Symbolic access: medical students' awareness of institutional culture and its influence on learning, a phenomenographic study

BACKGROUND

The discussion of access in medical education has its focus largely on physical and epistemological access, leaving a qualitative gap regarding sociocultural factors which enable access in this context. This study introduces and defines symbolic access, a concept with a specific lens on sociocultural inclusion, and the influence it has on student learning within the South African medical education landscape.

METHODS

A phenomenographic design was used to explore students' conceptions of symbolic access and its impact on learning. One-on-one exploratory interviews were conducted with fifteen final year medical students at the University of Witwatersrand in Johannesburg. Interviews were analysed using Sjöström and Dahlgren's seven-step phenomenography model.

RESULTS

Four categories of description were induced, which described students' understanding of symbolic access, these were rejection, disregard, invalidation, and actualization. Four dimensions of variation were discovered expressing the diversity of events which informed the collectives' understanding of the phenomenon. These dimensions were; interactions with educators, peer relationships, educational environment, and race. Categories of description and dimensions of variation formed the Outcome Space, a visual representation of the student experience of symbolic access. The outcome space had a double narrative related to symbolic access; exclusion (major) and actualization (minor). Medical student's chief experience within the medical community was exclusion, however clinical immersion, meaningful participation, peer-relationships, and clinical skills lessons facilitated community enculturation, and impacted learning.

CONCLUSION

Despite deeply exclusionary experiences throughout their programme, medical students articulated a paradox of both awareness and no awareness of symbolic access. The awareness of symbolic access was predominantly influenced by clinical experiences and clinical immersion during the pre-clinical and clinical years of study. Further, descriptions of valuable learning experiences were connected to clinical events and the involvement with patient care. This study suggests that the actualization of symbolic access and description of meaningful learning experiences are linked. Medical educationalists should design undergraduate curricula with early clinical immersion at the fore and explore symbolic concepts pertaining to access, as they are linked to transformative learning experiences for the medical student.

Conceptual foundations of early numeracy: Evidence from infant brain data

Understanding the conceptual resources that children bring to mathematics learning is crucial for developing effective instruction and interventions. Despite the considerable number of studies examining the neural underpinnings of number representations in adults and the growing number of reports in children, very few studies have examined the neural correlates of the link between foundational resources related to numerical information and symbolic number representations in infants. There is currently an active debate about which foundational resources are critical for symbolic mathematics. Is early numerical discrimination best explained by a holistic and generalized sense of magnitude rather than a number sense? Does early number sense provide the conceptual basis for mapping numerical symbols to their meaning? Are foundational number systems marginal while children learn to count and perform symbolic arithmetic, and only later children map non symbolic representations of numerical magnitudes onto symbols? After describing the mainstream theories of numerical cognition and the sources of controversy, we review recent studies of the neural bases of human infants' numerical performance with the aim of clarifying the link between early conceptual resources and symbolic number systems as children's mathematical minds develop.

Some Clinical Contributions of Jacques Lacan

Jacques Lacan was a French psychiatrist and psychoanalyst who created an original metapsychology based on a close reading of the work of Sigmund Freud combined with the structural linguistics of Ferdinand de Saussure. Lacan's concept of the unconscious is that of a highly structured entity consisting of interlacing chains of signifiers (sounds, printed words, and images) based on principles of metaphor and metonymy. In this review article, the author provides a brief biographical summary of Lacan's formative years, his education, and his career, followed by a discussion of some of his major theoretical concepts. Lacan's three registers or orders of existence, the Imaginary, the Symbolic and the Real, and their relationship to normal and psychopathological mental functioning are described. Lacan's major structural diagnostic categories are defined as well as his proposed etiology for the development of each of them. Lacan's formulation of need, demand, and desire are described as well as his late concept of le sinthome. Brief clinical vignettes are used to illustrate some of Lacan's theoretical concepts, and some clinical recommendations are provided. Lacan's theories and practice were controversial over his almost 50-year career, and his work is largely unknown to psychiatrists and psychoanalysts in the United States. This article is an effort to fill a small part of this lacuna.

