Lawrence E M Grierson

McMaster University, Hamilton, Ontario, Canada

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Publications (44)83 Total impact

  • Ruth Chen · Lawrence E Grierson · Geoffrey R Norman ·
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    ABSTRACT: A principal justification for the use of high-fidelity (HF) simulation is that, because it is closer to reality, students will be more motivated to learn and, consequently, will be better able to transfer their learning to real patients. However, the increased authenticity is accompanied by greater complexity, which may reduce learning, and variability in the presentation of a condition on an HF simulator is typically restricted. This study was conducted to explore the effectiveness of HF and low-fidelity (LF) simulation for learning within the clinical education and practice domains of cardiac and respiratory auscultation and physical assessment skills. Senior-level nursing students were randomised to HF and LF instruction groups or to a control group. Primary outcome measures included LF (digital sounds on a computer) and HF (human patient simulator) auscultation tests of cardiac and respiratory sounds, as well as observer-rated performances in simulated clinical scenarios. On the LF auscultation test, the LF group consistently demonstrated performance comparable or superior to that of the HF group, and both were superior to the performance of the control group. For both HF outcome measures, there was no significant difference in performance between the HF and LF instruction groups. The results from this study suggest that highly contextualised learning environments may not be uniformly advantageous for instruction and may lead to ineffective learning by increasing extraneous cognitive load in novice learners. © 2015 John Wiley & Sons Ltd.
    Medical Education 03/2015; 49(3):276-85. DOI:10.1111/medu.12653 · 3.20 Impact Factor
  • Joyce Zazulak · Camilla Halgren · Megan Tan · Lawrence E M Grierson ·
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    ABSTRACT: Medical education research demonstrates that empathic behaviour is amenable to positive change when targeted through educational programmes. This study evaluates the impact of an arts-based intervention designed to nurture learner empathy through the provision of facilitated visual literacy activities. Health Sciences students (N=19) were assigned to two learning groups: a group that participated in a visual literacy programme at the McMaster Museum of Art and a control group that participated in the normal Health Sciences curriculum. All participants completed an inter-reactivity index, which measures empathy on affective and cognitive levels, prior to and following the programme. Those individuals assigned to the visual literacy programme also completed open-ended questions concerning the programme's impact on their empathic development. The index scores were subjected to independent within-group, between-test analyses. There was no significant impact of the programme on the participants' overall empathic response. However, sub-component analyses revealed that the programme had a significant positive effect on cognitive aspects of empathy. This finding was substantiated by the narrative reports. The study concludes that the affective focus of humanities-based education needs to be enhanced and recommends that learners are educated on the different components that comprise the overall empathic response. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Medical Humanities 02/2015; 41(1). DOI:10.1136/medhum-2014-010584
  • Kurt Domuracki · Arthur Wong · Lori Olivieri · Lawrence E M Grierson ·
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    ABSTRACT: Objectives Clinical skills expertise can be advanced through accessible and cost-effective video-based observational practice activities. Previous findings suggest that the observation of performances of skills that include flaws can be beneficial to trainees. Observing the scope of variability within a skilled movement allows learners to develop strategies to manage the potential for and consequences associated with errors. This study tests this observational learning approach on the development of the skills of central line insertion (CLI).Methods Medical trainees with no CLI experience (n = 39) were randomised to three observational practice groups: a group which viewed and assessed videos of an expert performing a CLI without any errors (F); a group which viewed and assessed videos that contained a mix of flawless and errorful performances (E), and a group which viewed the same videos as the E group but were also given information concerning the correctness of their assessments (FA). All participants interacted with their observational videos each day for 4 days. Following this period, participants returned to the laboratory and performed a simulation-based insertion, which was assessed using a standard checklist and a global rating scale for the skill. These ratings served as the dependent measures for analysis.ResultsThe checklist analysis revealed no differences between observational learning groups (grand mean ± standard error: [20.3 ± 0.7]/25). However, the global rating analysis revealed a main effect of group (d.f.2,36 = 4.51, p = 0.018), which describes better CLI performance in the FA group, compared with the F and E groups.Conclusions Observational practice that includes errors improves the global performance aspects of clinical skill learning as long as learners are given confirmation that what they are observing is errorful. These findings provide a refined perspective on the optimal organisation of skill education programmes that combine physical and observational practice activities.
