Stages Of Skill Acquisition Research Articles

Feasibility of High-Fidelity Simulator Models for Minimally Invasive Spine Surgery in a Resource-Limited Setting: Experience From East Africa.

Spine surgery is a rapidly evolving specialty with a continuous need to learn new skills. In resource-limited settings such as Africa, the need for training is greater. The use of simulation-based training is important in different stages of skill acquisition, especially for high-stake procedures such as spine surgery. Among the available methods of simulation, the use of synthetic models has gained popularity among trainers. Twenty participants of a neurosurgery training course, most of whom (65%) were neurosurgery residents and fellows, were recruited. They had hands-on training sessions using a high-fidelity lumbar degenerative spine simulation model and hands-on theater experience. After this, they completed a survey to compare their experience and assess the effectiveness of the lumbar spine model in stimulating real patient and surgery experiences. The participants were from four African countries, and the majority were neurosurgery residents. There were varying levels of experience among the participants in minimally invasive spine surgery, with the majority either having no experience or having only observed the procedure. All the participants said that the high-fidelity lumbar spine model effectively simulated real minimally invasive spine setup and real bone haptics and was effective in learning new techniques. Most of the participants agreed that the model effectively simulated real dura and nerve roots (95%), real muscle (90%), real bleeding from bones and muscles (95%), and real cerbrospinal fluid in the subarachnoid space. Among them, 95% agreed that the model is effective in lumbar minimally invasive spine training in resource-limited settings. With the development of new and better surgical techniques, the use of high-fidelity models provides a good opportunity for learning and training, especially in resource-poor settings where there is a paucity of training facilities and personnel.

Towards identifying a learning curve for robotic abdominal wall reconstruction: a cumulative sum analysis.

Over the past decade, an increase has been seen in robotics used for hernia repair, specifically robotic abdominal wall reconstruction (rAWR). However, the learning curve for rAWR can be steep and presently, little is understood regarding the optimal case volume required to achieve proficiency. The aim of our study was to review skill acquisition and describe the learning curve for rAWR. A retrospective, single-surgeon case series of consecutive patients who underwent rAWR from 2018 to 2022. The primary outcome was operative time, obtained from console time identified through the MyIntutive application. A one-sided cumulative sum analysis (CUSUM) curve for the total operative time was derived based on the mean operative time of chronological procedures (207min). 185 patients underwent rAWR between 2018 and 2022. These patients were more likely to be female, Caucasian, and have undergone two previous hernia repairs. ASA complexity increased over time with ASA 3 being predominant from 2020 onwards. The median hernia length was 15.0cm and the median width was 7cm. Average operative time was 207.8min and decreased over time. The CUSUM analysis identified four phases of skill acquisition with the following case volumes: Initial Learning Curve (0-20), Stabilization Phase (21-55), Second Learning Curve (56-70), 4) Skill Proficiency (> 70). In the early learning curve of rAWR, operative time decreased consistently after 70 cases, with an initial inflection after 20 cases. We identified varying stages of skill acquisition that are likely typical of a surgeon as they would progress through the learning curve of advanced robotic surgery. Future studies are needed to confirm the optimal case volume for determining the skill level for the performance of rAWR.

Behavioral-play familiarization for non-sedated magnetic resonance imaging in young children with mild traumatic brain injury.

