated ulcer, but amylase tests are not generally used to diagnose or monitor these disorders. Decreased blood and urine amylase levels may indicate permanent damage to the amylase-producing cells in the pancreas. Increased blood amylase levels with normal to low urine amylase levels
may indicate decreased kidney function or the presence of a macroamylase, a benign complex of amylase and other proteins that accumulates in the blood.
Dr. Maynard Luterman
Reference
Lipase is produced primarily in the pancreas, with a small amount in the liver, intestine, tongue, and stomach. Amylase is derived primarily from the pancreas and salivary glands; it is also present in the ovaries, small and large intestine, and skeletal muscle. Serum amylase is the most commonly used lab test. Serum lipase is believed to be more specific and will stay elevated for a longer period of time, as hyperlipasemia persists for 7 days and amylase should normalize within 4 days. Becuase lipase stays higher longer it may be more sensitive. However it is agreed that patients should be followed on their clincial improvement not on an absolute value of amylase or lipase.
Normal serum amylase and lipase levels do not exclude acute pancreatitis. In one consecutive series, normal serum amylase was documented in 67 of 352 (19%) of contrast–enhanced CT-proven cases of acute pancreatitis.
What other entities could cause an elevated amylase or lipase?
Disease can occur in other organs that produce amylase/lipase. Transmural absorption in intestinal infarction and transperitoneal absorption with a perforated viscus and peritonitis probably explain the hyperamylasemia/hyperlipasemia in these conditions. There is decreased renal clearance in patients with renal failure. Macroamylasemia is a condition in which amylase is bound to a larger protein moiety that prevents renal excretion. Thus, serum amylase is elevated in absence of pancreatitis. Macroamylasemia is diagnosed by detecting a low renal amylase clearance. Increased amylase and lipase
in cholecystitis is probably due to subclinical or undiagnosed coexistent pancreatitis.
Amylase levels may also be significantly increased in patients with pancreatic duct obstruction, cancer of the pancreas, and gallbladder attacks. Urine and blood amylase levels may also be elevated with a variety of other conditions, such as ovarian cancer, lung cancer, tubal pregnancy, mumps, intestinal obstruction, or perforated ulcer, but amylase tests are not generally used to diagnose or monitor these disorders. Decreased blood and urine amylase levels may indicate permanent damage to the amylase-producing cells in the pancreas. Increased blood amylase levels with normal to low urine amylase levels
may indicate decreased kidney function or the presence of a macroamylase, a benign complex of amylase and other proteins that accumulates in the blood.
Dr. Maynard Luterman
Reference
Monday, November 9, 2009
Clinical Skills Pearl Vol 2 (#11): PSA for prostate screening
When the PSA first came out, I was taught it was the mammogram for men. But breast and prostate cancer are different and the bottom line is that treatment in prostate cancer may not equate to increased longevity. In 2008, Annals of Medicine published the article I have summarized below......
Dr. Luterman
**********************************************************************
Prostate cancer is the most common non-skin cancer in men in the United States, and prostate cancer screening has increased in recent years. In 2002, the U.S. Preventive Services Task Force concluded that evidence was insufficient to recommend for or against screening for prostate cancer with prostate-specific antigen (PSA) testing.
Randomized, controlled trials and meta-analyses of PSA screening and cross-sectional and cohort studies of screening harms and of the natural history of screening-detected cancer were selected to answer the following questions: Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? What are the magnitude and nature of harms associated with prostate cancer screening, other than overtreatment? What is the natural history of PSA-detected, nonpalpable, localized prostate cancer? Few eligible studies were identified. Long-term adverse effects of false-positive PSA screening test results are unknown.
Conclusion: Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain.
Ann Intern Med. 2008 Aug 5;149(3):I37.
Dr. Luterman
**********************************************************************
Prostate cancer is the most common non-skin cancer in men in the United States, and prostate cancer screening has increased in recent years. In 2002, the U.S. Preventive Services Task Force concluded that evidence was insufficient to recommend for or against screening for prostate cancer with prostate-specific antigen (PSA) testing.
Randomized, controlled trials and meta-analyses of PSA screening and cross-sectional and cohort studies of screening harms and of the natural history of screening-detected cancer were selected to answer the following questions: Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? What are the magnitude and nature of harms associated with prostate cancer screening, other than overtreatment? What is the natural history of PSA-detected, nonpalpable, localized prostate cancer? Few eligible studies were identified. Long-term adverse effects of false-positive PSA screening test results are unknown.
Conclusion: Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain.
Ann Intern Med. 2008 Aug 5;149(3):I37.
PBL Pearl Vol 2 (#11): Instilling curiosity in students
Educators and instructional designers recognize that instilling curiosity in students encourages their disposition to learn. When students are magnetized by a new idea or a new situation and are compelled to explore further, regardless of external rewards, they can be said to be truly motivated. In each new project, they discover seeds for a future project or a new question to examine. Curiosity is a heightened state of interest resulting in exploration and its importance in motivating scholarship cannot be ignored. Curiosity is also a critical component of creativity and fostering curiosity and creativity in today's learners is a challenge faced by educators and instructional designers alike.
