Week 1- AMC lecture

Question 1

At what point in development does the brain double in size? And why?

Answer 1

Third trimester to age 2 due to increased synapses and myelination

Question 2

Describe Hubel and Wiesels theory of critical periods of brain development

Answer 2

Periods when environmental stimulation causes very active wiring/reshaping the brain: Experience causes constellation of neural firing patterns, Experience repeats, firing pattern repeats, Neurochemicals finalise pattern by switching off ability to rewire/refire in alternate pattern, Critical period ends

No stimulation during critical period: no proper brain development

Development of social brain: empathy, ability to regulate emotions, ability to delay gratification

Childrens’ brains more plastic than adults

Question 3

Describe Piaget’s theory of human cognitive development

Answer 3

Children all go through same universal process of cognitive development

Child is born with a small number of innate schemas (cohesive, repeatable action sequence possessing component actions tightly interconnected and governed by core meaning) including thoughts, actions and knowledge about a particular situation

Due to biological maturation and environmental stimulation, child builds more and more schemas of increasing complexity Eg Innate and simple: sucking reflex, Learned and complex: ordering food at a restaurant

Question 4

According to Piaget, what are the 2 ways in which a child can build up knowledge?

Answer 4

Assimilation: existing schema works well for new situation, knowledge attached to new situation is assimilated into existing schema

Accommodation: No existing schema fits new situation, so a schema must be altered to accommodate the new information

Question 5

What are piagets stages?

Answer 5

Sensorimotor 0-2 y object permanence

Pre-operational 2-7 y egocentric

Concrete operations 7-11 y conservation of number

Formal operations 11+ y abstract thinking

Question 6

What is object permanence?

Answer 6

infant looks for an object after it is hidden

Question 7

Describe the pre operational stage of Piaget

Answer 7

Child is egocentric: sees the world from own perspective, language development rapidly progresses, use of symbols (play, magical thinking), does not yet understand conservation of number/volume

Question 8

What is the concrete operations stage of Piaget?

Answer 8

onset of logical thinking, children can now understand conservation of number, volume

Question 9

What is the formal operations stage of Piaget?

Answer 9

onset of abstract, systematic thinking, ability to manipulate different aspects of a problem to come to imaginative solutions If A>B and B>C, then A>C

Question 10

What are the implications of piagets work?

Answer 10

Children need to be ‘ready’ before they can move to the next stage (don’t try teaching trigonometry to a three year old)

Students must be active in their own learning

Teachers should help children ‘discover’ the world, providing experiences that force accommodation of schemata

Question 11

What are criticisms of piagets work?

Answer 11

Research based on subjective data, small sample size No account taken of culture

Underestimates childrens’ abilities

Overestimates adults’ abilities (only 40-60% of college students may reach formal operations)

Question 12

Describe Vygotskys social and cultural development theory

Answer 12

Learning does not follow a universal process in all cultures

Learning happens socially, and can be rapidly increased through help from others

Learning happens through language: self-talk, private (inner) talk

Question 13

Describe the theory of mind

Answer 13

Children do not automatically know that others do not know the same things they know: it develops over time

Developing this skill helps children to understand and anticipate the actions of others, understand feelings of others, empathise

Question 14

Which groups of people may have deficits in their theory of mind skills?

Answer 14

Autism Schizophrenia Attention deficit disorder

Question 15

What factors may affect the way a person responds to a situation?

Answer 15

Temperament: inborn tendencies: (novelty-seeking, reward dependence, harm avoidance, persistence) Personality: develops with experience Life experience People tend to have set patterns of perception, emotional and physical reactions, automatic thoughts, and behavioural tendencies in response to a situation

Question 16

What are the Theories of cognitive development?

Answer 16

Piaget

Vygotsky

Theory of mind

Question 17

What factors increase the complexity of healthcare?

Answer 17

Patient: co morbidities Deprivation index Hospital environment: culture, leadership, staffing Workload: defensive practice, paperwork, training, understaffing, no time Team: supportive? Right mix? Adequate training? Culture: how doctors are perceived

Question 18

What is heuristics?

Answer 18

Rule of thumb solutions quick decision-making process, takes best-fit approach to find solution,

Often does not take all information into account allows one to focus on KEY facts

Often the easiest…but not always the BEST solutions

Question 19

What shortcuts in thinking do we have?

Answer 19

Heuristics: best fit, rule of thumb

Auto pilot: use pre-existing schema to react to a situation often works well, trouble occurs when schema does not fit the situation

Question 20

What is attribution bias?

Answer 20

Attribute our errors to situational factors

We attribute errors of others to character flaws

Question 21

What is Discounting of disconfirmatory evidence?

Answer 21

Tendency to stick with a diagnosis once it’s been chosen, even when new/conflicting information comes in

Question 22

What errors of thinking do we have?

Answer 22

• Attribution bias
• Discounting of discomfirmatory evidence
• Inadvertently putting people into sets
• Availability bias
• Affective bias theory of cognitive dissonance
• Pressure to conform
• Effects of stress and fatigue
• Diffusion of responsibility

Question 23

What is availability bias?

Answer 23

Tending to come up with a solution that happens to be on your mind that’s the fifth depression I’ve seen this week

Question 24

What is affective bias?

Answer 24

Basing your decisions on your emotional reaction to a patient Oh, she’s really needy, she’s just looking for attention

Question 25

What is the theory of cognitive dissonance?

Answer 25

If we find ourselves acting in a way that does not fit with our thoughts or values, this causes discomfort… Often we change our thinking, rather than altering our actions… ‘Stealing is wrong’ I have taken 3 staplers from work, Well, I’ve only borrowed them

Question 26

What is pressure to conform?

Answer 26

several people give a wrong answer, even if clearly wrong, others feel pressured to agree

Having a ‘mate’ greatly increases ability to give correct answers 3 or more opposing people is enough to encourage conformity

Question 27

What effects do stress and fatigue have on thinking?

Answer 27

To fully perceive a situation accurately and respond appropriately is effortful

When stressed, our ability to think flexibly declines

We are far more likely to resort to quick/automatic/error-prone thinking Errors are more likely

Question 28

What is diffusion of responsibility?

Answer 28

The more people are aware of a problem, the more everybody else thinks someone else will do something about it

Question 29

How can you best avoid medical errors?

Answer 29

Be realistic: have a system that helps recognise when likely to make errors, ensure to check thinking at those times with others

Safety netting: ‘Come back in 2 days if you’re no better’

Diagnosis: Every diagnosis is provisional, until new information

Red flags: prompts to help you act Insert thinking points into your care plan: rethink cases from scratch

Hierarchy and pressure to conform: Errors more likely if junior staff too trusting of what they are told, teams should have processes to help people speak up

Teams: Share your work, be supervised, keep checking your work against others (reflective practice)

Question 30

Aside from feelings, what other things can affect the way we act?

Answer 30

Environment around us

Roles we are assigned

What we learn from others

Question 31

Describe early baby brain development

Answer 31

What happens in adult happens in baby’s brain. Eg: stressed mum –> cortisol released & impeded neuronal growth & connectivity

OR happy mum–> dopamine released: stimulates neuronal connectivity

Question 32

What are the models of thinking?

Answer 32

• System1 :Quick, Automatic, Prone to irrational bias
• System2: Slower, Morelogical, Morerational
• Unconscious: Thalamus –> Amygdala (doesn’t use cortex)

Question 33

What is Loss aversion?

Answer 33

Loss Aversion

• Loss x2 psychologically more powerful than winning
• Irrational decisions when fearful of losing