Annals of the New York Academy of Sciences, Dec 1, 2003
: Nongenomic gonadal steroid feedback to oxytocin containing neurons in the supraoptic nucleus of... more : Nongenomic gonadal steroid feedback to oxytocin containing neurons in the supraoptic nucleus of the hypothalamus is mediated via the neurosteroid allopregnanolone (3α‐OH‐DHP) that acts as an allosteric modulator of the postsynaptic GABAA receptors. We found evidence to support the idea that neurosteroids not only potentiate GABAA receptor function but also prevent its suppression by PKC. In addition, we found that neurosteroid sensitivity of GABAA receptor itself is dependent on the balance between endogenous phosphatase and PKC activity and not, as previously suggested, on subunit composition changes of the GABAA receptor. These data imply that native GABAA receptors are only sensitive to 3α‐OH‐DHP if there is endogenous phosphatase activity. In contrast, when, due to endogenous release of oxytocin in the hypothalamus, the intracellular balance is shifted from high phosphatase activity toward a higher level of PKC‐dependent phosphorylation, this leads to 3α‐OH‐DHP‐insensitivity of the GABAA receptors. How the regulatory mechanisms of the GABAA receptor physiology for the hypothalamus may also account for alterations in GABA transmission observed in other brain areas is discussed.
In this study, we investigate how neurosteroid sensitivity of GABA A receptors (GABA A Rs) is reg... more In this study, we investigate how neurosteroid sensitivity of GABA A receptors (GABA A Rs) is regulated. We examined this issue in neurons of the supraoptic nucleus (SON) of the rat and found that, during parturition, the GABA A Rs become insensitive to the neurosteroid allopregnanolone attributable to a shift in the balance between the activities of endogenous Ser/Thr phosphatase and PKC. In particular, a constitutive endogenous tone of oxytocin within the SON after parturition suppressed neurosteroid sensitivity of GABA A Rs via activation of PKC. Vice versa before parturition, during late pregnancy, application of exogenous oxytocin brings the GABA A Rs from a neurosteroid-sensitive mode toward a condition in which the receptors are not sensitive. This indicates that there may be an inverse causal relationship between the extent to which the GABA A R or one of its interacting proteins is phosphorylated and the neurosteroid sensitivity of the GABA A R. Neurosteroid sensitivity was not affected by changes in subunit composition of GABA A Rs known to occur concurrently in these cells.
Background Morbidity and mortality meetings (M&MMs) are organized in most hospital departments wi... more Background Morbidity and mortality meetings (M&MMs) are organized in most hospital departments with an educational purpose to learn from adverse events (AEs) to improve patient care. M&MMs often lack effectiveness due to unsuccessful systematic follow-up of areas of improvement. This can have an effect on improving patient safety and care. Therefore, a new strategy that focuses on implementing areas of improvement into daily practice is necessary. The study aim is to see if we could improve the implementation of meeting outcomes from the M&MM by using a cyclic workflow, and which factors are important to achieve its implementation. Methods This prospective study took place at the department of gynecologic oncology of a university hospital. Research was conducted with a participatory action research (PAR) approach using 10 consecutive M&MMs in 2019 and 2020. The cyclical workflow consisted of an action list based on the PDCA-cycle, a check of the implementation of areas for improveme...
ABSTRACTBackgroundEngaging with the arts can enrich medical education by fostering transformative... more ABSTRACTBackgroundEngaging with the arts can enrich medical education by fostering transformative learning, reflection, and a holistic view of the patient.ObjectiveTo explore the development of professional competence of residents in prolonged arts-based medical education.MethodsWe followed residents (n=99) of various specialties as they engaged in arts-based learning through creative and reflective assignments such as painting, sculpting, and formal analysis. Participants were interviewed about their learning process and experiences, one-on-one and in small groups, by independent researchers using short, semistructured interviews. We used grounded theory to inform an iterative process for data collection and analysis over the course of 3 years (2016-2018).ResultsSeven themes were constructed, which showed that (1) slowing down education provides room for reflection; (2) absence of judgment and rules sparks experimentation; (3) engaging with emotions fostered reflection and motivati...