Mild traumatic brain injury (mTBI) sustained in early childhood affects the brain at a peak developmental period and may disrupt sensitive stages of skill acquisition, thereby compromising child functioning. However, due to the challenges of collecting non-sedated neuroimaging data in young children, the consequences of mTBI on young children's brains have not been systematically studied. In typically developing preschool children (of age 3-5years), a brief behavioral-play familiarization provides an effective alternative to sedation for acquiring awake magnetic resonance imaging (MRI) in a time- and resource-efficient manner. To date, no study has applied such an approach for acquiring non-sedated MRI in preschool children with mTBI who may present with additional MRI acquisition challenges such as agitation or anxiety. The present study aimed to compare the effectiveness of a brief behavioral-play familiarization for acquiring non-sedated MRI for research purposes between young children with and without mTBI, and to identify factors associated with successful MRI acquisition. Preschool children with mTBI (n=13) and typically developing children (n=24) underwent a 15-minutes behavioral-play MRI familiarization followed by a 35-minutes non-sedated MRI protocol. Success rate was compared between groups, MRI quality was assessed quantitatively, and factors predicting success were documented. Among the 37 participants, 15 typically developing children (63%) and 10 mTBI (77%) reached the MRI acquisition success criteria (i.e., completing the two first sequences). The success rate was not significantly different between groups (p=.48; 95% CI [-0.36 14.08]; Cramer's V=.15). The images acquired were of high-quality in 100% (for both groups) of the structural images, and 60% (for both groups) of the diffusion images. Factors associated with success included older child age (Β=0.73, p=.007, exp(B)=3.11, 95% CI [1.36 7.08]) and fewer parental concerns (Β=-1.56, p=.02, exp(Β)=0.21, 95% CI [0.05 0.82]) about the MRI procedure. Using brief behavioral-play familiarization allows acquisition of high-quality non-sedated MRI in young children with mTBI with success rates comparable to those of non-injured peers.

Enhancing motor imagery practice using synchronous action observation

In this paper, we discuss a variety of ways in which practising motor actions by means of motor imagery (MI) can be enhanced via synchronous action observation (AO), that is, by AO + MI. We review the available research on the (mostly facilitatory) behavioural effects of AO + MI practice in the early stages of skill acquisition, discuss possible theoretical explanations, and consider several issues related to the choice and presentation schedules of suitable models. We then discuss considerations related to AO + MI practice at advanced skill levels, including expertise effects, practical recommendations such as focussing attention on specific aspects of the observed action, using just-ahead models, and possible effects of the perspective in which the observed action is presented. In section “Coordinative AO + MI”, we consider scenarios where the observer imagines performing an action that complements or responds to the observed action, as a promising and yet under-researched application of AO + MI training. In section “The dual action simulation hypothesis of AO + MI”, we review the neurocognitive hypothesis that AO + MI practice involves two parallel action simulations, and we consider opportunities for future research based on recent neuroimaging work on parallel motor representations. In section “AO + MI training in motor rehabilitation”, we review applications of AO, MI, and AO + MI training in the field of neurorehabilitation. Taken together, this evidence-based, exploratory review opens a variety of avenues for future research and applications of AO + MI practice, highlighting several clear advantages over the approaches of purely AO- or MI-based practice.

An automatic control system with human-in-the-loop for training skydiving maneuvers: Proof-of-concept experiment

A real-time motion training system for skydiving is proposed. Aerial maneuvers are performed by changing the body posture and thus deflecting the surrounding airflow. The natural learning process is extremely slow due to unfamiliar free-fall dynamics, stress induced blocking of kinesthetic feedback, and complexity of the required movements. The key idea is to augment the learner with an automatic control system that would be able to perform the trained activity if it had direct access to the learner’s body as an actuator. The aiding system will supply the following visual cues to the learner: 1. Feedback of the current body posture; 2. The body posture that would bring the body to perform the desired maneuver; 3. Prediction of the future inertial position and orientation if the body retained its present posture. This paper presents results of a Proof-of-Concept experiment, whereby humans controlled a virtual skydiver free-falling in a computer simulation, by the means of their bodies. This task was impossible without the aiding system, enabling all participants to complete the task at the first attempt. The design of stabilizing closed loop control of highly non-linear and unstable dynamics with a human in the loop proved to be feasible. The future goal is applying this novel concept to aid novices maintain stability in free-fall and perceive the unfamiliar environmental dynamics, thus accelerating the initial stages of skill acquisition.

