Acquisition Of Expertise Research Articles

Introducing cross-cultural education in palliative care: focus groups with experts on practical strategies

BackgroundThe linguistic and cultural diversity found in European societies creates specific challenges to palliative care clinicians. Patients’ heterogeneous habits, beliefs and social situations, and in many cases language barriers, add complexity to clinicians’ work. Cross-cultural teaching helps palliative care specialists deal with issues that arise from such diversity. This study aimed to provide interested educators and decision makers with ideas for how to implement cross-cultural training in palliative care.MethodsWe conducted four focus groups in French- and Italian-speaking Switzerland. All groups consisted of a mix of experts in palliative care and/or cross-cultural teaching. The interdisciplinary research team submitted the data for thematic content analysis.ResultsFocus-group participants saw a clear need for courses addressing cross-cultural issues in end-of-life care, including in medical disciplines outside of palliative care (e.g. geriatrics, oncology, intensive care). We found that these courses should be embedded in existing training offerings and should appear at all stages of curricula for end-of-life specialists. Two trends emerged related to course content. One focuses on clinicians’ acquisition of cultural expertise and tools allowing them to deal with complex situations on their own; the other stresses the importance of clinicians’ reflections and learning to collaborate with other professionals in complex situations. These trends evoke recent debates in the literature: the quest for expertise and tools is related to traditional twentieth century work on cross-cultural competence, whereas reflection and collaboration are central to more recent research that promotes cultural sensitivity and humility in clinicians.ConclusionThis study offers new insights into cross-cultural courses in palliative and end-of-life care. Basic knowledge on culture in medicine, variable practices related to death and dying, communication techniques, self-reflection on cultural references and aptitude for interprofessional collaboration are central to preparing clinicians in end-of-life settings to work with linguistically and culturally diverse patients.

Temporal Profiles of Social Attention Are Different Across Development in Autistic and Neurotypical People

BackgroundSociocommunicative difficulties, including abnormalities in eye contact, are core diagnostic features of autism spectrum disorder (ASD). Many studies have used eye tracking to measure reduced attention to faces in autistic people; however, most of this work has not taken advantage of eye-tracking temporal resolution to examine temporal profiles of attention. MethodsWe used growth curve analysis to model attention to static social scenes as a function of time in a large (N = 650) sample of autistic participants and neurotypical participants across a wide age range (6–30 years). ResultsThe model yielded distinct temporal profiles of attention to faces in the groups. Initially, both groups showed a relatively high probability of attending to faces, followed by decline after several seconds. The neurotypical participants, however, were significantly more likely to return their attention to faces in the latter part of each 20-second trial, with increasing probability with age. In contrast, the probability of returning to the face in the autistic participants remained low across development. In participants with ASD, more atypical profiles of attention were associated with lower Vineland Adaptive Behavior Scales communication scores and a higher curvature in one data-driven cluster correlated with symptom severity. ConclusionsThese findings show that social attention not only is reduced in ASD, but also differs in its temporal dynamics. The neurotypical participants became more sophisticated in how they deployed their social attention across age, a pattern that was significantly reduced in the participants with ASD, possibly reflecting delayed acquisition of social expertise.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.

Quality of network support for the deliberate practice of popular musicians

To become an expert in music, an individual goes through different phases of deliberately practising domain-specific activities with the support of actors within his or her network. These network actors are often referred to in the research literature as “persons in the shadow,” because they are for the most part unnoticeable to an audience. Systematic research on popular music does not touch upon who these persons in the shadow are and how they support deliberate practice. Therefore, the aim of this study was to examine which network actors have supported popular musicians to deliberately practice their craft during childhood, the period of apprenticeship, and throughout their careers, along with the type of support that was provided. A mixed-method egocentric network analysis, combined with quantitative and qualitative analyses of data from interviews with five experts and five intermediate-level popular musicians, has shown that band members and instrumental teachers were perceived as being most supportive of musicians’ deliberate practice during childhood and period of apprenticeship. However, during the musicians’ careers, band members were perceived as being most supportive. Experts differed from intermediate-level musicians as follows: (a) experts had contact with a larger pool of band members and instrumental teachers during their careers; (b) their networks, especially of band members in different formations and instrumental teachers, changed constantly and frequently throughout their careers; (c) they were regularly confronted with unfamiliar musical content, which expanded their musical knowledge. In this article we suggest that future research should investigate how change in networks influences deliberate practice and the acquisition of expertise.

