Week 1- AMC lecture Flashcards
At what point in development does the brain double in size? And why?
Third trimester to age 2 due to increased synapses and myelination
Describe Hubel and Wiesels theory of critical periods of brain development
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
Describe Piaget’s theory of human cognitive development
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
According to Piaget, what are the 2 ways in which a child can build up knowledge?
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
What are piagets stages?
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
What is object permanence?
infant looks for an object after it is hidden
Describe the pre operational stage of Piaget
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
What is the concrete operations stage of Piaget?
onset of logical thinking, children can now understand conservation of number, volume
What is the formal operations stage of Piaget?
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
What are the implications of piagets work?
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
What are criticisms of piagets work?
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)
Describe Vygotskys social and cultural development theory
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
Describe the theory of mind
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
Which groups of people may have deficits in their theory of mind skills?
Autism Schizophrenia Attention deficit disorder
What factors may affect the way a person responds to a situation?
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
What are the Theories of cognitive development?
Piaget
Vygotsky
Theory of mind
What factors increase the complexity of healthcare?
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
What is heuristics?
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
What shortcuts in thinking do we have?
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
What is attribution bias?
Attribute our errors to situational factors
We attribute errors of others to character flaws
What is Discounting of disconfirmatory evidence?
Tendency to stick with a diagnosis once it’s been chosen, even when new/conflicting information comes in
What errors of thinking do we have?
- 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
What is availability bias?
Tending to come up with a solution that happens to be on your mind that’s the fifth depression I’ve seen this week
What is affective bias?
Basing your decisions on your emotional reaction to a patient Oh, she’s really needy, she’s just looking for attention
What is the theory of cognitive dissonance?
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
What is pressure to conform?
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
What effects do stress and fatigue have on thinking?
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
What is diffusion of responsibility?
The more people are aware of a problem, the more everybody else thinks someone else will do something about it
How can you best avoid medical errors?
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)
Aside from feelings, what other things can affect the way we act?
Environment around us
Roles we are assigned
What we learn from others
Describe early baby brain development
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
What are the models of thinking?
- System1 :Quick, Automatic, Prone to irrational bias
- System2: Slower, Morelogical, Morerational
- Unconscious: Thalamus –> Amygdala (doesn’t use cortex)
What is Loss aversion?
Loss Aversion
- Loss x2 psychologically more powerful than winning
- Irrational decisions when fearful of losing
