Manzone Julian, Regehr Glenn, Garbedian Shawn, Brydges Ryan
Wilson Centre, University Health Network; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Centre for Health Education Scholarship and Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Teach Learn Med. 2019 Oct-Dec;31(5):528-535. doi: 10.1080/10401334.2019.1600520. Epub 2019 Apr 16.
Medical curricula now include more time for trainees to manage their studying independently, yet evidence suggests that time is not well spent without guidance. Social-cognitivist models of self-regulated learning suggest value when guiding learners to set goals related to their performance processes (actions producing outcomes) versus their performance outcomes (products of performance). We expected participants oriented to set process goals would demonstrate better suturing skill retention compared with participants oriented to set outcome goals. We randomly assigned 41 medical students to two groups: outcome oriented or process oriented. They self-scored their performance using a visual analog scale on every third trial during 25 training trials, and during 10 retention trials 2 weeks later. Two raters assessed participants' suturing performances (process) and final products (outcome). After finding weak support for our hypothesis, we calculated a "self-monitoring calibration coefficient" as the Pearson's correlation between the raters' average score and each participant's self-scores. We used a mixed-effects analysis of variance to compare participants' performance scores as well as tests and an analysis of variance to compare their self-monitoring calibration coefficients. Analysis of skill retention data revealed a significant Group × Trial interaction, suggesting a benefit for the process group only for the 10th retention trial ( = .03). During training, the process group had significantly better ( = .02) self-monitoring calibration ( = .71 ± .29) than the outcome group ( = .38 ± .55). In retention, participants in both groups were significantly better calibrated ( = .04) with rater's scores of performance processes ( = .39 ± .60) versus performance outcomes ( = .11 ± .63). Our findings provide limited evidence for our original hypothesis. Perhaps more important, however, our self-monitoring calibration data highlighted inconsistencies between our interventions and our participants' apparent preferences. Not all participants adopted their assigned goal setting orientation, showing that researchers and educators must consider the extent to which trainees adopt imposed instructions in any educational intervention.
现在的医学课程安排了更多时间让实习生自主管理学习，但有证据表明，如果没有指导，这些时间并未得到有效利用。自我调节学习的社会认知模型表明，在指导学习者设定与他们的表现过程（产生结果的行动）而非表现结果（表现的产物）相关的目标时具有价值。我们预期，与设定结果目标的参与者相比，以设定过程目标为导向的参与者在缝合技能保持方面会表现得更好。我们将41名医科学生随机分为两组：结果导向组或过程导向组。在25次训练试验期间，他们每隔三次试验就使用视觉模拟量表对自己的表现进行自我评分，在两周后的10次保持试验期间也是如此。两名评分者评估了参与者的缝合表现（过程）和最终作品（结果）。在发现对我们的假设支持力度较弱后，我们计算了一个“自我监测校准系数”，即评分者平均得分与每个参与者自我评分之间的皮尔逊相关性。我们使用混合效应方差分析来比较参与者的表现得分，以及使用检验和方差分析来比较他们的自我监测校准系数。对技能保持数据的分析揭示了一个显著的组×试验交互作用，表明仅在第10次保持试验中过程组有优势（P = 0.03）。在训练期间，过程组的自我监测校准（r = 0.71±0.29）显著优于结果组（r = 0.38±0.55）（P = 0.02）。在保持阶段，两组参与者在与评分者对表现过程的评分（r = 0.39±0.60）相比表现结果的评分（r = 0.11±0.63）时，校准度都显著提高（P = 0.04）。我们的研究结果为我们最初的假设提供了有限的证据。然而，也许更重要的是，我们的自我监测校准数据突出了我们的干预措施与参与者明显偏好之间的不一致。并非所有参与者都采用了他们被分配的目标设定导向，这表明研究人员和教育工作者必须考虑在任何教育干预中实习生接受强加指令的程度。
