Effects of self-modeling on self-efficacy and balance beam performance

Reducing trainee mistakes. Better performance with changing to a high-fidelity simulation system?

BACKGROUND

Postpartum hemorrhage is a significant cause of both maternal morbidity and mortality worldwide and is increasing in incidence. This study aimed to assess improvement and identify shortcomings in trainee performance in different simulation systems in the management of postpartum hemorrhage.

OBJECTIVE

To perform a pilot study evaluating and comparing high- and low-fidelity simulation models, assessing improvement in repeated performance with high-fidelity mode and identifying mistakes made assessed using Objective Structured Assessment of Technical Skills and thereby exploring what aspects of emergency management of postpartum hemorrhage should be prioritized in teaching settings and assessing what simulation setup is most effective in achieving competence.

STUDY DESIGN

This was a prospective randomized, single-blinded, single-institution trial in a population of 17 junior obstetrical trainees at the Charité University Hospital Obstetric Simulation Center in Berlin. Trainees were randomized into 2 groups, with either initial low-fidelity simulation or high-fidelity simulation, followed by repeated assessment of performance, using the high-fidelity model simulation system. Individual simulation sessions were video-recorded and transcribed, and the timing of interventions was documented. Strandardized Objective Structured Assessment of Technical Skills forms were used as a checklist for performance.

RESULTS

There was a statistically significant general improvement in performance (P=.02; 24.7-27.2 of 31.0 points; average of 8.7%) in the second cycle of simulation assessment and a statistically significant training effect (P=.043; 24.4-28.4 of 31.0 points; average of 12.9%) in the group that underwent repeat simulation assessment from the initial low-fidelity system to the high-fidelity system compared with the group using the same high-fidelity setup (P=.276; 25.0-25.8 of 31.0; average of 2.4%).

CONCLUSION

There was an improvement in the performance when trainees underwent a repeated cycle of simulation assessment changing from a low-fidelity system to a high-fidelity system. Simulation assessment can identify mistakes and learning gaps that are important for obstetrical trainees. This study found that trainees make the same mistakes, regardless of which simulation model was initially used.

When and How to Provide Feedback and Instructions to Athletes?-How Sport Psychology and Pedagogy Insights Can Improve Coaching Interventions to Enhance Self-Regulation in Training

In specialist sports coaching, the type and manner of augmented information that the coach chooses to use in communicating and training with individual athletes can have a significant impact on skill development and performance. Informed by insights from psychology, pedagogy, and sport science, this position paper presents a practitioner-based approach in response to the overarching question: When, why, and how could coaches provide information to athletes during coaching interventions? In an ecological dynamics rationale, practice is seen as a search for functional performance solutions, and augmented feedback is outlined as instructional constraints to guide athletes' self-regulation of action in practice. Using the exemplar of team sports, we present a Skill Training Communication Model for practical application in the context of the role of a specialist coach, using a constraints-led approach (CLA). Further based on principles of a non-linear pedagogy and using the recently introduced Periodization of Skill Training (PoST) framework, the proposed model aims to support practitioners' understanding of the pedagogical constraints of feedback and instruction during practice. In detail, the PoST framework's three skill development and training stages work to (1) directly impact constraint manipulations in practice designs and (2) indirectly affect coaches' choices of external (coach-induced) information. In turn, these guide practitioners on how and when to apply different verbal instruction methodologies and aim to support the design of effective skill learning environments. Finally, several practical guidelines in regard to sports coaches' feedback and instruction processes are proposed.

Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video-enhanced feedback and deliberate practice

AIMS

This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations.

METHODS

Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated cost-effectiveness.

RESULTS

There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (P = .026, 95% confidence interval [CI] Wald 0.093 to 1.436; P = .026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (P = .007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (P = .04, 95% CI -0.068 to -0.001). The break-even analysis demonstrates cost-effectiveness for the intervention.

CONCLUSION

Simulated clinical encounters using personalised, structured, video-enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of Foundation Year doctors. The intervention is cost-effective with potential to reduce avoidable harm.

Personalized Video Feedback and Repeated Task Practice Improve Laparoscopic Knot-Tying Skills: Two Controlled Trials

PURPOSE

Compare the effect of personalized feedback (PF) vs. task demonstration (TD), both delivered via video, on laparoscopic knot-tying skills and perceived workload; and evaluate the effect of repeated practice.

METHOD

General surgery interns and research fellows completed four repetitions of a simulated laparoscopic knot-tying task at one-month intervals. Midway between repetitions, participants received via e-mail either a TD video (demonstration by an expert) or a PF video (video of their own performance with voiceover from a blinded senior surgeon). Each participant received at least one video per format, with sequence randomly assigned. Outcomes included performance scores and NASA Task Load Index (NASA-TLX) scores. To evaluate the effectiveness of repeated practice, scores from these trainees on a separate delayed retention test were compared against historical controls who did not have scheduled repetitions.

