Autonomy and focus of attention in medical motor skills learning: a randomized experiment

Franziska Pollok; David A Cook; Nizamuddin Shaikh; V Shane Pankratz; Mark E Morrey; Torrey A Laack

doi:10.1186/s12909-021-03020-z

Autonomy and focus of attention in medical motor skills learning: a randomized experiment

BMC Med Educ. 2022 Jan 19;22(1):46. doi: 10.1186/s12909-021-03020-z.

Authors

Franziska Pollok^{1

2}, David A Cook^{1

3}, Nizamuddin Shaikh⁴, V Shane Pankratz^{5

6}, Mark E Morrey⁷, Torrey A Laack^{8

9}

Affiliations

¹ Multidisciplinary Simulation Center, Mayo Clinic, Rochester, MN, USA.
² Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
³ Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
⁴ Division of General Surgery, Mayo Clinic, Rochester, MN, USA.
⁵ Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
⁶ Biostatistics Shared Resource of University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
⁷ Division of Adult Reconstruction, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
⁸ Multidisciplinary Simulation Center, Mayo Clinic, Rochester, MN, USA. laack.torrey@mayo.edu.
⁹ Department of Emergency Medicine, Mayo Clinic Multidisciplinary Simulation Center, 200 First Street SW, Rochester, MN, 55905, USA. laack.torrey@mayo.edu.

Abstract

Background: The 'OPTIMAL' (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning suggests that autonomy, external focus of attention, and perceived competence can improve learning of simple motor tasks. The authors hypothesized that enhanced (vs. routine) autonomy and external (vs. internal) focus of attention would improve first-try performance of two medical motor tasks.

Methods: The authors conducted a randomized two-by-two factorial design study with high school students as participants. Task instructions promoted either enhanced or routine autonomy, and either external or internal focus of attention. These conditions were replicated in a crossover design for two common medical tasks (chest compressions on a manikin and a Fundamentals of Laparoscopic Surgery peg transfer task). Primary outcomes were objective measures of task performance (chest compression deviation from target depth; peg transfer time with penalties for errors). Secondary outcomes included subjective perceptions of confidence, autonomy, and workload.

Results: One hundred thirty-three high school students participated in this study. The primary outcomes concerning enhanced vs. routine autonomy demonstrated no statistically significant difference in either task (chest compression depth deviation: difference -0.7 mm [score range 0 to 37.5 mm]; 95% confidence interval (CI95) -3.85, 2.41; p = .65; peg transfer penalized time: rate ratio 1.03; CI95 0.91, 1.31; p = .79). The authors likewise found no statistically significant difference for external vs. internal focus of attention (depth deviation: difference 1.1 mm; CI95 -2.04, 4.17; p = .50; penalized time: rate ratio 0.89; CI95 0.75, 1.13; p = .33). The authors found no statistically significant differences for either comparison in confidence, autonomy and workload (p > .09; differences ranged from -0.83 to 0.79 [scale range 0 to 10]).

Conclusions: First-try performance of chest compressions and peg transfer by novice learners is not significantly affected by enhanced (vs. routine) autonomy or external (vs. internal) focus of attention.

Keywords: Attention focus; Autonomy; Medical motor task; OPTIMAL theory; Simulation.

Publication types

Randomized Controlled Trial

MeSH terms

Attention
Humans
Learning*
Motivation
Motor Skills*
Task Performance and Analysis