Denise Kay

The Use of Structural Analysis to Develop Antecedent-based Interventions for Students with Autism

Evidence continues to maintain that the use of antecedent variables (i.e., instructional practices, and environmental characteristics) increase prosocial and adaptive behaviors of students with disabilities (e.g., Kern et al. in J Appl Behav Anal 27(1):7–19, 1994; Stichter et al. in Behav Disord 30:401–418, 2005). This study extends the literature by systematically utilizing practitioner-implemented structural analyzes within school settings to determine antecedent variables affecting the prosocial behavior of students with autism. Optimal antecedents were combined into intervention packages and assessed utilizing a multiple baseline design across settings. All three students demonstrated improvement across all three settings. Rates of engagement and social interaction were obtained from classroom peers to serve as benchmark data. Findings indicate that practitioners can implement structural analyzes and design corresponding interventions for students with ASD within educational settings.

Learning theories 101: application to everyday teaching and scholarship.

Shifts in educational research, in how scholarship in higher education is defined, and in how funding is appropriated suggest that educators within basic science fields can benefit from increased understanding of learning theory and how it applies to classroom practice. This article uses a mock curriculum design scenario as a framework for the introduction of five major learning theories. Foundational constructs and principles from each theory and how they apply to the proposed curriculum designs are described. A summative table that includes basic principles, constructs, and classroom applications as well as the role of the teacher and learner is also provided for each theory.

Teaching evidence-based lifestyle management in family medicine training

Dear Editor, There is strong evidence that lifestyle changes, including nutrition and activity, contribute to the prevention and treatment of chronic diseases [1]. Obesity is the cause or an aggravating factor for many of these. The US Preventive Services Task Force recommends that primary care providers screen all adults for obesity and manage them with intensive multicomponent behavioral interventions [2]. However, primary care physicians are still hesitant to suggest lifestyle changes in their management, reporting lack of knowledge and confidence with these types of interventions and available tools [3]. Lifestyle medicine (LM) is an evidence-based science that uses lifestyle changes in the prevention and treatment of chronic non-communicable diseases [4]. Incorporating LM in Undergraduate Medical Education (UME) represents ‘an acute and timely need’ [5]. Research reports on the impact of LM educational interventions are scant. We designed an innovative interactive session, during our medical students’ Family Medicine training clerkship, to increase and align undergraduate medical education learner’s knowledge and confidence in applying LM when managing obesity. The intervention session was 60 min, mandatory and formatively assessed. It included a lecture and solving two similar clinical scenarios on obesity lifestyle management. The lecture objectives covered obesity management guidelines, weight loss benefits, and the formation of weight loss goals using specific, measurable, attainable, relevant and timely methods. Each clinical scenario required evidence-based calculations of patients’ body mass index, weight loss and calorie intake goals using evidence-based online tools from the National Institute of Health and United States Department of Agriculture. A clinical faculty expert in obesity management delivered the same lecture and clinical scenarios, using three different strategies. Strategy-1: solving the clinical scenario and discussion of the correct results and online tools. Strategy-2: Strategy-1 plus a collaborative activity and online tools handout. Strategy-3: Strategy 2 plus a demonstration through expert modeling. For all learners’ this was their first exposure to these obesity related concepts which were new to our curriculum. We deployed each session with a different set of medical students at different points in the 4 year curriculum. Strategy-1 end of third year; Strategy-2 end of fourth year; and Strategy-3 at the beginning of third year. Before and after the intervention we assessed students’ knowledge and confidence in solving the clinical scenarios. Seventy-seven students received the intervention and 93–96% completed the assessment across groups. There was little variance in the proportion of students with increased confidence after the intervention comparing Strategy-1 vs. Strategy-2 vs. Strategy-3 (46.2 vs. 57.1 vs. 53.8%, respectively). The proportion of students with increased knowledge was lower using Strategy-1 and 2 and highest using Strategy-3 (23.1 vs. 28.6 vs. 61.5%, respectively). The Strategy-3 session was most effective in improving confidence (53.8%) and knowledge (61.5%). Interestingly, not all students with increased confidence showed an improvement in their knowledge. We further explored the alignment of knowledge and confidence. We defined a learner to be aligned if they were confident and answered at least 2 of 3 questions correctly or if they were not confident and answered one or no knowledge questions correctly out of 3. We defined a learner to be not-aligned if they were confident and answered one or less questions correctly of 3 or if they were not-confident but answered 2 or more knowledge questions correctly of 3. Alignment preand post-intervention for Strategy-1 decreased from 65 to 57%; for Strategy-2 did not change (77, 77%); for Strategy-3 increased from 48 to 91%. We conclude that our medical students’ demonstrated increase in confidence and knowledge as an endorsement of this innovative approach to teaching LM; specifically in Strategy-3, which highlights the importance of expert modeling. Assessing both student’s confidence and knowledge represents a step forward in evaluating the efficacy of the instruction in medical education.