Can the Perceived Difficulty of a Task Enhance Trainee Performance?

Abstract

Human understanding of how to efficiently train learners in procedural skills is imperfect. The concept of self-efficacy - confidence in one's ability to successfully complete a task - may be useful to learners. Theories of motivation and instructional design suggest there are specific targets for improving learner success. We aimed to study the effects of induced conceptions of ability on motor learning using both undergraduate and medical students. Forty undergraduate and medical students underwent a 15-minute training session teaching the basics of colonoscopy on a low-cost, moderate fidelity colonoscopy simulation model. Students were then tasked to intubate the cecum of a similarly constructed colonoscopy model with a real colonoscope. Before each task, participants were given a note which either read "90% of your peers completed the task in less than 5 minutes" (positive [+] comparison group) or "10% of your peers completed the task in less than 5 minutes" (negative [-] comparison group). Immediately after receiving the note, participants were then asked to complete a self-efficacy questionnaire, ranking their confidence on a scale from 0 to 10 for successfully completing the task. A NASA TLX was collected to understand the students' mental effort with the task. Participants then underwent stratified randomization into 2 crossover groups (G1 = + note, then - note; G2 = - note, then + note) and again performed the colonoscopy task. Following the session completion, all students had received both notes and crossed over to complete both tasks. Time spent on both tasks and task completion (reaching the cecum) was the measured outcomes. Self-efficacy (confidence) levels were significantly higher in the positive note condition for both comparison groups in (p < 0.05). However, task completion rates were higher in the negative note group in Task 1 (p < 0.05) and the same in Task 2 (p = 0.6). Time spent by participants in each task was longer in the negative note groups in both tasks (p = 0.06 in Task 1; p = 0.07 in Task 2). No difference was found between both groups in the mental effort after each task (Table 1). This prospective, cross-over study suggests that performance expectancies can be influenced by preinduced conceptions. Performance was enhanced in Task 1 when participants were given a relatively "low success rate prediction." This may be due to an enhanced focus that led to increased performance-while participants who were given the prediction of a "higher success rate" were more confident but performed less well. The crossover groups for Task 2 performed in a similar manner despite different confidence levels. This study supports the idea that self-efficacy expectations are relevant for trainee education and performance.