Abstract
BackgroundThe ‘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.MethodsThe 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.ResultsOne 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]).ConclusionsFirst-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.
Highlights
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
Chest compression outcomes were analyzed using adjusted models to account for potential confounders for age, sex and manikin to evaluate the potential impact of the two experimental factors of autonomy and attentional focus
Autonomy: enhanced vs. routine We found no statistically significant differences in the primary outcome between enhanced and routine autonomy for either chest compressions or peg transfer
Summary
Overview We conducted a randomized 2x2 factorial experiment, with crossover between two medical motor tasks (chest compressions and peg transfer) for each of the two medical tasks. The instructors gave a brief explanation of the instruments (graspers) for all groups, followed by brief instructions specific to the independent variables (detailed below) They were asked to transfer, in a defined sequence, 3 wedges from numbered pegs (1, 2, 3) on the left side of a pegboard to corresponding numbered pegs on the right side. Participants in the enhanced autonomy condition were given the choice of standing on the right or left side of the manikin (a task-related choice) For peg transfer, they could choose the wedge color (orange or green) and the sequence (1-2-3 or 3-2-1) in which to transfer the wedges (a task-unrelated choice). Chest compression outcomes were analyzed using adjusted models to account for potential confounders for age, sex and manikin to evaluate the potential impact of the two experimental factors of autonomy and attentional focus. Data analysis was done with SAS version 9.4 (SAS Institute, Cary, NC)
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