    Medical Education 02/2015; 49(2). DOI:10.1111/medu.12631 · 3.20 Impact Factor
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    Ruth Chen · Lawrence Grierson · Geoffrey Norman ·
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    ABSTRACT: Health profession educators have identified auscultation skill as a learning need for health professional students. This article explores the application of cognitive load theory (CLT) to designing cardiac and respiratory auscultation skill instruction for senior-level undergraduate nursing students. Three experiments assessed student auscultation performance following instructional manipulations of the three primary components of cognitive load: intrinsic, extraneous, and germane load. Study 1 evaluated the impact of intrinsic cognitive load by varying the number of diagnoses learned in one instruction session; Study 2 evaluated the impact of extraneous cognitive load by providing students with single or multiple examples of diagnoses during instruction; and Study 3 evaluated the impact of germane cognitive load by employing mixed or blocked sequences of diagnostic examples to students. Each of the three studies presents results that support CLT as explaining the influence of different types of cognitive processing on auscultation skill acquisition. We conclude with a discussion regarding CLT's usefulness as a framework for education and education research in the health professions.
    Advances in Health Sciences Education 11/2014; 20(4). DOI:10.1007/s10459-014-9573-x · 2.12 Impact Factor
  • Inge Schabort · Mathew Mercuri · Lawrence E M Grierson ·
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    ABSTRACT: Objective: To determine predictors of international medical graduate (IMG) success in accordance with the priorities highlighted by the Thomson and Cohl judicial report on IMG selection. Design: Retrospective assessment using regression analyses to compare the information available at the time of resident selection with those trainees' national certification examination outcomes. Setting: McMaster University in Hamilton, Ont. Participants: McMaster University IMG residents who completed the program between 2005 and 2011. Main outcome measures: Associations between IMG professional experience or demographic characteristics and examination outcomes. Results: The analyses revealed that country of study and performance on the Medical Council of Canada Evaluating Examination are among the predictors of performance on the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada certification examinations. Of interest, the analyses also suggest discipline-specific relationships between previous professional experience and examination success. Conclusion: This work presents a useful technique for further improving our understanding of the performance of IMGs on certification examinations in North America, encourages similar interinstitutional analyses, and provides a foundation for the development of tools to assist with IMG education.
    Canadian family physician Medecin de famille canadien 10/2014; 60(10):e478-84. · 1.34 Impact Factor
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    ABSTRACT: ABSTRACT Two experiments were conducted to examine time and energy optimization strategies for movements made with and against gravity. In Experiment 1, the authors manipulated concurrent visual feedback, and knowledge about feedback. When vision was eliminated upon movement initiation, participants exhibited greater undershooting, both with their primary submovement and their final endpoint, than when vision was available. When aiming downward, participants were more likely to terminate their aiming following the primary submovement or complete a lower amplitude corrective submovement. This strategy reduced the frequency of energy-consuming corrections against gravity. In Experiment 2, the authors eliminated vision of the hand and the target at the end of the movement. This procedure was expected to have its greatest impact under no-vision conditions where no visual feedback was available for subsequent planning. As anticipated, direction and concurrent visual feedback had a profound impact on endpoint bias. Participants exhibited pronounced undershooting when aiming downward and without vision. Differences in undershooting between vision and no vision were greater under blocked feedback conditions. When performers were uncertain about the impending feedback, they planned their movements for the worst-case scenario. Thus movement planning considers the variability in execution, and avoids outcomes that require time and energy to correct.
    Journal of Motor Behavior 09/2014; 46(6):433-443. DOI:10.1080/00222895.2014.933767 · 1.42 Impact Factor
  • Lawrence E M Grierson ·

    Medical Education 05/2014; 48(5):461-2. DOI:10.1111/medu.12412 · 3.20 Impact Factor
  • Lawrence E M Grierson ·
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    ABSTRACT: Much has been made in the recent medical education literature of the incorrect characterization of simulation along a continuum of low to high fidelity (Cook et al. JAMA 306(9): 978-988, 2011; Norman et al. Med Educ 46(7): 636-647, 2012; Teteris et al. Adv Health Sci Educ 17(1): 137-144, 2012). For the most part, the common definition within the medical education community has been that simulations that present highly realistic performance characteristics, contexts, and scenarios are referred to as high-fidelity, while simulations that reduce to-be-learned skills to simpler constructs or constituent parts are referred to as low-fidelity. The issue with this is that highly-realistic has tended to mean the degree to which the simulation looks like the criterion context with little regard for what features of the simulation are in fact relevant to the skill that the educator hopes to teach. The inherent assumption that high fidelity simulations lead to better learning-an assumption for which there is a lack of supporting evidence (Norman et al. Med Educ 46(7): 636-647, 2012)-only exacerbates the problem. So much so that some have suggested that the term be abandoned all together (Hamstra et al. Acad Med J Assoc Am Med Coll 2014). While, it is true that fidelity and its importance are misconstrued in the medical education literature, the construct, defined classically as the degree of faithfulness that exists between two entities, is still fundamental to understanding the effectiveness that any one simulation might have in preparing learners for clinical performance. However, the concept of simulation fidelity must be recast in terms of the fundamental information processing events that underpin human performance.