Paraprofessionals delivering brief psychological interventions: Qualitative accounts of training and supervision

AbstractAimIn response to the ever‐increasing demand for access to mental health provisions in the United Kingdom, there have been innovative studies examining brief interventions. Some services are increasing their efforts to train and supervise paraprofessionals to deliver brief, low‐intensity psychological interventions. It is essential to consider paraprofessionals' experiences in acquiring and providing new interventions. This qualitative improvement project aimed to learn about paraprofessionals' experiences of receiving training and supervision to provide brief psychological interventions.MethodsAll providing paraprofessionals in two secondary care adult mental health community teams in the East of England completed a semi‐structured interview, which was transcribed and subjected to thematic analysis.ResultsSelf‐directed learning helped build participants' understanding of the interventions and repeating procedural skills helped build their confidence. Shadowing, peer support and availability of supervising psychologists emerged as important factors in the service of learning. Following the skill acquisition stage, many participants described an increase in their comfort to work flexibly and reported being patient‐centred in their approach. Paraprofessionals described natural uncertainties arising when learning a new intervention, demonstrating self‐reflection over their practice.DiscussionThis qualitative improvement project provides evidence that recognised learning processes and models in developing therapists' skills are also applicable to paraprofessionals with little experience. With a focus on using manuals to ensure consistency of the delivery of interventions, the paraprofessionals' journey also highlights the different needs in ever‐changing community settings. Future research directions are considered.

Visual strategies of young soccer players during a passing test - A pilot study.

In sports, studies on visual behavior have mostly focused on expert-novice differences during decision making tasks and during aiming tasks. How visual behavior changes during the early stages of skill acquisition however, has hardly been documented. The current study investigated gaze behavior of young soccer players during the execution of a soccer passing task. Gaze behavior of eleven 8- to 10-year-old soccer players was recorded while they performed the Loughborough Soccer Passing Test. Based on their score, participants were then divided into a high performance group (N=5), and a low performance group (N=6). Results showed that the low performance group tended to look more at the ball while they were handling it. These findings suggest that gaze strategies develop alongside technical skills. More insights in the interplay between technical skills and gaze strategies during skill acquisition could lead to improved training methods for young soccer players.

Learning Curve from 100 Cases of Totally Thoracoscopic Mitral Valve Replacement.

To investigate and analyze the learning curve of totally thoracoscopic mitral valve replacement and provide a quantitative reference for cardiac surgeons to carry out the operation step by step. The clinical data were retrospectively analyzed of 100 consecutive patients with totally thoracoscopic mitral valve replacement successively performed by the same surgeon in a single center from May 2019 to June 2020. The learning curve was divided into 2 stages by using cumulative sum analysis, and relevant surgical parameters and perioperative indicators were analyzed. The first stage of the learning curve is the skill acquisition stage, which includes 1 to 40 surgical procedures. The second stage is the proficiency stage, involving 41 to 100 operations. Among the surgical parameters of the patients in the 2 stages, detectable improvements were observed in operative time, cardiopulmonary bypass time, cross-clamp time, and intraoperative injury. After surgery, the amount of drainage, length of hospital stay, blood creatinine levels, and oxygenation index 24 h after surgery were also significantly different between the 2 groups (all P < .05). The age and sex distributions of the patients were balanced, and there was no statistically significant difference in terms of conversion to median sternotomy between the 2 stages (P > .05). Cumulative sum analysis was used to accurately analyze the learning curve of totally thoracoscopic mitral valve replacement, indicating that 40 cases are needed to master the technique.

The Linguistically Informed Virtue-Novice as Precocious: a Reply to Stichter’s The Skillfulness of Virtue

Stichter’s The Skillfulness of Virtue provides an original and contemporary discussion of virtue-acquisition from an interdisciplinary standpoint. By equating virtues to skills, he offers an empirically informed progression towards virtue expertise. With the focus on gaining proficiency, there is little room to analyse the status of the virtue-novice, who is equated to a novice in any other skill: an agent consciously following simple rules, gaining experience in order to respond to normatively-laden situations with more automaticity in the following stages of skill-acquisition. This paper argues for a disanalogy between the virtue novice and novices in other skills, resulting from the understanding that follows from learning virtue words such as ‘kindness’ and ‘honesty’. Our brains are structured to find and subsequently use patterns to skilfully move around in our environment. These patterns can be represented in what Stichter calls ‘schemas’ or mental models of categorisations. Virtue words refer to patterns that would be difficult to categorise without linguistic labels, as instances of these categories are highly divergent. Virtue words are thus learned through examples of virtuous behaviour. Moreover, as virtue words are thick ethical concepts, they contain a normative load. I argue that due to these characteristics, novices who use virtue vocabulary are in a more advanced position than novices in other skills. So, a kindness novice who understands the word ‘kind’ has a better idea of how to act kindly than the chess novice has an idea of how to play chess by understanding the word ‘chess’.