Alterations in Violinists’ Practice Behaviors in Response to Differing Technical Demands in the Material

The pedagogical literature strongly suggests that when a musician works on a specific piece of repertoire, one should choose practice strategies tailored to the challenges presented by that material. Such a behavioral choice could represent an instantiation of focused and deliberate practice, a critical aspect of the relationship between experience and the acquisition of expertise. However, most of the literature investigating individual practice has used a single stimulus for all participants, or else has employed surveys or other proxy measures of practicing behavior. In this study, participants of three different experience levels (high school, collegiate, or professional violinists) practiced three excerpts, each featuring a different signature challenge. Results suggest that practice is highly idiosyncratic, that participants do adjust their approaches to the challenges of the material, but that individuals of differing experience levels identify remarkably similar problems within the material.

Pharmacy Students' Self-efficacy for Pharmaceutical Expertise Affects Successful Experiences as Enactive Attainments in Pharmacy Practice Experience in Japan

Pharmacy practice experience (PPE) is essential in the six-year course of pharmaceutical education in Japan. We previously found that PPE reinforced students' self-efficacy for curriculums (SECs), leading robust acquisition and reconstruction of pharmaceutical expertise. In this study, we aimed to clarify whether students' SECs affect successful experiences as enactive attainments in PPE. We distributed survey questionnaires to the fifth-year students in Keio University in 2016-2017 before and after PPE. The students made a self-assessment of their psychological state "expect to do well" on a seven-point Likert scale for each curriculum (C1 to C18), and their successful experiences were also collected from free description type questionnaire. We could follow up 139 students. The SEC scores increased from pre-PPE to post I (p<0.001) and II terms (p<0.01). The increase in SEC scores during PPE was associated with the rate of students' successful experiences in the first-term PPE (p=0.04). The path analysis revealed the following as significant predictive factors of SECs for successful experiences: basic sciences (C1, C2, C3, C4, C5, and C6) with stand-ardizing coefficient 0.35, health and environmental sciences (C11 and C12) with 0.39, and pharmaceutical sciences (C7, C8, C9, C10, C13, and C14) with -0.51. Students in the first-term PPE tended to experience successful performance in medical professions by using their pharmaceutical expertise that they had learned. In this study, for the first time, we demonstrated that Japanese students' SECs for pharmaceutical expertise affected successful experiences, leading better outcomes of PPE.

Functional, anatomical and diffusion tensor MRI study of radiology expertise.

BackgroundRepeated practice to acquire expertise could result in the structural and functional changes in relevant brain circuits as a result of long-term potentiation, neurogenesis, glial genesis, and remodeling.PurposeThe goal of this study is to use task fMRI to study the brain of expert radiologists performing a diagnosis task where a series of medical images were presented during fMRI acquisition for 12s and participants were asked to choose a diagnosis. Structural and diffusion-tensor MRI were also acquired.MethodsRadiologists (N = 12, 11M, 38.2±10.3 years old) and non-radiologists (N = 17, 15M, 30.6±5.5 years old) were recruited with informed consent. Medical images were presented for 12 s and three multiple choices were displayed and the participants were asked to choose a diagnosis. fMRI, structural and diffusion-tensor MRI were acquired. fMRI analysis used FSL to determine differences in fMRI responses between groups. Voxel-wise analysis was performed to determine if subcortical volume, cortical thickness and fractional anisotropy differed between groups. Correction for multiple comparisons used false discovery rate.ResultsRadiologists showed overall lower task-related brain activation than non-radiologists. Radiologists showed significantly lower activation in the left lateral occipital cortex, left superior parietal lobule, occipital pole, right superior frontal and precentral gyri, lingual gyrus, and the left intraparietal sulcus (p<0.05). There were no significant differences between groups in cortical thickness, subcortical volume and fractional anisotropy (p>0.05).ConclusionsRadiologists and non-radiologists had no significant difference in structural metrics. However, in diagnosis tasks, radiologists showed markedly lower task-related brain activations overall as well as a number of high-order visual and non-visual brain regions than non-radiologists. Some brain circuits appear to be uniquely associated with differential-diagnosis paradigm expertise that are not involved in simpler object-recognition cases. Improved understanding of the brain circuitry involved in acquisition of expertise might be used to design optimal training paradigms.