    Advances in Health Sciences Education 04/2014; 19(2). DOI:10.1007/s10459-014-9504-x · 2.12 Impact Factor
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    Jing Li · Lawrence Grierson · Mary X Wu · Ronny Breuer · Heather Carnahan ·
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    ABSTRACT: Objective: To explore a method of quantitative evaluation on operation behavior of acupuncture manipulation and further analyze behavior features of professional acupuncture manipulation. Methods: According to acupuncture basic manipulations, Scales for Operation Behavior of Acupuncture Basic Manipulation was made and Delphi method was adopted to test its validity. Two independent estimators utilized this scale to assess operation behavior of acupuncture manipulate among 12 acupuncturists and 12 acupuncture-novices and calculate interrater reliability, also the differences of total score of operation behavior in the two groups as well as single-step score, including sterilization, needle insertion, needle manipulation and needle withdrawal, were compared. Results: The validity of this scale was satisfied. The inter-rater reliability was 0. 768. The total score of operation behavior in acupuncturist group was significantly higher than that in the acupuncture-novice group (13.80 +/- 1.05 vs 11.03 +/- 2.14, P < 0.01). The scores of needle insertion and needle manipulation in the acupuncturist group were significantly higher than those in the acupuncture-novice group (4.28 +/- 0.91 vs 2.54 +/- 1.51, P < 0.01; 2.56 +/- 0.65 vs 1.88 +/- 0.88, P < 0.05); however, the scores of sterilization and needle withdrawal in the acupuncturist group were not different from those in the acupuncture-novice group. Conclusion: This scale is suitable for quantitative evaluation on operation behavior of acupuncture manipulation. The behavior features of professional acupuncture manipulation are mainly presented with needle insertion and needle manipulation which has superior difficulty, high coordination and accuracy.
    Zhongguo zhen jiu = Chinese acupuncture & moxibustion 03/2014; 34(3):247-51.
  • Ruth Chen · Kelly Dore · Lawrence E. M. Grierson · Rose Hatala · Geoffrey Norman ·
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    ABSTRACT: This article provides an overview of cognitive load theory (CLT) and explores applications of CLT to health profession and nursing education research, particularly for multimedia and simulation-based applications. The article first reviews the 3 components of cognitive load: intrinsic, extraneous, and germane. It then discusses strategies for manipulating cognitive load variables to enhance instruction. Examples of how CLT variables can be modulated during instruction are provided. Lastly, the article discusses current applications of CLT to health profession and nursing education research and presents future research directions, focusing on the areas of multimedia and simulation-based learning. French Le présent article offre un aperçu de la théorie de la charge cognitive (TCC) et explore les applications de la TCC dans la recherche sur la formation des professionnels de la santé et des soins infirmiers, plus particulièrement les applications multimédias et fondées sur la simulation. L'article revoit tout d'abord les trois types de charge cognitive : intrinsèque, extrinsèque et germane. Il examine ensuite les stratégies permettant de manipuler les variables de la charge cognitive en vue d'améliorer l'enseignement. Des exemples montrant comment les variables de la TCC peuvent être modulées pendant l'enseignement sont fournis. Enfin, l'article discute les applications actuelles de la TCC dans le domaine de la recherche sur la formation des professionnels de la santé et des soins infirmiers et présente les orientations futures de la recherche, l'accent étant mis sur les secteurs de l'apprentissage multimédia et fondé sur la simulation.
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 01/2014; 46(2).