EXPRESS: Arithmetic operations without symbols are unimpaired in adults with math anxiety

This study characterizes a previously unstudied facet of a major causal model of math anxiety. The model posits that impaired "basic number abilities" can lead to math anxiety, but what constitutes a basic number ability remains underdefined. Previous work has raised the idea that our perceptual ability to represent quantities approximately without using symbols constitutes one of the basic number abilities. Indeed, several recent studies tested how participants with math anxiety estimate and compare non-symbolic quantities. However, little is known about how participants with math anxiety perform arithmetic operations (addition and subtraction) on non-symbolic quantities. This is an important question because poor arithmetic performance on symbolic numbers is one of the primary signatures of high math anxiety. To test the question, we recruited 92 participants and asked them to complete a math anxiety survey, two measures of working memory, a timed symbolic arithmetic test, and a non-symbolic "approximate arithmetic" task. We hypothesized that if impaired ability to perform operations was a potential causal factor to math anxiety, we should see relationships between math anxiety and both symbolic and approximate arithmetic. However, if math anxiety relates to precise or symbolic representation, only a relationship between math anxiety and symbolic arithmetic should appear. Our results show no relationship between math anxiety and the ability to perform operations with approximate quantities, suggesting that difficulties performing perceptually based arithmetic operations does not constitute a basic number ability linked to math anxiety.

Number symbols are processed more automatically than nonsymbolic numerical magnitudes: Findings from a Symbolic-Nonsymbolic Stroop task

Are number symbols (e.g., 3) and numerically equivalent quantities (e.g., •••) processed similarly or distinctly? If symbols and quantities are processed similarly then processing one format should activate the processing of the other. To experimentally probe this prediction, we assessed the processing of symbols and quantities using a Stroop-like paradigm. Participants (N_Study1 = 80, N_Study2 = 63) compared adjacent arrays of symbols (e.g., 4444 vs 333) and were instructed to indicate the side containing either the greater quantity of symbols (nonsymbolic task) or the numerically larger symbol (symbolic task). The tasks included congruent trials, where the greater symbol and quantity appeared on the same side (e.g. 333 vs. 4444), incongruent trials, where the greater symbol and quantity appeared on opposite sides (e.g. 3333 vs. 444), and neutral trials, where the irrelevant dimension was the same across both sides (e.g. 3333 vs. 333 for nonsymbolic; 333 vs. 444 for symbolic). The numerical distance between stimuli was systematically varied, and quantities in the subitizing and counting range were analyzed together and independently. Participants were more efficient comparing symbols and ignoring quantities, than comparing quantities and ignoring symbols. Similarly, while both symbols and quantities influenced each other as the irrelevant dimension, symbols influenced the processing of quantities more than quantities influenced the processing of symbols, especially for quantities in the counting rage. Additionally, symbols were less influenced by numerical distance than quantities, when acting as the relevant and irrelevant dimension. These findings suggest that symbols are processed differently and more automatically than quantities.

Overview of the Referential Process: The Operation of Language Within and Between People

Human mentation involves multiple formats of thought, which are connected substantially but partially, and may operate within or outside of awareness. The modes of thought include symbolic processes which are discrete representations with properties of reference and generativity, and which may be images or words, and subsymbolic components which are continuous in format and based on analogic relationships. The organization of experience is based on memory schemas, including emotion schemas organized through episodes that involve related sensory and bodily experiences with particular people in particular contexts. The referential process is a set of bidirectional functions that enable connection between the subsymbolic components operating in multiple sensory channels and the discrete single channel verbal code. The process involves three major functions: Arousal, the activation of an emotion schema not yet in symbolic form; Symbolizing, describing an event in which the schema has been activated; and Reflection/Reorganizing, exploring and elaborating the emotional meaning of such an event. The concepts of the theory concern psychological aspects of thought, but are potentially mappable onto the underlying neural structure.

Temporal expectation driven by rhythmic cues compared to that driven by symbolic cues provides a more precise attentional focus in time

Temporal expectation is the ability to select the precise point in time for doing something to produce an optimal effect. Two sources of information that humans use to generate temporal expectations are rhythmic and symbolic cues. Both types of cues have been proven effective in directing attention to a future point in time resulting in improved performance. However, the temporal precision of the two forms of temporal expectation have rarely been compared. In the current study, 17 participants performed two temporal expectation tasks in which either a rhythmic cue or a symbolic cue indicated that a future target would appear after a 500-ms (short) or 1,500-ms (long) interval; the target appeared at the expected time in 54% of trials and at an unexpected earlier or later interval in 36% of trials. In both tasks, we observed that the reaction time (RT) curves were U-shaped, with a slower RT for the earlier and later unexpected intervals and a faster RT for intervals approaching the expected point in time. Furthermore, we found a significant interaction between task and the quadratic term of temporal expectation, which indicates that the U-shaped RT curves for the rhythmic cue task are steeper than those for the symbolic cue task. Thus, the current results revealed that compared with symbolic cues, temporal expectation driven by rhythmic cues provides a more precise attentional focus in time.