Perceptual learning in the identification\xa0of lung cancer in chest radiographs

Extensive research has shown that practice yields highly specific perceptual learning of simple visual properties such as orientation and contrast. Does this same learning characterize more complex perceptual skills? Here we investigated perceptual learning of complex medical images. Novices underwent training over four sessions to discriminate which of two chest radiographs contained a tumor and to indicate the location of the tumor. In training, one group received six repetitions of 30 normal/abnormal images, the other three repetitions of 60 normal/abnormal images. Groups were then tested on trained and novel images. To assess the nature of perceptual learning, test items were presented in three formats – the full image, the cutout of the tumor, or the background only. Performance improved across training sessions, and notably, the improvement transferred to the classification of novel images. Training with more repetitions on fewer images yielded comparable transfer to training with fewer repetitions on more images. Little transfer to novel images occurred when tested with just the cutout of the cancer region or just the background, but a larger cutout that included both the cancer region and some surrounding regions yielded good transfer. Perceptual learning contributes to the acquisition of expertise in cancer image perception.

Using the Chief Complaint Driven Medical History: Theoretical Background and Practical Steps for Student Clinicians.

This article was migrated. The article was marked as recommended. A previous short report presented an approach to teaching a focused medical history in the emergency department by using a chief complaint directed differential diagnosis guided streamlined series of questioning. It was proposed that such an approach teaches clinical expertise. The current article presents a review of a robust literature in the acquisition of cognitive expertise, and specifically how novices become experts through the acquistion of increasingly relevant and pertinent information. The review traces the development of several concepts such as exemplars illness scripts, problem representations, the use of semantic qualifiers and shows how the current proposed method incorporates those approaches. The method is applied specifically to two patient chief complaints commonly encountered in the emergency deparment and suggests how this approach would be useful in developing diagnostic ability in student physicians.

Application of derivative products for integrating expert knowledge into assembly process planning

The use of physical mock-ups offers the possibility to evaluate the efficiency of assembly processes in early design stages of product development. Therefore, the challenges of assembly procedures, which arise during the implementation of new large-dimension assembly groups, can be managed prematurely. Assembly training with a derivative product in an assembly workshop stimulates a knowledge exploitation of function and performance of assembly groups. The paper shows the acquisition of technical expertise from shop floor staff and knowledge from non-experts from assembly operations during the assembly workshop, by using the handling with a derivative product. These information were integrated into the implementation process of assembly planning.

Employee Branding and Talent Acquisition- an Imperative Need

within the triumphing enterprise age, affiliations want to rehash and to rethink themselves at an important stage and to come to be agiler. advancement of HR the officers proposes a circulate from massive mindset on place of business closer to duty, gaining knowledge of and improvement of marketers and task for capability. The belief driving this examination is to study the affiliation between the worker Branding and expertise Acquisition. The expressive research configuration is used for the present paintings. An top notch inspecting has been used to deliver collectively the facts. The individuals inside the review are 180 HR directors of picked IT groups in Bangalore. The device used for statistics aggregation is a self-specific,self-figured and organized poll. After the assessment, it very well can be presumed that worker Branding decidedly impacts talent Acquisition. The examination famous that in an open ability economic machine, business enterprise emblem is noteworthy in deciding on and maintenance, and protection of excessive functionality experts and should be revolved around gaining knowledge of and administration development, adaptability, prizes and competency systems. A part of the inspiration reliant on the exam is also shown in this paper.

From perceptual to conceptual categorization of wines: What is the effect of expertise?

Wine supply in the French market is structured in an intricate system of categories based on origin. There is very little knowledge about consumers understanding of this complex category system and the sensory styles behind these categories. This study investigated how assessors with different level of expertise categorized Beaujolais wines from general to more specific levels of categorization (grape variety, appellation, and “lieu-dit”) in both perceptual (wines) and conceptual (wine labels) conditions. Based on the literature on expertise, we expected a stronger effect in the perceptual condition, in particular for the most specific levels of categorization. For each wine categorization level, three sets of 12 wines were tasted by three panels of 60 assessors: a panel of unfamiliar novices with no much exposure to Beaujolais wines; a panel of familiar novices with regular exposure to Beaujolais wines; and a panel of experts from the Beaujolais. In both perceptual and conceptual conditions, assessors were asked to perform a binary sorting task, followed by a verbalisation task. Data were analysed using DISTATIS. At each level, with a few exceptions, a clearer separation was observed between the two categories in the conceptual condition than in the perceptual condition. Although the experts categorized the labels by grape variety, they did not spontaneously categorize the wines in that way. Finally, we observed a clear expertise effect only in the conceptual condition. This result will be discussed in terms of expertise acquisition and categorization processes.

Cardiac surgery residents training in Germany—Status quo and future prospects

Residency training for specialization in cardiac surgery in Germany recently underwent a series of changes. A new 6-year integrated curriculum has been created that is based on acquisition of specific expertise rather than a rigid time frame. In effect, the training paradigm is one that is competency-based. After compliance with the curricular requirements and successfully completion of an examination, the Federal Medical Chamber grants the status of a licensed specialized physician (“Facharzt”) and issues a certificate, which allows for independent clinical practice. There is no recertification during the course of the physicians' professional career. The educational curricula for specialized training are issued by the National Medical Chamber in cooperation with the respective surgical societies and passed by the German Medical Assembly.