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    Jing Li · Lawrence Grierson · Mary X Wu · Ronny Breuer · Bin Zhou · Heather Carnahan ·
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    ABSTRACT: To observe the features of acupuncture needle twirling manipulations in order to promote the development of objective and quantitative performance standards of acupuncture manipulation. Twelve expert acupuncturists and 12 novices were enrolled in this study. Everyone of them was instructed to perform 10 trials of the uniform reinforcing and reducing technique of acupuncture on an artificial skin-pad that was mounted to a six-axis force transducer and each subject had his or her dominant hand index finger affixed with an infrared light emitting diode for acquiring parameters of acupuncture needle manipulation. The force transducer was used to measure the force the participant applied as they held an acupuncture needle to stimulate the skin-pad, and at the mean time, an optoelectric camera was employed to measure the position of the diode. In comparison with the expert acupuncturist group, the straggling coefficient of needle-twirling frequency was significantly bigger in the novice group (P < 0.01), suggesting a higher consistency in the trial-by-trial needle-twirling operation of the expert acupuncturists. Comparison of the needle-twirling force showed that the force values of the Z-axis in both expert group and novice group were considerably higher than those of the X-axis and Y-axis in the same one group (P < 0.01). The time of pre-needle-twirling of the novice group was markedly longer than that of the expert group (P < 0.01), suggesting a skilled operation technique of the expert acupuncturists. No significant differences were found between the expert acupuncturist group and novice group in the needle-twirling amplitude, frequency, force and total operation time (P > 0.05). Movement frequency consistency and temporal efficiency are the action features of expert acupuncturists in performing the uniform reducing-reinforcing twirling skill, which differentiates the performances of experts from novices. The assessment and training of this acupuncture skill should focus on these kinematic features.
    Zhen ci yan jiu = Acupuncture research / [Zhongguo yi xue ke xue yuan Yi xue qing bao yan jiu suo bian ji] 10/2013; 38(5):415-9.
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    Kulamakan M Kulasegaram · Lawrence E M Grierson · Geoffrey R Norman ·
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    ABSTRACT: Medical education research focuses extensively on experience and deliberate practice (DP) as key factors in the development of expert performance. The research on DP minimises the role of individual ability in expert performance. This claim ignores a large body of research supporting the importance of innate individual cognitive differences. We review the relationship between DP and an innate individual ability, working memory (WM) capacity, to illustrate how both DP and individual ability predict expert performance. This narrative review examines the relationship between DP and WM in accounting for expert performance. Studies examining DP, WM and individual differences were identified through a targeted search. Although all studies support extensive DP as a factor in explaining expertise, much research suggests individual cognitive differences, such as WM capacity, predict expert performance after controlling for DP. The extent to which this occurs may be influenced by the nature of the task under study and the cognitive processes used by experts. The importance of WM capacity is greater for tasks that are non-routine or functionally complex. Clinical reasoning displays evidence of this task-dependent importance of individual ability. No single factor is both necessary and sufficient in explaining expertise, and individual abilities such as WM can be important. These individual abilities are likely to contribute to expert performance in clinical settings. Medical education research and practice should identify the individual differences in novices and experts that are important to clinical performance.
    Medical Education 10/2013; 47(10):979-89. DOI:10.1111/medu.12260 · 3.20 Impact Factor
  • Lawrence E M Grierson · Simran Ohson · James Lyons ·
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    ABSTRACT: Humans are able to perceive unique types of biological motion presented as point-light displays (PLDs). Thirty years ago, Runeson and Frykholm (Human Perception and Performance, 7(4), 733, 1981, Journal of Experimental Psychology: General, 112(4), 585, 1983) studied observers' perceptions of weights lifted by actors and identified that the kinematic information in a PLD is sufficient for an observer to form an accurate perception of the object weight. However, research has also shown that extrinsic object size characteristics also influence the perception of object weight (Gordon, Forssberg, Johansson, & Westling in Experimental Brain Research, 83(3), 477-482, 1991). This study addresses the relative contributions of these two types of visual information to observers' perceptions of lifted weight, through an experiment in which participants viewed an actor lifting boxes of various sizes (small, medium, or large) and weights (25, 50, or 75 lb) under four PLD conditions-box-at-rest, moving-box, actor-only, and actor-and-box-and one full-vision video condition, and then provided a weight estimate for each box lifted. The results indicated that lift kinematics and box size contributed independently to weight perception. Interestingly, the most robust weight differentiations were elicited in the conditions in which both types of information were presented concurrently, despite their converse natures. Furthermore, full-vision video presentation, which contained visual information beyond kinematics and object information, elicited the best estimates.
