University Medical Centre Göttingen, Germany.
Med Teach. 2013 Sep;35(9):760-6. doi: 10.3109/0142159X.2013.801942. Epub 2013 Jun 28.
Financial incentives are effective in moderating physician and patient behaviour, but they have not been studied in the context of medical education.
This study assessed whether financial incentives can motivate students to acquire electrocardiogram (ECG) interpretation skills.
Students enrolled for a cardio-respiratory teaching module (n = 121) were randomised to an intervention (financial incentive) or a control (book voucher raffle) condition. All students took three validated exams of ECG interpretation skills (at module entry, module exit and seven weeks later). Only the exit exam was financially incentivised in the intervention group. The primary outcome was the proportion of students who correctly identified ≥60% of clinically important diagnoses in the exit exam.
Financial incentives more than doubled the odds of correctly identifying ≥60% of diagnoses in the exit exam (adjusted odds ratio 2.44, 95% confidence interval 1.05-5.67) and significantly increased student learning time. However, there was no significant effect on performance levels in the retention exam.
Financial incentives increase reported learning time and examination results in the short-term. The lack of a sustained effect on performance suggests that financial incentives may foster a superficial or strategic rather than a deep approach to learning.
经济激励在调节医生和患者行为方面非常有效，但尚未在医学教育背景下进行研究。
本研究旨在评估经济激励是否可以激励学生掌握心电图（ECG）解读技能。
参加心肺教学模块的学生（n=121）被随机分配到干预组（经济激励）或对照组（书籍代金券抽奖）。所有学生都接受了三次 ECG 解读技能的验证性考试（在模块开始时、模块结束时和七周后）。只有干预组的期末考试是经济激励的。主要结果是在期末考试中正确识别出≥60%临床重要诊断的学生比例。
经济激励使期末考试中正确识别出≥60%诊断的学生比例增加了两倍以上（调整后的优势比为 2.44，95%置信区间为 1.05-5.67），并显著增加了学生的学习时间。然而，在保留考试中，对表现水平没有显著影响。
经济激励在短期内增加了报告的学习时间和考试成绩。对绩效的持续影响表明，经济激励可能会促进学生形成肤浅或策略性的学习方式，而不是深入的学习方式。