Educational Effect of Practical Training on Students' Robust Acquisition and Reconstruction of Expertise on Pharmaceutical Sciences They Had Learned before Practical Training

Long-term practical training in the 6-year course of pharmaceutical education is a program for students after acquiring basic knowledge on pharmaceutical sciences and preclinical training. However, it remains unproved whether practical training affects students' robust acquisition and reconstruction of pharmaceutical expertise which they had learned before starting practical training. To address this issue, we administered survey questionnaires to 5th-year students (n=149) of Keio University in 2016 both before and after practical training. From the viewpoint of self-efficacy, psychological approach was applied to evaluate respondents' psychological state "to do well" on a 7-point Likert scale (1=disagree, 4=neither, 7=agree) for specific subjects C1-C18 (18 core units of pharmaceutical expertise in the current Model Core Curriculum for Pharmaceutical Education), mainly including basic pharmaceutical sciences, public health, clinical pharmacology and pharmacotherapy. C1-C18 total score values, which reflect the strength of certainty to acquire expertise, were significantly higher after the first term of practical training compared to before training, regardless of the pharmacy and the hospital (p<0.001), but not after the second term. Specific factors associated with increased score values for "to do well" were not extracted from other questionnaire answers concerning students' mentors or their self-learning during practical training. These results demonstrated that practical training at least partly reinforced students' feeling of "to do well", contributing to their robust acquisition and reconstruction of pharmaceutical expertise. Giving students recognition individually of their learning process themselves encourages more effective practical training toward their development of resources as a pharmacist.

Over-the-Counter versus Limit-Order Markets: The Role of Traders’ Expertise

Abstract Over-the-counter (OTC) markets attract substantial trading volume despite exhibiting frictions absent in centralized limit-order markets. We compare the efficiency of OTC and limit-order markets when traders’ expertise is endogenous. We show that asymmetric access to counterparties in OTC markets yields increased rents from expertise acquisition for a few well-connected core traders. When the existence of gains to trade is uncertain, traders’ higher expertise in OTC markets can improve allocative efficiency. In contrast, when expertise primarily causes adverse selection, competitive limit-order markets tend to dominate. Our model provides guidance for policy makers and empiricists evaluating the efficiency of market structures.

Impact of a course in evidence-informed policy-making on the acquisition of methodological knowledge: Findings from before-and-after studies conducted on three consecutive cohorts of master students

The practice of evidence-informed policy-making (EIPM) consists of systematically searching, analyzing, synthesizing and disseminating the best available research evidence to inform decision-makers about policy problems, policy tools, implementation options, and/or policy evaluation results. Identifying the best available scientific evidence is not a simple task. The vast majority of research evidence contains risks of bias that hinder the reliability of their conclusions. In order to select the soundest available research evidence, policy analysts need to know how to critically appraise research evidence and identify different risks of bias. Formal theories on expertise acquisition in public bureaucracies suggest that these skills and knowledge should be acquired within academia rather than within governmental agencies. We thus created a 45-hour course in EIPM, POL-7061, that was first offered in 2012 to students enrolled in the Master’s Program in Public Affairs at Université Laval (Québec, Canada). The course mainly teaches techniques for searching and appraising different types of empirical studies. In 2013, we conducted a before-and-after study to assess the impact of the course on the methodological knowledge of the students. We repeated the exercise on two consecutive cohorts in 2014 and 2015. Mean percent of pre-post improvement on the knowledge test was 37% for the 2013 cohort, 51% for the 2014 cohort and 31% for the cohort of 2015. Teaching techniques in EIPM to Master’s students in public affairs is thus feasible and can have a positive impact on their basic methodological knowledge.

Wine expertise: perceptual learning in the chemical senses

Researchers have long been interested in the kinds of perceptual learning that take place in those who acquire wine expertise. However, progress in this field has been hampered by differing accounts of what, exactly, counts as expertise, not to mention the exact nature of any learning taking place. That said, the majority of studies published to date have tended to document more pronounced changes in conceptual knowledge structures than in terms of enhanced smell or taste sensitivity per se. Converging neuroimaging research from studies where experts and non-experts taste/evaluate wine in the brain scanner has also highlighted changes in neural activation in those brain areas consistent with enhanced conceptual/synthetic analysis in wine experts. Given the impressive effects that have been demonstrated elsewhere in the literature on perceptual learning, several reasons as to why similar effects have typically not been widely observed in the case of wine expertise are briefly discussed: Relevant factors here likely include everything from the distinctly suboptimal environment for sensory analysis in the brain scanner, through to the mismatch between the kinds of tasks/training typically involved in the acquisition of wine expertise, and the type of perceptual threshold testing normally used to assess the consequences of perceptual learning.