In 2016 and 2017, we started an innovative learning track in the Radboudumc that combines arts an... more In 2016 and 2017, we started an innovative learning track in the Radboudumc that combines arts and medical education, and appraised the learning processes involved. The voluntary track was followed by 32 and 30 participants respectively, mostly interns and a few residents. The initiative built upon the ideas of several American educational developments which incorporated museum visits. We extended the format by having participants join artists in their studios, to allow students to have an immersive experience of a different discipline, rather than only observing its end products. The track did not have specific learning objectives. However, participants were encouraged to set personal goals and to reflect on what they learned in terms of observation skills, creative thinking, personalized health care, and frame reflection. Here we report the rationale of the track, and illustrate preliminary conclusions with participants' quotes.
Several studies have reported on the negative impact of interruptions and distractions on anaesth... more Several studies have reported on the negative impact of interruptions and distractions on anaesthetic, surgical and team performance in the operating theatre. This study aimed to gain a deeper understanding of these events and why they remain part of everyday clinical practice. We used a mixed methods observational study design. We scored each distractor and interruption according to an established scheme during induction of anaesthesia and the surgical procedure for 58 general surgical cases requiring general anaesthesia. We made field notes of observations, small conversations and meetings. We observed 64 members of staff for 148 hours and recorded 4594 events, giving a mean (SD) event rate of 32.8 (16.3) h-1. The most frequent events observed during induction of anaesthesia were door movements, which accounted for 869 (63%) events, giving a mean (SD) event rate of 28.1 (14.5) h-1. These, however, had little impact. The most common events observed during surgery were caseirrelevant verbal communication and smartphone usage, which accounted for 1020 (32%) events, giving a mean (SD) event rate of 9.0 (4.2) h-1. These occurred mostly in periods of low work-load in a sub-team. Participants ranged from experiencing these events as severe disruption through to a welcome distraction that served to keep healthcare professionals active during low work-load, as well as reinforcing the social connections between colleagues. Mostly, team members showed no awareness of the need for silence among other sub-teams and did not vocalise the need for silence to others. Case-irrelevant verbal communication and smartphone usage may serve a physical and psychological need. The extent to which healthcare professionals may feel disrupted depends on the situation and context. When a team member was disrupted, a resilient team response often lacked. Reducing disruptive social activity might be a powerful strategy to develop a habit of cross-monitoring and mutual help across surgical and anaesthetic sub-teams. Further research is needed on how to bridge cultural borders and develop resilient interprofessional behaviours.
Assessment & Evaluation in Higher Education, 2019
To foster lifelong learning skills, we need new didactic approaches with aligned assessment metho... more To foster lifelong learning skills, we need new didactic approaches with aligned assessment methods. Therefore, we investigated whether the outcomes of a project assignment show a different relation to learning strategies than a longitudinal knowledge-based assessment. We studied learning strategies of first year students of medicine and biomedical sciences (n ¼ 248) and performed hierarchical regression analyses for the learning strategies and grades of the longitudinal knowledge-based test and project assignment. Scores of students, measured with the Motivated Strategies for Learning Questionnaire (Likert scale 1-7), were relatively low for critical thinking (3.53), compared to rehearsal (4.40), elaboration (4.82), organisation (4.69) and metacognitive self-regulation (4.33). Knowledge based tests showed a significant relation to elaboration (p < 0.01). For the project-based assessment, we did not find a significant relation to any learning strategy (p ¼ 0.074). Explained variance of the grades was low for all learning strategies (R 2 < 0.043). Different types of assessment did not discriminate between students with high or low scores on learning strategies associated with lifelong learning. An explanation is that the curriculum is not aligned with assessment, or students do not benefit in terms of grades. We conclude that, if assessment is to drive lifelong learning skills, this is not self-evident.
Higher education tries to comply with a societal need for lifelong, self-directed learners, for w... more Higher education tries to comply with a societal need for lifelong, self-directed learners, for which suitable learning formats are needed. Here, we consider Open Space Technology (OST) as a format for self-directed learning in medical education. It involves a voluntary meeting in which students explore topics of their own interest, related to the overall course theme, and divide themselves over small groups accordingly. After having studied for almost two years in a curriculum with a fixed course format comprising daily mandatory group meetings, OST provided a new education environment. We used qualitative methods to investigate how students experience a transition to OST. We coded audio transcripts of student group discussions and short interviews with teachers. This led to a final set of 30 codes further categorized into 6 themes. While increased autonomy motivated students and gave them a sense of freedom, having to structure their own learning brought about initial insecurities. Relatedness to teachers, a positive atmosphere and interaction with peers helped students deal with these insecurities and use them as a starting point for critical thinking. We conclude that OST is a valuable aid in the development of self-directed learning.