Any discussion of curiosity must begin with Daniel Berlyne, considered to be the seminal mind in the study of curiosity. His neurophysiological view associated curiosity with exploratory behavior.
He identified two forms of exploratory behavior, diversive (e.g., seeking relief from boredom) and specific (e.g., uncertainty, conceptual conflict). It is specific curiosity that is of most interest to educators. Berlyne described specific exploration in the context of epistemic curiosity, that is, "the brand of arousal that motivates the quest for knowledge and is relieved when knowledge is procured" (1960, p. 274). It follows that epistemic curiosity results in specific exploration. This exploration ultimately resolves the uncertainty or conceptual conflict and returns the individual to a moderate, pleasurable tonus level. Although his work was cut short by his untimely death, his accomplishments paved the way for later investigations into the area of curiosity.
Berlyne's colleague, Day, extended the work, representing it graphically as a curvilinear relationship between level of arousal (or stimulation) and efficiency (1982). At the optimal level, a person enters the Zone of Curiosity characterized by exploration, excitement, and interest. Below the optimal level, the individual is unmotivated, disinterested, and inefficient. Beyond the optimal level, the individual enters a Zone of Anxiety with resulting behaviors including defensiveness, disinterest, avoidance, and inefficiency. This curvilinear explanation of curiosity was used in later studies including in an instructional design context exploring differences in young learners' curiosity and achievement in an electronic learning environment (Arnone & Grabowski, 1992, Arnone, Grabowski, & Rynd, 1994).
Whatever explanation one accepts, it cannot be dismissed that curiosity is a necessary ingredient for motivating scholarship. In his motivational design model for enhancing instruction, Keller (1987) acknowledges the important role that stimulating curiosity plays in gaining and sustaining learners' attention, the first component of his model. In fact, it has been argued that curiosity is an equally important factor in each of the other components - relevance, confidence, and satisfaction (Arnone & Small, 1995).
Next week: 10 tips to evoke curiosity in your students......
Any discussion of curiosity must begin with Daniel Berlyne, considered to be the seminal mind in the study of curiosity. His neurophysiological view associated curiosity with exploratory behavior.
He identified two forms of exploratory behavior, diversive (e.g., seeking relief from boredom) and specific (e.g., uncertainty, conceptual conflict). It is specific curiosity that is of most interest to educators. Berlyne described specific exploration in the context of epistemic curiosity, that is, "the brand of arousal that motivates the quest for knowledge and is relieved when knowledge is procured" (1960, p. 274). It follows that epistemic curiosity results in specific exploration. This exploration ultimately resolves the uncertainty or conceptual conflict and returns the individual to a moderate, pleasurable tonus level. Although his work was cut short by his untimely death, his accomplishments paved the way for later investigations into the area of curiosity.
Berlyne's colleague, Day, extended the work, representing it graphically as a curvilinear relationship between level of arousal (or stimulation) and efficiency (1982). At the optimal level, a person enters the Zone of Curiosity characterized by exploration, excitement, and interest. Below the optimal level, the individual is unmotivated, disinterested, and inefficient. Beyond the optimal level, the individual enters a Zone of Anxiety with resulting behaviors including defensiveness, disinterest, avoidance, and inefficiency. This curvilinear explanation of curiosity was used in later studies including in an instructional design context exploring differences in young learners' curiosity and achievement in an electronic learning environment (Arnone & Grabowski, 1992, Arnone, Grabowski, & Rynd, 1994).
Whatever explanation one accepts, it cannot be dismissed that curiosity is a necessary ingredient for motivating scholarship. In his motivational design model for enhancing instruction, Keller (1987) acknowledges the important role that stimulating curiosity plays in gaining and sustaining learners' attention, the first component of his model. In fact, it has been argued that curiosity is an equally important factor in each of the other components - relevance, confidence, and satisfaction (Arnone & Small, 1995).
Next week: 10 tips to evoke curiosity in your students......
Taken from:
Dr. Luterman
Monday, November 2, 2009
Clinical Skills Pearl Vol 2 (#10): Gallbladder - Part 2
Gallbladder Part B...
Dr. Maynard Luterman
***************************************************************************************************
What is Murphy's sign? What is the best set of lab tests to order to diagnose cholecytitis? What's better CT or Ultrasound to make the diagnosis?