A Phenomenographic Approach to Understanding the Expertise of Perioperative Nurses.

Understanding the ways that perioperative nurses view the acquisition of expertise may provide foundational information for perioperative nurse educators. Our study aimed to evaluate specific types of expertise exhibited by experienced perioperative nurses and identify how nurses perceived these areas of expertise. We interviewed 20 perioperative nurses working in a university hospital in Korea. We extracted six themes regarding perioperative nursing expertise: sticking to principles, using available resources in complex situations, paying close attention to details, seeing the whole picture, prioritizing actions according to patients' conditions, and organizing a team to maximize efficiency. These findings may help perioperative educators develop practical educational strategies for novice perioperative nurses by providing a common language regarding the areas of expertise exhibited by experienced perioperative nurses.

Job Satisfaction Among Methadone Maintenance Treatment Clinic Service Providers in Jiangsu, China: A Cross-sectional Survey.

Objective:Service providers’ job satisfaction is critical to the stability of the work force and thereby the effectiveness of methadone maintenance treatment (MMT) programs. This study aimed to explore MMT clinic service providers’ job satisfaction and associated factors in Jiangsu, China.Methods:This secondary study used baseline data of a randomized interventional trial implemented in Jiangsu, China. A survey was conducted among 76 MMT service providers using the computer-assisted self-interview (CASI) method. Job satisfaction responses were assessed via a 30-item scale, with a higher score indicating a higher level of job satisfaction. Perceived institutional support and perceived stigma due to working with drug users were measured using a 9-item scale. Correlation and multiple linear regression analyses were performed to identify factors associated with job satisfaction.Results:Correlation analyses found a significant association between job satisfaction and having professional experience in the prevention and control of HIV, other sexually transmitted infections, or other infectious diseases (P = 0.046). Multiple regression analyses revealed that working at MMT clinics affiliated with Center for Disease Control and Prevention sites was associated with a lower level of job satisfaction (P = 0.014), and perception of greater institutional support (P = 0.001) was associated with a higher level of job satisfaction.Conclusion:Job satisfaction among MMT clinic service providers was moderate in our study. Our findings suggest that institutional support for providers should be improved, and that acquisition of additional expertise should be encouraged.

Mandatory Surgical Subinternship in the Final Year of Medical School - a Stepping Stone to Becoming a Surgeon?

The final year is an important time for a medical student as this is when medical knowledge is transformed into medical responsibilities. The field of surgery is firmly anchored in the educational structure as it is mandatory during the practical year of a medical student. The purpose of this paper is to identify factors that influence medical students to choose surgery after the final year of medical school. An online survey conducted by the AG DGOU 2012 provided complete data sets from a total of 9079 participants. 184 of these had already completed their PJ compulsory sub-internship (tertiary) surgery. These were divided into four groups for analysis: decision to specialise in surgery prior to the PJ compulsory tertiary ("yes, before", JV), during the PJ compulsory ("yes, during", JW), decision against before the PJ compulsory ("no, before", NV) or during the compulsory ("no, during", NW). The total of 38 survey items were summarised for overall assessment, taking into account the decision on subject specialisation. 57.9% of the respondents were positive regarding the overall impression of the surgical internship during their final year. The respondents of the JW group were especially positive, having made the decision to become a surgeon, based on their internship experience during the final year in comparison to the NW group (decision against surgery). We find significant differences in all analysed items: integration into team JW/NW (p ≤ 0.003), acquisition of expertise (p ≤ 0.014), teachers (p ≤ 0.025), quality and structure of teaching (p ≤ 0.043) and overall satisfaction with the required tertial (p ≤ 0.037). In comparison to other specialities, in the field of surgery there is the option of recruiting directly within the framework of the compulsory internship. The results reveal unsatisfactory structures from a student perspective. The lack of medical care/support, the insufficient inclusion in therapeutic considerations, the lack of professional knowledge and lack of contact with the teachers are just a few key points that negatively impact the overall outcome of students' satisfaction with the compulsory tertiary education. The results of the present study should serve as motivation and contribute to the restructuring of the compulsory core of the Practical Year, which the Master Plan 2020 will entail.