In this paper we describe how honors students of an art university and a classical research unive... more In this paper we describe how honors students of an art university and a classical research university in the east of the Netherlands, came together to work on the development of new ecologies of art and science. We narrate a yearlong learning journey by highlighting two main projects, first a local Wunderkammer project and subsequently a joint research trip to New York, Boston and Cambridge for investigating similar initiatives across the Atlantic. While going beyond the borders of disciplines and institutions, in search of new terrain, students reframe their own field as well. By experimenting with the form of our honors tracks we hope to widen the horizon of young people and help them unleash their potential. Our meandering story describes how the honors track kept on changing form, by allowing students to claim radical ownership, and how this has taught us that such experiments can not only be carried out in a responsible manner, but may also create more powerful environments fo...
This book provides unique insights into how health professionals and people with Parkinson’s dise... more This book provides unique insights into how health professionals and people with Parkinson’s disease shape care together. It shows both the courage and vulnerabilities of those who have to face this disease. It consists of photos of people with Parkinson’s disease and their care professionals, both of their interaction and portrayed individually, interwoven with fragments of their dialogue about meaningful care. This book is an integral part of a research project at Radboud university medical center into person-centred care. With it, we hope to contribute to a positive, hopeful vision of ever-improving Parkinson’s care.
Practicing a "safe" disclosure of adverse events remains challenging for healthcare professionals... more Practicing a "safe" disclosure of adverse events remains challenging for healthcare professionals. In addition, knowledge on how to deliver a disclosure is still limited. This review focuses on how disclosure communication may be practiced based on the perspectives of patients and healthcare professionals. Empirical studies conducted between September 2008 and October 2019 were included from the databases PubMed, Web of Science and Psychinfo. After full text analysis and quality appraisal this scoping review included a total of 23 studies out of 2537 studies. As a first step, the needs of patients and the challenges of healthcare professionals with the practice of providing an effective disclosure were extracted from the empirical literature. Based on these findings, the review demonstrates that specific disclosure communication strategies on the level of interpersonal skills, organization, and supportive factors may facilitate healthcare professionals to provide optimal disclosure of adverse events. These may be relevant to provide patients with a tailored approach that accompanies their preferences for information and recognition. In conclusion, healthcare professionals may need training in interpersonal (verbal and nonverbal) communication skills. Furthermore, it is important to develop an open (organizational) culture that supports the communication of adverse events and disclosure as a standard practice.
Annals of the New York Academy of Sciences, Dec 1, 2003
: Nongenomic gonadal steroid feedback to oxytocin containing neurons in the supraoptic nucleus of... more : Nongenomic gonadal steroid feedback to oxytocin containing neurons in the supraoptic nucleus of the hypothalamus is mediated via the neurosteroid allopregnanolone (3α‐OH‐DHP) that acts as an allosteric modulator of the postsynaptic GABAA receptors. We found evidence to support the idea that neurosteroids not only potentiate GABAA receptor function but also prevent its suppression by PKC. In addition, we found that neurosteroid sensitivity of GABAA receptor itself is dependent on the balance between endogenous phosphatase and PKC activity and not, as previously suggested, on subunit composition changes of the GABAA receptor. These data imply that native GABAA receptors are only sensitive to 3α‐OH‐DHP if there is endogenous phosphatase activity. In contrast, when, due to endogenous release of oxytocin in the hypothalamus, the intracellular balance is shifted from high phosphatase activity toward a higher level of PKC‐dependent phosphorylation, this leads to 3α‐OH‐DHP‐insensitivity of the GABAA receptors. How the regulatory mechanisms of the GABAA receptor physiology for the hypothalamus may also account for alterations in GABA transmission observed in other brain areas is discussed.
