Margalit Ziv

Simulation Based Medical Education: an opportunity to learn from errors

Medical professionals and educators recognize that Simulation Based Medical Education (SBME) can contribute considerably to improving medical care by boosting medical professionals’ performance and enhancing patient safety. A central characteristic of SBME is its unique approach to making (and learning from) mistakes, which is regarded as a powerful educational experience and as an opportunity for professional improvement. The basic assumption underlying SBME is that increased practice in learning from mistakes and in error management in a simulated environment will reduce occurrences of errors in real life and will provide professionals with the correct attitude and skills to cope competently with those mistakes that could not be prevented. The main message of the present paper is that this assumption, which serves as the driving force of SBME, should also serve as a starting point for critical thinking and questioning regarding the multiple aspects and components of SBME. These questions, in turn, should lead to empirical research that will provide feedback concerning changes that may be necessary in order to attain the goal of improving medical professionals’ performance. Based on such research, SBME will be held accountable for its outcomes, i.e. whether its educational techniques indeed result in decreased occurrence of errors or not, and whether the ability to cope with the errors that do occur is significantly improved. The first of three issues that were addressed concerns individuals’ experience of performing mistakes. It is suggested that in order to benefit fully from the experience of performing mistakes in a simulated context, medical educators should create a balance between the emotional load associated with the experience and the professional lessons that can be learned. Furthermore, research should focus on the long-term effects of the experience in changing professionals’ attitudes and behaviour. The second question concerned the contribution of the different components of the educational experience to creating the desired changes in professionals’ performance. Analysis of the teaching and learning involved in each stage of the educational event should serve as the basis for research that aims at identifying the unique contribution and efficiency of each element, and defining the essential core activities of a simulated experience. Finally, the need to define a newly emerging profession—SBME educator—was addressed. The professional qualifications are, clearly, multidisciplinary and should be based on the growing experience of medical educators in training students and professionals. Defining the profession is essential in order to create academic environments in which professionals will be trained to develop and implement new programmes, accompanied by research and assessment.

Teaching as a natural cognition and its relations to preschoolers’ developing theory of mind

Abstract Teaching is an important aspect in people’s lives and cultures. We explore it from a cognitive-developmental perspective. Teaching may be a natural cognition that, despite its complexity, is learned at an early age without any apparent instruction. We propose that theory of mind may be an important cognitive prerequisite for teaching. We briefly describe a study that tested relations between children’s developing theory of mind and actual teaching. Children at the ages of 3- and 5-years were presented new theory of mind tasks about teaching and then were observed teaching peers a game they had just learned. We found corresponding age-related differences in children’s understanding of teaching as manifested in their performance on the teaching-theory of mind tasks and in their teaching strategies. It is suggested that theory and research on theory of mind might need to be expanded to include on-line, interactive situations such as teaching.

The Linguistic Affiliation Constraint and phoneme recognition in diglossic Arabic

This study tested the effect of the phonemes linguistic affiliation (Standard Arabic versus Spoken Arabic) on phoneme recognition among five-year-old Arabic native speaking kindergarteners (N=60). Using a picture selection task of words beginning with the same phoneme, and through careful manipulation of the phonological properties of target phonemes and distractors, the study showed that childrens recognition of Standard phonemes was poorer than that of Spoken phonemes. This finding was interpreted as indicating a deficiency in the phonological representations of Standard words. Next, the study tested two hypotheses regarding the specific consequences of under-specified phonological representations: phonological encoding versus phonological processing. These hypotheses were addressed through an analysis of the relative power of distractors. The findings revealed that childrens difficulty in accessing Standard Arabic phonemes was due to a difficulty in the phonological encoding of Standard words. We discuss the implications of the findings for language and literacy development in diglossic Arabic.

Early literacy in Arabic: An intervention study among Israeli Palestinian kindergartners

Arabic Literacy acquisition was studied among Israeli Palestinian low socioeconomic status kindergartners within the framework of an intervention study, implemented by teachers. On pretest, letter naming, alphabetic awareness, and phonological awareness were very low. Whereas the comparison group hardly progressed throughout the year, the intervention group progressed substantially on all three skills. The diglossic nature of the Arabic letter name system was manifested in childrens transition from a mixture of two systems to preference for standard over colloquial names following the intervention. As in other alphabets, visual similarity and adjacency increased letter confusability. The unique features of Arabic literacy are discussed.

Understanding of Emotions and False Beliefs Among Hearing Children versus Deaf Children

Emotion understanding and theory of mind (ToM) are two major aspects of social cognition in which deaf children demonstrate developmental delays. The current study investigated these social cognition aspects in two subgroups of deaf children-those with cochlear implants who communicate orally (speakers) and those who communicate primarily using sign language (signers)-in comparison to hearing children. Participants were 53 Israeli kindergartners-20 speakers, 10 signers, and 23 hearing children. Tests included four emotion identification and understanding tasks and one false belief task (ToM). Results revealed similarities among all childrens emotion labeling and affective perspective taking abilities, similarities between speakers and hearing children in false beliefs and in understanding emotions in typical contexts, and lower performance of signers on the latter three tasks. Adapting educational experiences to the unique characteristics and needs of speakers and signers is recommended.