Dissimilar Phonemes Create a Contextual Interference Effect During a Nonword Repetition Task.

Purpose: The contextual interference effect is a motor learning phenomenon where conditions that decrease overall learning during practice enhance overall learning with new tasks. In the limb literature, this effect is observed when different practice conditions are used (e.g., blocked vs. random practice schedules). In speech motor learning, contextual interference effects are mixed. The differences observed during speech motor learning may be due to the stimuli used. We hypothesized that dissimilar phonemes might create interference during speech motor learning, such that training accuracy would decrease. However, generalization accuracy would increase compared to practice with nonwords containing similar phonemes. Method: Thirty young adults with typical speech and hearing participated in a motor learning study using a cross-over design. Participants engaged in nonword repetition training followed by an immediate retention and transfer task with two sets of nonwords: nonwords with similar phonemes and nonwords with dissimilar phonemes. Percent consonants correct were calculated to examine the effects of the two different types of nonwords based on the stage of skill acquisition. Results: A contextual interference effect was observed in this study using nonwords that varied in phonemic similarity. Nonwords with similar phonemes were produced with greater accuracy during the training stage of skill acquisition, and nonwords with dissimilar phonemes were produced with greater accuracy during the transfer stage. Conclusion: The proposed hypothesis for this study was met – practicing nonwords with dissimilar phonemes resulted in greater accuracy in the transfer phase of this experiment. Results indicate that phonemic dissimilarity produced contextual interference and influenced speech motor learning. These results indicate that the linguistic properties of stimuli must be factored into speech motor learning. Future research should explore if other linguistic variables interact with variables of motor learning to enhance speech practice and generalization outcomes.

The Role of Spatial Abilities in Medicine: Implications for Selection and Training

The ability to represent and process spatial information is central to many aspects of medicine, including learning anatomy, performing surgery, and using medical imagery technologies. Consistent with this view, there is evidence that task performance in a variety of medical specialties is correlated with spatial abilities. In this talk, I will take a broad view of spatial abilities, which includes both small‐scale and large‐scale spatial abilities and the ability to understand and use spatial representations. I will review research on how these abilities are related to the development of expertise in medical specialties such as surgery and dentistry. This research raises questions of whether individual differences in medical performance are best viewed in terms of an ability model or a skill model of individual differences. It suggests that spatial abilities are most important at the early stages of skill acquisition and in non‐routine situations whereas more routine spatial skills become less dependent on spatial abilities with training.

Insights for farmer training programs from system dynamics: A case study from Northern Michigan

Training programs for new farmers are proposed as a solution to rural food insecurity, rural development, and the recruitment and training of younger farmers simultaneously. However, evaluation of these programs and evidence for their individual or collective impact is sparse. In this paper, we use in-depth interviews combined with an exploratory model to evaluate the current and potential effectiveness of a farmer training program in Michigan’s Upper Peninsula. We use the model to represent the theoretical progression of farmers through three subsequent stages of skill acquisition: training, new farmer (practicing skills on land owned by the program) and experienced (farming on their own). We find that recruitment, access to local markets, rapidity of skill acquisition, and access to start-up costs are all important factors that facilitate trainees’ transition to farming on their own, but of these, start-up costs for independent farming appear to be the most significant barrier. While this model is exploratory and not predictive, these insights can inform the design of effective programs for training farmers. In addition, this study also demonstrates how systems dynamics can be a valuable method to evaluate and maximize the effectiveness of training programs.