    Attention Perception & Psychophysics 09/2013; 75(8). DOI:10.3758/s13414-013-0539-5 · 2.17 Impact Factor
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    ABSTRACT: The online visual control of movement involves contributions from 2 processes: a process early in the trajectory concerned with comparisons between actual and expected sensory consequences and another process late in the trajectory that reduces the discrepancy between the position of the hand and the target. This experiment was designed to determine how early and late visual controls are impacted by the illusory characteristics of the target in a rapid reaching task. Participants performed 500 ms movements to the vertices of Müller-Lyer figures with the availability of full vision on the majority of trials. However, on a fraction of the trials, movements to the targets were performed with either early vision (first 200 ms of movement), late vision (last 200 ms of movement) or no vision. Although participants undershoot the targets under all target and visual conditions, the impact of the target configuration was greatest when vision was available during only the final portion of the movement trajectory and least when only early vision was available for limb regulation. Aiming bias under full-vision and no-vision conditions was intermediate. These findings indicate that visual context has a greater impact on late discrete limb regulation than on early dynamic control of the limb trajectory.
    Experimental Brain Research 06/2013; 229(4). DOI:10.1007/s00221-013-3614-1 · 2.04 Impact Factor
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    Panteha Tajmir · Lawrence E M Grierson · Heather Carnahan ·
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    ABSTRACT: ABSTRACT The impact of exposure to cold on individuals' motor skills demands a deeper understanding of the ways in which cold weather influences psychomotor and haptic performance. In this study, various facets of psychomotor performance were evaluated in order to determine the impacts of ambient cold exposure on older persons. Healthy younger and older persons performed a battery of haptic psychomotor tests at room (23° C) and cold (1° C) ambient temperatures. The results indicate that older individuals do not perform as well as younger persons across the battery of tests, with cold temperature further degrading their performance in dexterity tasks (in, for example, Minnesota Manual Dexterity test placing: F [1, 16] = 10.23, p < .01) and peak precision grip force generation (F [1, 16] = 18.97, p < .01). The results suggest that cold weather may have an impact on the occupations older persons are able to perform during the winter months.
    Canadian Journal on Aging / La Revue canadienne du vieillissement 05/2013; 32(2):1-8. DOI:10.1017/S0714980813000184
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    Lawrence E M Grierson · James L Lyons · Adam Dubrowski ·
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    ABSTRACT: Objectives: It is well known that precision skills are best learned when they are practised in the sensorimotor context that is present when performance is most important. However, a particular skill may vary with respect to the sensorimotor context in which it is performed. Certain sensorimotor variations can make a task more or less complex than others. Recent accounts of skill learning describe how task difficulty can be manipulated to provide optimised challenges to progress learners beyond their current level of expertise. This study tests the idea that simplified practise contexts lead novice learners to acquire skill proficiency that is more generalisable to new contexts. Methods: We present a learning experiment in which the performances of novices who acquired a set level of proficiency in the endoscopic pots-and-beans task through performance-based practise using a gaze-up endoscopic monitor arrangement were compared against the performances of novices who acquired an equivalent level of proficiency using a simplified gaze-down arrangement. Participants returned after 1 week for retention and transfer testing. Results: Time and accuracy analyses revealed that participants in both training groups improved significantly over the practise protocol and maintained this performance after a period of retention. However, the comparisons of the visual display transfer performances (i.e. on the gaze-up arrangement) of the gaze-down trainees against the retention performances (i.e. also on the gaze-up arrangement) of their gaze-up counterparts and vice versa revealed that gaze-down trainees made fewer errors in both performance contexts (F(1,16) = 7.97, p = 0.01 and F(1,16) = 57.05, p = 0.04, respectively). Conclusions: These findings highlight the benefits associated with using simplified sensorimotor practise contexts for novice learners. Beginners will learn best from simplified practise because it allows them to develop good movement strategies for dealing with potential error without being overwhelmed by task complexity.