In this study, we investigate how neurosteroid sensitivity of GABA A receptors (GABA A Rs) is reg... more In this study, we investigate how neurosteroid sensitivity of GABA A receptors (GABA A Rs) is regulated. We examined this issue in neurons of the supraoptic nucleus (SON) of the rat and found that, during parturition, the GABA A Rs become insensitive to the neurosteroid allopregnanolone attributable to a shift in the balance between the activities of endogenous Ser/Thr phosphatase and PKC. In particular, a constitutive endogenous tone of oxytocin within the SON after parturition suppressed neurosteroid sensitivity of GABA A Rs via activation of PKC. Vice versa before parturition, during late pregnancy, application of exogenous oxytocin brings the GABA A Rs from a neurosteroid-sensitive mode toward a condition in which the receptors are not sensitive. This indicates that there may be an inverse causal relationship between the extent to which the GABA A R or one of its interacting proteins is phosphorylated and the neurosteroid sensitivity of the GABA A R. Neurosteroid sensitivity was not affected by changes in subunit composition of GABA A Rs known to occur concurrently in these cells.
Background Morbidity and mortality meetings (M&MMs) are organized in most hospital departments wi... more Background Morbidity and mortality meetings (M&MMs) are organized in most hospital departments with an educational purpose to learn from adverse events (AEs) to improve patient care. M&MMs often lack effectiveness due to unsuccessful systematic follow-up of areas of improvement. This can have an effect on improving patient safety and care. Therefore, a new strategy that focuses on implementing areas of improvement into daily practice is necessary. The study aim is to see if we could improve the implementation of meeting outcomes from the M&MM by using a cyclic workflow, and which factors are important to achieve its implementation. Methods This prospective study took place at the department of gynecologic oncology of a university hospital. Research was conducted with a participatory action research (PAR) approach using 10 consecutive M&MMs in 2019 and 2020. The cyclical workflow consisted of an action list based on the PDCA-cycle, a check of the implementation of areas for improveme...
ABSTRACTBackgroundEngaging with the arts can enrich medical education by fostering transformative... more ABSTRACTBackgroundEngaging with the arts can enrich medical education by fostering transformative learning, reflection, and a holistic view of the patient.ObjectiveTo explore the development of professional competence of residents in prolonged arts-based medical education.MethodsWe followed residents (n=99) of various specialties as they engaged in arts-based learning through creative and reflective assignments such as painting, sculpting, and formal analysis. Participants were interviewed about their learning process and experiences, one-on-one and in small groups, by independent researchers using short, semistructured interviews. We used grounded theory to inform an iterative process for data collection and analysis over the course of 3 years (2016-2018).ResultsSeven themes were constructed, which showed that (1) slowing down education provides room for reflection; (2) absence of judgment and rules sparks experimentation; (3) engaging with emotions fostered reflection and motivati...
In 2016 and 2017, we started an innovative learning track in the Radboudumc that combines arts an... more In 2016 and 2017, we started an innovative learning track in the Radboudumc that combines arts and medical education, and appraised the learning processes involved. The voluntary track was followed by 32 and 30 participants respectively, mostly interns and a few residents. The initiative built upon the ideas of several American educational developments which incorporated museum visits. We extended the format by having participants join artists in their studios, to allow students to have an immersive experience of a different discipline, rather than only observing its end products. The track did not have specific learning objectives. However, participants were encouraged to set personal goals and to reflect on what they learned in terms of observation skills, creative thinking, personalized health care, and frame reflection. Here we report the rationale of the track, and illustrate preliminary conclusions with participants' quotes.
Several studies have reported on the negative impact of interruptions and distractions on anaesth... more Several studies have reported on the negative impact of interruptions and distractions on anaesthetic, surgical and team performance in the operating theatre. This study aimed to gain a deeper understanding of these events and why they remain part of everyday clinical practice. We used a mixed methods observational study design. We scored each distractor and interruption according to an established scheme during induction of anaesthesia and the surgical procedure for 58 general surgical cases requiring general anaesthesia. We made field notes of observations, small conversations and meetings. We observed 64 members of staff for 148 hours and recorded 4594 events, giving a mean (SD) event rate of 32.8 (16.3) h-1. The most frequent events observed during induction of anaesthesia were door movements, which accounted for 869 (63%) events, giving a mean (SD) event rate of 28.1 (14.5) h-1. These, however, had little impact. The most common events observed during surgery were caseirrelevant verbal communication and smartphone usage, which accounted for 1020 (32%) events, giving a mean (SD) event rate of 9.0 (4.2) h-1. These occurred mostly in periods of low work-load in a sub-team. Participants ranged from experiencing these events as severe disruption through to a welcome distraction that served to keep healthcare professionals active during low work-load, as well as reinforcing the social connections between colleagues. Mostly, team members showed no awareness of the need for silence among other sub-teams and did not vocalise the need for silence to others. Case-irrelevant verbal communication and smartphone usage may serve a physical and psychological need. The extent to which healthcare professionals may feel disrupted depends on the situation and context. When a team member was disrupted, a resilient team response often lacked. Reducing disruptive social activity might be a powerful strategy to develop a habit of cross-monitoring and mutual help across surgical and anaesthetic sub-teams. Further research is needed on how to bridge cultural borders and develop resilient interprofessional behaviours.