Electroencephalographic evidence for a reinforcement learning advantage during motor skill acquisition

The feedback that we receive shapes how we learn. Previous research has demonstrated that quantitative feedback results in better performance than qualitative feedback. However, the data supporting a quantitative feedback advantage are not conclusive and further little work has been done to examine the mechanistic neural differences that underlie the relative benefits of quantitative and qualitative feedback. To address these issues, participants learned a simple motor task in quantitative and qualitative feedback conditions while electroencephalographic (EEG) data were recorded. We found that participants were more accurate and had a larger neural response – the feedback related negativity - when qualitative feedback was provided. Our data suggest that qualitative feedback is more advantageous than quantitative feedback during the early stages of skill acquisition. Additionally, our findings support previous work suggesting that a reinforcement learning system within the human medial-frontal cortex plays a key role in motor skill acquisition.

Establishing metrics and control laws for the learning process: ball and beam balancing

Understanding how dexterity improves with practice is a fundamental challenge of motor control and neurorehabilitation. Here we investigate a ball and beam implementation of a dexterity puzzle in which subjects stabilize a ball at the mid-point of a beam by manipulating the angular position of the beam. Stabilizability analysis of different biomechanical models for the ball and beam task with time-delayed proportional-derivative feedback identified the angular position of the beam as the manipulated variable. Consequently, we monitored the changes in the dynamics with learning by measuring changes in the control parameters. Two types of stable motion are possible: node type (nonoscillatory) and spiral type (oscillatory). Both types of motion are observed experimentally and correspond to well-defined regions in the parameter space of the control gains. With practice the control gains for each subject move close to or on the portion of the boundary which separates the node-type and spiral-type solutions and which is associated with the rightmost characteristic exponent of smallest real part. These observations suggest that with learning the control gains for ball and beam balancing change in such a way that minimizes overshoot and the settling time. This study provides an example of how mathematical analysis together with careful experimental observations can shed light onto the early stages of skill acquisition. Since the difficulty of this task depends on the length of the beam, ball and beam balancing tasks may be useful for the rehabilitation of children with dyspraxia and those recovering from a stroke.

The Embodiment of Aerial Practice: Body, Mind, Emotion

ABSTRACT The purpose of this qualitative study was to examine the embodied qualities of aerial practice among 13 US undergraduate students (M age = 20.46 years old). Drawing on the philosophy of embodiment, interview questions addressed bodily sensations, cognition, and the role of music and mirror viewing. The first emerging theme from the analysis was bodily sensations and cognition, including integrating cognitive and sensory bodily awareness (thinking and sensing the movements), bodily awareness and visual cues (e.g., emphasizing bodily sensations), and pain and the body. The second theme was music, mind, body, and emotion, including the embodiment of music and performance without music. In movement programs, cognitive and sensory bodily awareness are keys to all stages of skill acquisition. Overreliance on mirror viewing may diminish proprioception. Given that pain does not entirely disappear with continuous practice, it can affect movement execution. Bodily expressions with or without music can be embodied and artistic.

Visualizing event sequence game data to understand player\u2019s skill growth through behavior complexity

Analysis of game data is used to study player behavior. For puzzle-based games where solutions are usually defined by their action sequences, player behavior can also be studied by their solution complexity. In this paper, we present a visualization system to help learning expert to understand how actions, timing and the resulting strategy change with regard to the solution complexity. To establish a novel perspective into the patterns not only in action choices but also in behavior complexity, we designed an interactive, customized line chart to track how complexity and performance change at each stage of skill acquisition. Specialized glyph system (Strategy Signature) is implemented to find strategy differences easily with simple visual cues. Contextual information can be explored by switching the view modes to see potential links between complexity and raw attributes. Evaluation with expert users shows that the system effectively reduced their time and effort in finding interesting subgroups and gave them unexplored angles of behavior complexity to contemplate player’s skill growth. In summary, this paper illustrates a visualization approach to enable analysis into the subtleties of behavior complexity in video games.Graphical abstract

The role of simulation-based education in cardiology

### Learning objectives Simulation-based education (SBE) is a ‘technique and not a technology’ which aims to ‘replace or amplify real-life experiences with guided experience that evoke or replicate substantial aspects...