    Medical Education 02/2013; 47(2):166-72. DOI:10.1111/medu.12084 · 3.20 Impact Factor
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    James J. Burkitt · Lawrence E. M. Grierson · Victoria Staite · Digby Elliott · James Lyons ·
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    ABSTRACT: Performers adopt strategies to use visual information if they know that it will be available whereas uncertainty about its availability leads performers to prepare for the worst-case scenario. Since the impact of prior knowledge has generally been examined as performance-based changes across a series of trials, this study investigates the impact of prior knowledge on learning. Participants practiced target-directed aiming movements either with cues about the random availability of vision, no cues regarding vision or in blocks of stable visual information availability. Participants who received prior knowledge were more efficient in preparing their acquisition movements when vision was available. In retention and transfer, all participants were able to take advantage of the visual information available in order to optimize performance outcome. Thus, adult performers appear able to change their strategic behavior quickly to accommodate new sensory and prior knowledge conditions.
    Advances in Physical Education 02/2013; 3(1):1-9. DOI:10.4236/ape.2013.31001
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    Jing Li · Lawrence E M Grierson · Mary X Wu · Ronny Breuer · Heather Carnahan ·
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    ABSTRACT: BACKGROUND: Little is known with regard to how acupuncture skills are optimally taught, learnt and evaluated despite clear evidence that technical skill acquisition is important to trainee success in health professions. OBJECTIVES: This study reports an investigation of the sensorimotor aspects of the acupuncture lifting-thrusting skill in order to highlight the important kinematic and kinetic features of the action. The study also explores the role of perceptual acuity in accurate acupuncture performance. METHODS: Twelve novice and 12 expert acupuncturists watched a standardised video demonstrating the mild reinforcing and reducing technique of lifting-thrusting on an acupuncture point and then performed 10 trials of the technique on an artificial skin pad mounted on a six-axis force transducer with an infrared light-emitting diode affixed to the index finger of their dominant hand. The force transducer measured the force applied by participants as they needled the acupuncture point while an optoelectric camera measured the position of the diode. Subsequently, the participants engaged in two tests of general perceptual acuity. RESULTS: Repeated measures analyses of variance indicated that experts are more consistent in their trial-by-trial amplitude (p=0.03) and lifting-thrusting velocity (p=0.029) than novices. Measures of perceptual acuity revealed no differences between novices and experts. CONCLUSIONS: Movement amplitude and velocity consistency are the action features of the mild reinforcing and reducing lifting-thrusting skill that differentiate the performances of experts from novices. The acquisition of acupuncture expertise is a function of extended practice rather than any inherent perceptual ability.
    Acupuncture in Medicine 02/2013; 31(2). DOI:10.1136/acupmed-2012-010265 · 1.50 Impact Factor
  • Geoff Norman · Kelly Dore · Lawrence Grierson ·

    Medical Education 12/2012; 46(12):1227. DOI:10.1111/medu.12071 · 3.20 Impact Factor
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    Geoff Norman · Kelly Dore · Lawrence Grierson ·
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    ABSTRACT: High-fidelity simulators have enjoyed increasing popularity despite costs that may approach six figures. This is justified on the basis that simulators have been shown to result in large learning gains that may transfer to actual patient care situations. However, most commonly, learning from a simulator is compared with learning in a 'no-intervention' control group. This fails to clarify the relationship between simulator fidelity and learning, and whether comparable gains might be achieved at substantially lower cost. This analysis was conducted to review studies that compare learning from high-fidelity simulation (HFS) with learning from low-fidelity simulation (LFS) based on measures of clinical performance. Using a variety of search strategies, a total of 24 studies contrasting HFS and LFS and including some measure of performance were located. These studies referred to learning in three areas: auscultation skills; surgical techniques, and complex management skills such as cardiac resuscitation. Both HFS and LFS learning resulted in consistent improvements in performance in comparisons with no-intervention control groups. However, nearly all the studies showed no significant advantage of HFS over LFS, with average differences ranging from 1% to 2%. The factors influencing learning, and the reasons for this surprising finding, are discussed.
    Medical Education 05/2012; 46(7):636-47. DOI:10.1111/j.1365-2923.2012.04243.x · 3.20 Impact Factor

Publication Stats

369 Citations
83.00 Total Impact Points


  • 2008-2015
    • McMaster University
      • • Department of Family Medicine
      • • Department of Kinesiology
      Hamilton, Ontario, Canada
  • 2009-2013
    • Toronto Rehabilitation Institute
      Toronto, Ontario, Canada
  • 2011
    • Ryerson University
      Toronto, Ontario, Canada
  • 2009-2011
    • SickKids
      Toronto, Ontario, Canada
  • 2006
    • University of Waterloo
      • Department of Kinesiology
      Waterloo, Ontario, Canada