Assessment & Evaluation in Higher Education, 2019
To foster lifelong learning skills, we need new didactic approaches with aligned assessment metho... more To foster lifelong learning skills, we need new didactic approaches with aligned assessment methods. Therefore, we investigated whether the outcomes of a project assignment show a different relation to learning strategies than a longitudinal knowledge-based assessment. We studied learning strategies of first year students of medicine and biomedical sciences (n ¼ 248) and performed hierarchical regression analyses for the learning strategies and grades of the longitudinal knowledge-based test and project assignment. Scores of students, measured with the Motivated Strategies for Learning Questionnaire (Likert scale 1-7), were relatively low for critical thinking (3.53), compared to rehearsal (4.40), elaboration (4.82), organisation (4.69) and metacognitive self-regulation (4.33). Knowledge based tests showed a significant relation to elaboration (p < 0.01). For the project-based assessment, we did not find a significant relation to any learning strategy (p ¼ 0.074). Explained variance of the grades was low for all learning strategies (R 2 < 0.043). Different types of assessment did not discriminate between students with high or low scores on learning strategies associated with lifelong learning. An explanation is that the curriculum is not aligned with assessment, or students do not benefit in terms of grades. We conclude that, if assessment is to drive lifelong learning skills, this is not self-evident.
Higher education tries to comply with a societal need for lifelong, self-directed learners, for w... more Higher education tries to comply with a societal need for lifelong, self-directed learners, for which suitable learning formats are needed. Here, we consider Open Space Technology (OST) as a format for self-directed learning in medical education. It involves a voluntary meeting in which students explore topics of their own interest, related to the overall course theme, and divide themselves over small groups accordingly. After having studied for almost two years in a curriculum with a fixed course format comprising daily mandatory group meetings, OST provided a new education environment. We used qualitative methods to investigate how students experience a transition to OST. We coded audio transcripts of student group discussions and short interviews with teachers. This led to a final set of 30 codes further categorized into 6 themes. While increased autonomy motivated students and gave them a sense of freedom, having to structure their own learning brought about initial insecurities. Relatedness to teachers, a positive atmosphere and interaction with peers helped students deal with these insecurities and use them as a starting point for critical thinking. We conclude that OST is a valuable aid in the development of self-directed learning.
In this paper we describe how honors students of an art university and a classical research unive... more In this paper we describe how honors students of an art university and a classical research university in the east of the Netherlands, came together to work on the development of new ecologies of art and science. We narrate a yearlong learning journey by highlighting two main projects, first a local Wunderkammer project and subsequently a joint research trip to New York, Boston and Cambridge for investigating similar initiatives across the Atlantic. While going beyond the borders of disciplines and institutions, in search of new terrain, students reframe their own field as well. By experimenting with the form of our honors tracks we hope to widen the horizon of young people and help them unleash their potential. Our meandering story describes how the honors track kept on changing form, by allowing students to claim radical ownership, and how this has taught us that such experiments can not only be carried out in a responsible manner, but may also create more powerful environments fo...
This book provides unique insights into how health professionals and people with Parkinson’s dise... more This book provides unique insights into how health professionals and people with Parkinson’s disease shape care together. It shows both the courage and vulnerabilities of those who have to face this disease. It consists of photos of people with Parkinson’s disease and their care professionals, both of their interaction and portrayed individually, interwoven with fragments of their dialogue about meaningful care. This book is an integral part of a research project at Radboud university medical center into person-centred care. With it, we hope to contribute to a positive, hopeful vision of ever-improving Parkinson’s care.