Relations between the Development of Teaching and Theory of Mind in Early Childhood.

The relations among children’s theory of mind (ToM), their understanding of the intentionality of teaching, and their own peer teaching strategies were tested. Seventy-five 3-, 4-, and 5-year-olds completed 11 ToM and understanding-of-teaching tasks. Subsequently, 30 of the children were randomly chosen to teach a peer how to play a board game, and their teaching strategies and levels of contingent teaching were recorded. There were developmental changes in the children’s understanding of teaching as an intentional activity. When teaching their peers, 3-year-olds used demonstration, whereas 4- and 5-year-olds added verbal explanations and began to adapt contingently to the learners’ changing knowledge level. Relations among ToM, understanding of teaching, and teaching level were found. The results suggest that the development of children’s teaching strategies and their contingency are closely tied to the development of ToM.

Mothers' and Teachers' Mental-State Discourse With Preschoolers During Storybook Reading

Mothers and teachers play a pivotal role in promoting preschool children’s theory of mind. This study explored and compared mothers’ and teachers’ mental-state discourse during storybook reading with children, focusing on their use of mental terms and references to three mental-state aspects: false belief, mental causality, and different points of view. Participants were 60 mothers and their children, and 60 teachers and 300 preschoolers. Mothers read the book to one child and teachers read the same book to groups of 5 children. The book involved a central false-belief theme. Main findings revealed that mothers and teachers elaborated on book-related mental states. However, teachers’ discourse included more mental terms and more references to mental causality and different people’s perspectives. The findings suggest that reading books with rich mental-state contents encourages rich discourse on mental-state elements. Parents and teachers should be guided in how to use their unique knowledge and relationships with children to enrich their mediation of books’ mental-state aspects and discuss them with children.

Children request teaching when asking for names of objects

We propose that in addition to childrens requests for word names being a reflection of an understanding of the referential nature of words, they may also be requests for adults teaching. These possible requests for teaching among toddlers, along with other indications, suggest that teaching may be a natural cognition that may be related to the development of theory of mind.

Shared Book Reading Interactions Within Families From Low Socioeconomic Backgrounds and Children's Social Understanding and Prosocial Behavior

The study explored the nature of mother–child conversation during and after a shared book reading (SBR) interaction and how it relates to children’s social understanding and prosocial behavior. Participants were 61 mother–child dyads (children’s mean age 5 years, 8 months) from low socioeconomic strata (SES). Mother–child SBR and their conversation following the reading were video-recorded. Children’s social understanding was evaluated via their ability to distinguish between social norms violations and moral violations. Prosocial behavior was evaluated through children’s sharing behavior. Results showed that during SBR, mothers and children from low SES tended to stick to the written text, whereas following the book reading, they elaborated beyond the explicit aspects of the text. Furthermore, references to socioemotional issues during mother–child conversation correlated with the child’s social understanding and prosocial behavior, beyond the child’s vocabulary level.

Theory of mind impairment after right-hemisphere damage

ABSTRACT Background: Some patients after right-hemisphere damage (RHD) show difficulty in Theory of Mind (TOM), namely, in the ability to attribute and reason about mental states of others and of themselves. Aims: This study explored TOM abilities of individuals with right-hemisphere brain damage. Methods & Procedures: We developed and administered a battery of TOM tasks (the aTOMia battery) to evaluate the TOM abilities of the right-hemisphere brain damaged participants in comparison to healthy control participants. The aTOMia battery included 8 types of TOM tasks. The participants were 25 Hebrew-speakers with RHD aged 25–65 years (mean 53), 8 women and 17 men; 22 of them had a right cerebrovascular accident, and 3 were surgically treated: 2 for tumours, and 1 for cavernoma. Outcomes & Results: The participants with RHD showed heterogeneity with respect to their TOM abilities—17 of them had TOM impairment (aTOMia), whereas 8 showed normal TOM. All patients, including the aTOMic patients, were able to use sentence embedding in their responses to the aTOMia tests items, indicating that their purely syntactic ability of embedding was intact (and did not underlie their aTOMia). Conclusions: Individuals with RHD form a heterogeneous group. Some of them, but not all, have aTOMia. Therefore, the TOM abilities of each individual with right hemisphere should be examined. Whereas purely syntactic abilities are not affected by aTOMia, such TOM impairment may have implications for everyday life, and for the use and comprehension of language during social interaction and in understanding and conveying information.