Masters R S W, Lo C Y, Maxwell J P, Patil N G
Institute of Human Performance, The University of Hong Kong, Hong Kong SAR, China.
Surgery. 2008 Jan;143(1):140-5. doi: 10.1016/j.surg.2007.06.018. Epub 2007 Dec 3.
Implicitly learned motor skills are characterized by minimal conscious knowledge of the movements involved and stable performance despite stress, fatigue, or multi-tasking. In contrast, explicitly learned motor skills are characterized by conscious knowledge of the movements and performance that tends to be less stable under stress, fatigue, and multi-tasking. We examined the acquisition of a basic surgical skill in three observational learning treatment conditions designed to accomplish implicit or explicit motor learning. We then tested performance in conditions that emulated multi-tasking in the operating theater. Our intention was to elaborate current understanding of implicit and explicit processes that underpin observational learning in the surgical environment.
Thirty-six novice adults were assigned randomly to an observation-only, an instructed-observation, or a guided-observation treatment condition, in which they learned to perform a suturing and knot-tying task in a Learning Phase. Their performance during multi-tasking was then assessed objectively by motion analysis during a Test Phase.
In the Learning Phase, performance improved equally in the treatment conditions throughout learning, with participants using fewer hand movements and completing the task more quickly. Participants in the observation-only and the guided-observation treatment condition, however, reported significantly less movement-related knowledge than participants in the instructed-observation condition. In the Test Phase, participants in the instructed-observation condition exhibited slower completion times and more hand movements when they were required to multi-task, whereas in the observation-only and the guided-observation treatment condition, participants showed stable performance.
A surgical skill that is learned by observation alone or by observation accompanied by guidance to reduce the number of errors that are committed tends to be learned implicitly and to have stable performance during multi-tasking. The efficacy of observation for acquiring technical skills implies that, at least for some skills, verbal instructions may not be necessary.
内隐学习的运动技能的特点是对所涉及的动作只有极少的意识性认知，并且在压力、疲劳或多任务处理情况下仍能保持稳定的表现。相比之下，外显学习的运动技能的特点是对动作有意识的认知，并且在压力、疲劳和多任务处理情况下表现往往不太稳定。我们在三种旨在实现内隐或外显运动学习的观察性学习治疗条件下，研究了一种基本手术技能的习得情况。然后，我们在模拟手术室多任务处理的条件下测试了表现。我们的目的是详细阐述目前对手术环境中观察性学习背后的内隐和外显过程的理解。
36名成年新手被随机分配到仅观察、有指导观察或引导观察治疗条件下，在学习阶段他们学习执行缝合和打结任务。然后在测试阶段通过运动分析客观评估他们在多任务处理时的表现。
在学习阶段，在整个学习过程中，各治疗条件下的表现均有同等程度的提高，参与者使用的手部动作更少，完成任务更快。然而，仅观察和引导观察治疗条件下的参与者报告的与动作相关的知识明显少于有指导观察条件下的参与者。在测试阶段，有指导观察条件下的参与者在需要进行多任务处理时完成时间较慢，手部动作更多，而在仅观察和引导观察治疗条件下，参与者表现稳定。
仅通过观察或在观察时伴有指导以减少所犯错误数量而习得的手术技能往往是通过内隐方式习得的，并且在多任务处理时表现稳定。观察对于获得技术技能的有效性意味着，至少对于某些技能来说，言语指导可能并非必要。