Learning disabilities: Developmental dyscalculia

Developmental dyscalculia (DD) is a developmental learning disability that manifests as a persistent difficulty in comprehending even the most basic numeric and arithmetic concepts, despite normal intelligence and schooling opportunities. Given the predominant use of numbers in modern society, this condition can pose major challenges in the sufferer's everyday life, both in personal and professional development. Since, to date, we still lack a universally recognized and psychometrically driven definition of DD, its diagnosis has been applied to a wide variety of cognitive profiles. In this chapter, we review the behavioral and neural characterization of DD as well as the different neurocognitive and etiologic accounts of this neurodevelopmental disorder. We underline the multicomponential nature of this heterogeneous disability: different aspects of mathematical competence can be affected by both the suboptimal recruitment of general cognitive functions supporting mathematical cognition (such as attention, memory, and cognitive control) and specific deficits in mastering numeric concepts and operations. Accordingly, both intervention paradigms focused on core numeric abilities and more comprehensive protocols targeting multiple neurocognitive systems have provided evidence for effective positive outcomes.

Processing symbolic and non-symbolic proportions: Domain-specific numerical and domain-general processes in intraparietal cortex

Previous studies on the processing of fractions and proportions focused mainly on the processing of their overall magnitude information in the intraparietal sulcus (IPS). However, the IPS is also associated with domain-general cognitive functions beyond processing overall magnitude, which may nevertheless be involved in operating on magnitude information of proportions. To pursue this issue, the present study aimed at investigating whether there is a shared neural correlate for proportion processing in the intraparietal cortex beyond overall magnitude processing and how part-whole relations are processed on the neural level. Across four presentation formats (i.e., fractions, decimals, dot patterns, and pie charts) we observed a shared neural substrate in bilateral inferior parietal cortex, slightly anterior and inferior to IPS areas recently found for overall magnitude proportion processing. Nevertheless, when evaluating the neural correlates of part-whole processing (i.e., contrasting fractions, dot patterns, and pie charts vs. decimals), we found wide-spread activation in fronto-parietal brain areas. These results indicate involvement of domain-general cognitive processes in part-whole processing beyond processing the overall magnitude of proportions. The dissociation between proportions involving part-whole relations and decimals was further substantiated by a representational similarity analysis, which revealed common neural processing for fractions, pie charts, and dot patterns, possibly representing their bipartite part-whole structure. In contrast, decimals seemed to be processed differently on the neural level, possibly reflecting missing processes of actual proportion calculation in decimals.

Visual content of words delays negation

Many studies have shown the advantage of processing visualizable words over non-visualizables due to the associated image code. The present paper reports the case of negation in which imagery could slow down processing. Negation reverses the truth value of a proposition from false to true or vice versa. Consequently, negation works only on propositions (reversing their truth value) and cannot apply directly to other forms of knowledge representation such as images (although they can be veridical or not). This leads to a paradoxical hypothesis: despite the advantage of visualizable words for general processing, the negation of clauses containing words related to the representation of an image would be more difficult than negation containing non-visualizable words. Two experiments support this hypothesis by showing that sentences with a previously negated visualizable word took longer to be read than sentences with previously negated non-visualizable words. The results suggest that a verbal code is used to process negation.

A metasynthesis of published case studies through Lacan's L-schema: Transference in perversion

Transference in perversion is characterized by specific problems such as a defiant and polemic attitude, erotic transference, projections, and aggression. Such transference poses particular problems in the treatment of perversion and might render analytical work with these patients impossible. The authors propose that Lacan's L-schema can contribute to separating productive from counterproductive aspects of transference as it distinguishes between an Imaginary and a Symbolic dimension in transference. In this meta-synthesis of 11 published case studies on sexual perversion, patterns of transference are analysed. On the Imaginary dimension, the authors found that patients with perversion tend to (un)consciously engage the analyst in a relationship characterized by identification, fusion and rivalry. On the Symbolic dimension, they found that perverse patients are able to question their motives, lapses, symptoms, and subjective identity. The thematic analysis revealed the importance of the position of the analyst in this work, which is described within the L-schema as being the representative of the otherness in the Other. Implications for clinical practice and recommendations for further research are outlined.

Symbol interdependency in symbolic and embodied cognition

Whether computational algorithms such as latent semantic analysis (LSA) can both extract meaning from language and advance theories of human cognition has become a topic of debate in cognitive science, whereby accounts of symbolic cognition and embodied cognition are often contrasted. Albeit for different reasons, in both accounts the importance of statistical regularities in linguistic surface structure tends to be underestimated. The current article gives an overview of the symbolic and embodied cognition accounts and shows how meaning induction attributed to a specific statistical process or to activation of embodied representations should be attributed to language itself. Specifically, the performance of LSA can be attributed to the linguistic surface structure, more than special characteristics of the algorithm, and embodiment findings attributed to perceptual simulations can be explained by distributional linguistic information.