Lawrence E M Grierson

University of Toronto, Toronto, Ontario, Canada

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Publications (40)78.38 Total impact

  • 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; · 2.71 Impact Factor
  • Inge Schabort, Mathew Mercuri, Lawrence E M Grierson
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    ABSTRACT: 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.
    Canadian family physician Médecin de famille canadien. 10/2014; 60(10):e478-84.
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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; · 1.04 Impact Factor
  • Lawrence E M Grierson
    Medical Education 05/2014; 48(5):461-2. · 3.62 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; · 2.71 Impact Factor
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    ABSTRACT: To explore a method of quantitative evaluation on operation behavior of acupuncture manipulation and further analyze behavior features of professional acupuncture manipulation.
    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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    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. · 3.62 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; · 2.15 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; · 2.17 Impact Factor
  • 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;
  • 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; · 1.05 Impact Factor
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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. · 3.62 Impact Factor
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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.
  • Geoff Norman, Kelly Dore, Lawrence Grierson
    Medical Education 12/2012; 46(12):1227. · 3.62 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. · 3.62 Impact Factor
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    ABSTRACT:   Video-based observational practice can extend simulation-based learning outside the training space. This study explores the value of collaborative feedback provided during observational practice to the acquisition of clinical skills.   Nursing students viewed a video demonstrating the proper ventrogluteal injection technique before performing a videotaped pre-test trial on a simulator. They were then assigned randomly to one of three observational practice groups: a group that observed the expert demonstration (EO group); a group that viewed the expert demonstration, self-assessed their individual pre-test and contrasted their self-assessments with expert feedback (ESO group), and a group that observed the expert demonstration, self-assessed and contrasted their assessments with those of an expert, and formed a community that engaged in peer-to-peer feedback (ESPO group). The observation of all videos, the provision of assessments and all networking occurred via an Internet-mediated network. After 2 weeks, participants returned for post-tests and transfer tests.   The pre-test-post-test analyses revealed significant interactions (global rating scale: F((2,22)) =4.00 [p =0.033]; checklist: F((2,22)) =4.31 [p =0.026]), which indicated that post-test performance in the ESPO group was significantly better than pre-test performance. The transfer analyses revealed main effects for both the global rating scale (F((2,23)) =6.73; p =0.005) and validated checklist (F((2,23)) =7.04; p =0.004) measures. Participants in the ESPO group performed better on the transfer test than those in the EO group.   The results suggest that video-based observational practice can be effective in extending simulation-based learning, but its effectiveness is mediated by the amount of time the learner spends engaged in the practice and the type of learning activities the learner performs in the observational practice environment. We speculate that increasing collaborative interactivity supports observational learning by increasing the extent to which the educational environment can accommodate learners' specific needs.
    Medical Education 04/2012; 46(4):409-16. · 3.62 Impact Factor
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    ABSTRACT: Technical and communicative skills are both important features for one's perception of practitioner competence. This research examines how trainees' perceptions of practitioner competence change as they view health care practitioners who vary in their technical and communicative skill proficiencies. Occupational therapy students watched standardized encounters of a practitioner performing a patient transfer in combinations of low and high technical and communicative proficiency and then reported their perceptions of practitioner competence. The reports indicate that technical and communicative skills have independently identifiable impacts on the perceptions of practitioner competency, but technical proficiency has a special impact on the students' perceptions of practitioner communicative competence. The results are discussed with respect to the way in which students may evaluate their own competence on the basis of either technical or communicative skill. The issue of how this may lead trainees to dedicate their independent learning efforts to an incomplete set of features needed for the development of practitioner competency is raised.
    Teaching and Learning in Medicine 04/2012; 24(2):111-6. · 1.12 Impact Factor
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    Lawrence E M Grierson
    Advances in Health Sciences Education 03/2012; 17(1):1-4. · 2.71 Impact Factor

Publication Stats

199 Citations
78.38 Total Impact Points


  • 2011–2013
    • University of Toronto
      • • Department of Occupational Science and Occupational Therapy
      • • Department of Rehabilitation Science
      Toronto, Ontario, Canada
    • Ryerson University
      Toronto, Ontario, Canada
    • Universidad Pontificia Bolivariana
      Medellín, Antioquia, Colombia
  • 2009–2013
    • Toronto Rehabilitation Institute
      Toronto, Ontario, Canada
  • 2008–2013
    • McMaster University
      • • Department of Kinesiology
      • • Department of Family Medicine
      Hamilton, Ontario, Canada
    • Liverpool John Moores University
      • • School of Sport and Exercise Sciences
      • • Research Institute for Sport and Exercise Sciences (RISES)
      Liverpool, ENG, United Kingdom
  • 2009–2011
    • SickKids
      • Department of Surgery
      Toronto, Ontario, Canada
  • 2006–2010
    • University of Waterloo
      • Department of Kinesiology
      Waterloo, Quebec, Canada