Department of Medicine, University of Toronto, Toronto and The Wilson Centre, University Health Network, Toronto, Ontario, Canada.
Med Educ. 2012 Jul;46(7):648-56. doi: 10.1111/j.1365-2923.2012.04268.x.
Simulation training offers opportunities for unsupervised, self-regulated learning, yet little evidence is available to indicate the efficacy of this approach in the learning of procedural skills. We evaluated the effectiveness of directed self-regulated learning (DSRL) and instructor-regulated learning (IRL), respectively, for teaching lumbar puncture (LP) using simulation.
We randomly assigned internal medicine residents in postgraduate year 1 to either DSRL ('directed' to progress from easy to difficult LP simulators during self-regulated learning) or IRL (in groups of four led by an instructor). All participants practised for up to 50 minutes and completed a pre-test, post-test and delayed (by 3 months) retention test on the simulator. Pairs of blinded trained experts independently rated all videotaped performances using a validated global rating scale and a modified version of a validated checklist. Participants provided measures of LP experience and self-reported confidence. We analysed the pre-post (n = 42) and pre-post-retention performance scores (n = 23) using two separate repeated-measures analyses of variance (anovas) and computed Pearson correlation coefficients between participants' confidence and performance scores.
Inter-rater agreement was strong for both performance measures (intra-class correlation coefficient > 0.81). The groups achieved similar pre-test and post-test scores (p > 0.05) and scores in both groups improved significantly from the pre- to the post-test (p < 0.05). On retention, a significant interaction (F(2,42) = 3.92, p = 0.03) suggests the DSRL group maintained its post-test performance, whereas that in the IRL group dropped significantly (p < 0.05). Correlations between self-reported confidence and post-test performance were positive and significant for the DSRL group, and negative and non-significant for the IRL group.
Both IRL and DSRL led to improved LP performance immediately after practice. Whereas the IRL group's skills declined after 3 months, the DSRL group's performance was maintained, suggesting a potential long-term benefit of this training. Participants in the DSRL group also developed a more accurate relationship between confidence and competence following practice. Further research is needed to clarify the mechanisms of self-regulated learning and its role in simulation contexts.
模拟训练为自主学习提供了机会，但几乎没有证据表明这种方法在程序性技能学习中的有效性。我们分别评估了定向自我调节学习（DSRL）和指导者调节学习（IRL）在使用模拟教学腰椎穿刺（LP）中的效果。
我们将第一年住院医师随机分配到 DSRL（在自主学习期间，“指导”从简单到困难的 LP 模拟器进展）或 IRL（由一名指导者带领的四人一组）。所有参与者练习时间长达 50 分钟，并在模拟器上完成预测试、后测试和延迟（3 个月后）保留测试。两名经过培训的专家使用经过验证的综合评分量表和经过修改的验证清单对所有录像表现进行了独立评估。参与者提供了 LP 经验和自我报告的信心的测量值。我们使用两个单独的重复测量方差分析（anova）分析了预测试后（n = 42）和预测试后保留测试（n = 23）的表现得分，并计算了参与者的信心和表现得分之间的 Pearson 相关系数。
两种表现测量的评分者间一致性均很强（组内相关系数 > 0.81）。两组在预测试和后测试中的得分相似（p > 0.05），且两组在预测试后都有显著提高（p < 0.05）。在保留测试中，显著的交互作用（F（2，42）= 3.92，p = 0.03）表明，DSRL 组保持了后测试的表现，而 IRL 组的表现显著下降（p < 0.05）。DSRL 组的自我报告信心与后测试表现之间的相关性为正且显著，而 IRL 组的相关性为负且不显著。
IRL 和 DSRL 都能在练习后立即提高 LP 表现。尽管 IRL 组的技能在 3 个月后下降，但 DSRL 组的表现得以维持，这表明这种培训可能具有长期效益。在练习后，DSRL 组的参与者也在信心和能力之间建立了更准确的关系。需要进一步研究来阐明自我调节学习的机制及其在模拟情境中的作用。
