Exercise #7: Using behaviors to change emotion

Prior work has shown that the human placenta is an available and realistic model for microdissection simulation. We sought to find a measurable improvement in the technical skills of neurosurgical residents with deliberate practice of microdissection tasks using a placental model. Postgraduate year (PGY) 1 to 3 neurosurgery residents were consented. A 1-min video of each participant's baseline skills skeletonizing placental vessels was recorded. Participants underwent 10 practice sessions with intermittent informal feedback for 30-60 min over 18 mo. Another 1-min video was recorded following the 10th dissection. The videos were blinded and assessed by 3 board eligible or certified microsurgical neurosurgeons using a modified Objective Structured Assessment of Aneurysm Clipping Skills. Performance was compared via t-testing among four domains: instrument handling, time flow and forward planning, quality of dissection, and respect for tissue. Microdissection, instrument handling, and quality of dissection were significantly improved after deliberate practice with the placental simulator (P < .05). Improvement was seen in time flow and forward planning and respect for tissue; however, this failed to be significant. Subjectively, residents expressed enjoyment performing the exercise. They also expressed a desire for demonstrations or videos to watch before practice sessions. The placental simulation model provides microsurgical skill development with minimal deliberate practice sessions. Practice exercises are favorably regarded and interest in continuing them is strong by residents. Residents expressed a desire to make the dissection more deliberate with demonstration, breakdown of steps, and mimicry, which could improve the effectiveness and enjoyment of the skills session.

This book looks at a series of citizen-led campaigns to provide information about and energise the institutions of local self-governance in India following the 73rd and 74th Amendment Acts. Staggering in their outreach and magnitude, the campaigns, popularly known as PEVACs (Pre-election Voters’ Awareness Campaigns), reached out to huge swathes of the population, particularly in rural India, through a unique network that incorporated civil-society organisations across the country, the media and the State Election Commission itself. The book journeys through the heat and dust of these extraordinary campaigns, drawing from a repertoire of field reports and interviews to reflect on the significance of this ‘experiment’ on deepening democracy in India. In particular, it analyses the methodology of the campaigns and posits that this itself became an extraordinary exercise in democratic practice, indicating the shape that deliberation and dialogic practices could actually take on the field. As the campaigns moved from district to district, through their street plays, posters, pamphlets, jagrut yatras, candidate–voter dialogues, rehearsals of voting procedures, setting up of information booths, and participatory workshops for newly elected representatives, a new dialogical experiment was born and shaped. By examining these campaigns, this book emphasises the idea that governance is not just the business of central (federal) governments but also of citizens outside the formal institutions of governance, without whose active participation democracy cannot be deepened.

Chapter 2 - Instructions for the deliberate practice exercises