Cross-task cue utilisation and situational awareness in simulated air traffic control

ObjectiveTo examine the role of cross-task cue utilisation in the acquisition of situational awareness during the initial stages of learning to operate an air traffic control simulation. BackgroundCue-based associations are an important component of situational awareness, a construct that is necessary for skilled process control, where the location, movement, and direction of multiple targets needs to be managed. However, the potential for high levels of situational awareness is difficult to assess in the absence of exposure. Previous research suggests that cross-task cue utilisation predicts the acquisition of feature-event associations that form the basis of situational awareness MethodSixty university students undertook an assessment of cue utilisation in the context of motor vehicle driving and subsequently engaged in an air traffic control simulation task. During the air traffic control simulation task, situational awareness queries were introduced based on the Situation Awareness Global Assessment Test (SAGAT). ResultsThe analyses revealed that participants who demonstrated relatively higher levels of cross-task cue utilisation also demonstrated greater performance on the SAGAT and achieved greater performance during the simulated air traffic control task. ConclusionThe outcomes suggest a relationship between cross-task cue utilisation and situational awareness, particularly at the initial stages of skill acquisition. ApplicationAssessments of cross-task cue utilisation may be used to distinguish the propensity for prospective trainees to acquire the situational awareness necessary for complex, process control tasks such as air traffic control.

The contribution of basic linguistic skills to handwriting among fifth-grade Arabic-speaking children

Previous research has attempted to characterise the contribution of motor, cognitive, and linguistic variables to handwriting. In this study, we aimed at assessing the contribution of basic linguistic skills (namely phonological processing, orthographic knowledge and morphology awareness) to the three dimensions of handwriting (i.e. legibility, speed and spelling) in the same participants. For this purpose, 200 normally developing fifth-grade children, in whom motor variables are hypothesised to play little role in handwriting, participated in this study. Handwriting (text copy and dictation) and other linguistic measures (testing phonology, orthography and morphology) were subjected to regression analyses. These showed that the same linguistic measures contributed differently to the various dimensions of handwriting and explained 26%, 13% and 57% of the variance in legibility, speed and spelling respectively. These findings indicated that legibility and speed were relatively poorly explained and emphasise the need to include other linguistic and non-linguistic variables in the study of handwriting in this age group. Future research on Arabic should developmentally investigate handwriting from earlier stages of skill acquisition and assess the contribution of linguistic, cognitive and motor factors, not only to text copy and dictation but also to other tasks such as free writing and written expression.

Cingulate and cerebellar beta oscillations are engaged in the acquisition of auditory-motor sequences.

Singing, music performance, and speech rely on the retrieval of complex sounds, which are generated by the corresponding actions and are organized into sequences. It is crucial in these forms of behavior that the serial organization (i.e., order) of both the actions and associated sounds be monitored and learned. To investigate the neural processes involved in the monitoring of serial order during the initial learning of sensorimotor sequences, we performed magnetoencephalographic recordings while participants explicitly learned short piano sequences under the effect of occasional alterations of auditory feedback (AAF). The main result was a prominent and selective modulation of beta (13-30Hz) oscillations in cingulate and cerebellar regions during the processing of AAF that simulated serial order errors. Furthermore, the AAF-induced modulation of beta oscillations was associated with higher error rates, reflecting compensatory changes in sequence planning. This suggests that cingulate and cerebellar beta oscillations play a role in tracking serial order during initial sensorimotor learning and in updating the mapping of the sensorimotor representations. The findings support the notion that the modulation of beta oscillations is a candidate mechanism for the integration of sequential motor and auditory information during an early stage of skill acquisition in music performance. This has potential implications for singing and speech. Hum Brain Mapp 38:5161-5179, 2017. © 2017 Wiley Periodicals, Inc.