Murphy sign, which is specific but not sensitive for cholecystitis, is described as tenderness and an inspiratory pause elicited during palpation of the RUQ. A retrospective study by Singer attempted to determine a set of clinical and laboratory parameters that could be used to predict the outcome of hepatobiliary scintigraphy (HBS) in all patients with suspected acute cholecystitis. The results of the study showed that, in 40 patients with pathologically confirmed acute cholecystitis, fever and leukocytosis were absent at the time of presentation in 36 (90%) and 16 (40%) of the patients, respectively. The study also found that no combination of laboratory or clinical values was useful in identifying patients at high risk for a positive HBS finding. And by the way an elevated alkaline phosphatase level is observed in 25% of patients with cholecystitis.
Ultrasonography provides greater than 95% sensitivity and specificity for the diagnosis of gallstones more than 2 mm in diameter. Ultrasonography is 90-95% sensitive for cholecystitis and is 78-80% specific.Studies indicate that emergency clinicians require minimal training in order to use right upper quadrant ultrasonography in their practice. The sensitivity and specificity of CT scan and MRI for predicting acute cholecystitis have been reported to be greater than 95%. Spiral CT scan and MRI (unlike endoscopic retrograde cholangiopancreatography [ERCP]) have the advantage of being noninvasive, but they have no therapeutic potential and are most appropriate in cases where stones are unlikely.
Dr. Maynard Luterman
***************************************************************************************************
What is Murphy's sign? What is the best set of lab tests to order to diagnose cholecytitis? What's better CT or Ultrasound to make the diagnosis?
Murphy sign, which is specific but not sensitive for cholecystitis, is described as tenderness and an inspiratory pause elicited during palpation of the RUQ. A retrospective study by Singer attempted to determine a set of clinical and laboratory parameters that could be used to predict the outcome of hepatobiliary scintigraphy (HBS) in all patients with suspected acute cholecystitis. The results of the study showed that, in 40 patients with pathologically confirmed acute cholecystitis, fever and leukocytosis were absent at the time of presentation in 36 (90%) and 16 (40%) of the patients, respectively. The study also found that no combination of laboratory or clinical values was useful in identifying patients at high risk for a positive HBS finding. And by the way an elevated alkaline phosphatase level is observed in 25% of patients with cholecystitis.
Ultrasonography provides greater than 95% sensitivity and specificity for the diagnosis of gallstones more than 2 mm in diameter. Ultrasonography is 90-95% sensitive for cholecystitis and is 78-80% specific.Studies indicate that emergency clinicians require minimal training in order to use right upper quadrant ultrasonography in their practice. The sensitivity and specificity of CT scan and MRI for predicting acute cholecystitis have been reported to be greater than 95%. Spiral CT scan and MRI (unlike endoscopic retrograde cholangiopancreatography [ERCP]) have the advantage of being noninvasive, but they have no therapeutic potential and are most appropriate in cases where stones are unlikely.
PBL Pearl Vol 2 (#10): The Quiet Student
What do you do with the quiet student? Here are some strategies......
Dr. Maynard Luterman
*********************************************************************************
Use verbal and non-verbal cues to encourage participation.
Do not rely on the same volunteers to answer every question. Respond to frequent volunteers in a way that indicates that you appreciate their responses, but want to hear from others as well. Move to a part of the room where quiet students are sitting; smile at and make eye contact with these students to encourage them to speak up. By the same token, when frequent volunteers speak, look around the room rather than only at them to encourage others to respond (see below).
Dr. Maynard Luterman
*********************************************************************************
Use verbal and non-verbal cues to encourage participation.
Do not rely on the same volunteers to answer every question. Respond to frequent volunteers in a way that indicates that you appreciate their responses, but want to hear from others as well. Move to a part of the room where quiet students are sitting; smile at and make eye contact with these students to encourage them to speak up. By the same token, when frequent volunteers speak, look around the room rather than only at them to encourage others to respond (see below).
Reduce students’ anxieties by creating an atmosphere in which they feel comfortable “thinking out-loud,” taking intellectual risks, asking questions, and admitting when they do not know something; one of the best ways to do this is to model these behaviors yourself.
Listen fully to your students’ questions and answers; avoid interrupting.
Resist the urge to interrupt when you think you know what the student is going to say or ask. Often, well-meaning and enthusiastic instructors make incorrect assumptions and leave their students’ actual questions unanswered or misrepresent what the students had planned to say.
Provide specific, encouraging, varied responses.
Point out what is helpful or interesting about student contributions.
Pick up on comments that were made but not discussed. Do not use the=2 0 same, standard praise to respond to every comment. When students hear “good point” again and again, they start to lose motivation. Ask follow-up questions to prompt students to clarify, refine, and support their ideas. When a student gives an incorrect or ill-conceived answer, respond in way that challenges the student to think more deeply or to reconsider the evidence. The best way to shut down participation, and learning, is to embarrass a student.
Place the emphasis on student ideas.
Encourage students to share their ideas and use those ideas (with attribution) whenever you can. Referring back to a comment made by a student in an earlier class demonstrates that you have thought about and appreciated what your students have to say.
http://teachingcenter.wustl.
Subscribe to:
Posts (Atom)