The impact of an autonomy supportive versus a controlling coaching environment on surgical skill acquisition for novice trainees

Abstract

Sports psychology literature often defines coaching environments in two ways: autonomy supportive (ASE) and controlling environment (CE). An ASE offers the trainee a degree of choice, positive reinforcement, and approachability. CE coaching provides prescriptive instructions with no choice, neglects positive reinforcement, and involves physical and/or vocal intimidation. The literature suggests that ASE conditions improve motor skills learning compared to controlling conditions; this has not been studied in surgical education. Medical students (n = 46) who were novices at laparoscopic surgical skills were randomly assigned to four groups based on the type of environment (ASE vs CE) and who initiated the feedback (trainee vs coach). Participants watched an instructional video in their coaching environment, performed a pre-test, underwent 80 min of coaching on the Fundamentals of Laparoscopic Surgery intra-corporeal suturing task, and then completed a post-test (PT). A resident and senior medical student served as coaches following ASE or CE coaching scripts. Time, errors, score, and amount of feedback for each practice trial were recorded. The coach was blinded to the score of each trial and the data were recorded by the assistant. A post-test survey was performed. Participants returned within a week to perform a retention test (RT). Results were analyzed with a 2 × 2 (environment x feedback controller) factorial ANOVA test. Post-test scores revealed a main effect of environment (p < 0.001). Similarly, on the retention test scores, a 2 × 2 factorial ANOVA revealed a main effect of environment (p = 0.002). Trainees in ASE conditions achieved significantly higher post-test and retention test scores. Neither the main effect of feedback controller nor the interaction between environment and feedback controller was significant. The ASE cohorts had higher positive affect scores (p = 0.009). Across all conditions, participants completed between 7 and 13 practice trials during the 80-min training session (mean = 8.8 ± 1.2). This 2 × 2 ANOVA revealed a significant main effect of feedback initiator (p = 0.008). Participants assigned to conditions in which the coach initiated the feedback performed significantly more trials than participants in the environments where they initiated feedback (9.3 ± 0.9 vs 8.5 ± 1.3). Neither the main effect of coaching environment nor the interaction between coaching environment and feedback initiator was significant. In novice trainees, an autonomy supportive coaching environment improves surgical skill acquisition and retention along with trainee-reported attitudes toward the learning environment when compared to a controlling coaching environment.