Practicing a "safe" disclosure of adverse events remains challenging for healthcare professionals... more Practicing a "safe" disclosure of adverse events remains challenging for healthcare professionals. In addition, knowledge on how to deliver a disclosure is still limited. This review focuses on how disclosure communication may be practiced based on the perspectives of patients and healthcare professionals. Empirical studies conducted between September 2008 and October 2019 were included from the databases PubMed, Web of Science and Psychinfo. After full text analysis and quality appraisal this scoping review included a total of 23 studies out of 2537 studies. As a first step, the needs of patients and the challenges of healthcare professionals with the practice of providing an effective disclosure were extracted from the empirical literature. Based on these findings, the review demonstrates that specific disclosure communication strategies on the level of interpersonal skills, organization, and supportive factors may facilitate healthcare professionals to provide optimal disclosure of adverse events. These may be relevant to provide patients with a tailored approach that accompanies their preferences for information and recognition. In conclusion, healthcare professionals may need training in interpersonal (verbal and nonverbal) communication skills. Furthermore, it is important to develop an open (organizational) culture that supports the communication of adverse events and disclosure as a standard practice.
"Over the past years we see a mushrooming of neuroscientific approaches to social domains. Suppos... more "Over the past years we see a mushrooming of neuroscientific approaches to social domains. Supposedly ‘new’ disciplines like neuromarketing, neuroethics, neuroeconomics, or neuro-education have arisen and thrive on anticipations of cross-fertilization between brain research and diverse fields of application. The reductionist tendency to ‘explain away’ sociological perspectives on human behavior by ‘revealing the underlying neurobiological mechanisms’ may lead to a neurobiologisation of society.
This neurobiologisation could be fuelled by future visions and science-fiction books or movies. By any means, the wedding of neurobiology and the humanities (referred to as ‘NeuroCulture’ or cultural neuroscience) remains controversial. In some areas the general public may hardly be aware of progress made, in other areas expectations exceed the current status of research. For example, whereas most people may not see themselves having chips implanted in their brains in their lifetime, ‘brain pacemakers’ for neurological disorders have caught on like wildfire. In contrast, one area in particular where expectations may be too high, is the field of education. The idea that brain research may yield better learning methodologies is credible and omnipresent. Nevertheless, currently, non-realizable expectations in teachers, students and educational policy makers might even pose dangers to education. In fact, the boundary between schools and science is dominated by a myriad of ‘neuromyths’. The emergent field of Mind, Brain and Education (MBE) strives to eradicate those myths and overcome the challenges for neuroscience to adapt to the practicalities of education. Whether the traditional concepts and models for bridging this gap will suffice is open to dispute.
This paper investigates the discrepancies between ‘neuromyths’ and the actualities of neuroscience research practices and its implications for the field of education, and examines whether a pluralistic metaphysics may prove a useful addition to the toolkit of MBE.
"
Uploads
Papers by Jur Koksma
This neurobiologisation could be fuelled by future visions and science-fiction books or movies. By any means, the wedding of neurobiology and the humanities (referred to as ‘NeuroCulture’ or cultural neuroscience) remains controversial. In some areas the general public may hardly be aware of progress made, in other areas expectations exceed the current status of research. For example, whereas most people may not see themselves having chips implanted in their brains in their lifetime, ‘brain pacemakers’ for neurological disorders have caught on like wildfire. In contrast, one area in particular where expectations may be too high, is the field of education. The idea that brain research may yield better learning methodologies is credible and omnipresent. Nevertheless, currently, non-realizable expectations in teachers, students and educational policy makers might even pose dangers to education. In fact, the boundary between schools and science is dominated by a myriad of ‘neuromyths’. The emergent field of Mind, Brain and Education (MBE) strives to eradicate those myths and overcome the challenges for neuroscience to adapt to the practicalities of education. Whether the traditional concepts and models for bridging this gap will suffice is open to dispute.
This paper investigates the discrepancies between ‘neuromyths’ and the actualities of neuroscience research practices and its implications for the field of education, and examines whether a pluralistic metaphysics may prove a useful addition to the toolkit of MBE.
"