RESULTS

Twenty-one trainees completed the randomized study. Mean change in performance scores was significantly greater for those receiving PF (difference = 23.1 of 150 [95% confidence interval (CI): 0, 46.2], P = .05). Perceived workload was also significantly reduced (difference = -3.0 of 20 [95% CI: -5.8, -0.3], P = .04). Compared with historical controls (N = 93), the 21 with scheduled repeated practice had higher scores on the laparoscopic knot-tying assessment two weeks after the final repetition (difference = 1.5 of 10 [95% CI: 0.2, 2.8], P = .02).

CONCLUSIONS

Personalized video feedback improves trainees' procedural performance and perceived workload compared with a task demonstration video. Brief monthly practice sessions support skill acquisition and retention.

Self-Efficacy in Mastery Learning to Apply a Therapeutic Psychomotor Skill

This study assessed changes in Self-efficacy scores produced by each of the four steps of instruction used to teach students a therapeutic psychomotor skill used by osteopathic physicians. Volunteering subjects were an entire class of 83 first-year osteopathic medical students (40 men, 43 women, M age = 25.1 yr.). Self-reported Self-efficacy to perform the skill was sampled: (1) after an instructor's demonstration of the skill during a laboratory session, (2) after paired students practiced during the laboratory session, (3) after independent self-paced practice outside class using an instructional handout and videotape, and (4) after receiving individualized feedback on skill performance from an instructor acting as the “patient.” The first two steps, representing typical skill instruction, produced mean Self-efficacy scores of 18% and 30%, respectively. On the last two steps, added to implement mastery learning, mean Self-efficacy scores increased to 75% and 85%, respectively. The instructors confirmed that all students mastered performance of the skill. Mastery learning was effective in developing both the therapeutic skill and high Self-efficacy to utilize the skill.

Is Mixed Practice More Effective than Physical Practice Alone for the Acquisition of Non-dominant Side Kicking Performance?

Perceiving and executing unfamiliar movements, such as left handed/footed movement skills in sports, places additional demands on the perceptual-cognitive system of players that may increase errors. The video self-modeling (VSM) method may provide an accessible solution to this issue, therefore the purpose of this study was to investigate the effect of the VSM method on the improvement of a non-preferred side kicking task. N = 28 participants engaged in one of three conditions; Mirror reversed/ physical practice (PP), best-of/ PP, or physical practice only. Though not significant, data analysis indicated improved kicking accuracy for all groups, with VSM groups showing the most improvement. However, qualitative data revealed the “best-of” group demonstrated more positive views toward their progress compared to other groups, and both VSM groups were more likely to attend to movement cues than target based cues. These trends may suggest merit for the use of VSM techniques, though its application and the source of mechanistic factors warrant further investigation.

Randomized trial to assess the effect of supervised and unsupervised video feedback on teaching practical skills

BACKGROUND

Feedback is a vital component of the learning process; however, great variation exists in the quality, quantity, and method of delivery. Video feedback is not commonly used in the teaching of surgical skills. The aim of this trial was to evaluate the benefit of 2 types of video feedback-individualized video feedback (IVF), with the student reviewing their performance with an expert tutor, and unsupervised video-enhanced feedback (UVF), where the student reviews their own performance together with an expert teaching video-to determine if these improve performance when compared with a standard lecture feedback.

METHODS

A prospective blinded randomized control trial comparing lecture feedback with IVF and UVF was carried out. Students were scored by 2 experts directly observing the performance and 2 blinded experts using a validated pro forma. Participants were recorded on video when performing a suturing task. They then received their feedback via any of the 3 methods before being invited to repeat the task.

RESULTS

A total of 32 students were recruited between the 3 groups. There was no significant difference in suturing skill performance scores given by those directly observing the students and those blinded to the participant. There was no statistically significant difference between the 2 video feedback groups (p = 1.000), but there was significant improvement between standard lecture feedback and UVF (p = 0.047) and IVF (p = 0.001).

CONCLUSION

Video feedback can facilitate greater learning of clinical skills. Students can attain a similar level of surgical skills improvement with UVF as with teacher-intensive IVF.

Randomized trial of the effect of video feedback on the acquisition of surgical skills

Background

Constructive feedback provides a mechanism for reinforcing learning during the acquisition of surgical skills. Feedback is usually given verbally, and sometimes documented, after direct observation by a trained assessor. The aim was to evaluate video recording as an effective modality for enhancing feedback, in comparison with standard verbal feedback alone.

Methods

This was a prospective, blinded, randomized clinical trial comparing standard verbal feedback plus video with standard verbal feedback alone. Validated pro formas for assessment were used and quality control was performed by independent expert assessors. Trial participants were recorded on video performing the surgical skill, and returned the next day to perform the skill again following video and standard verbal feedback (group 1) or standard verbal feedback alone (group 2).

Results

Forty-eight participants were divided equally between the two groups. There was a significant improvement in the mean overall procedure score for group 1 of 2·875 from a maximum achievable score of 20 (P = 0·003), but not for group 2. There were significant improvements in the specific domains of instrument familiarity, needle handling, skin handling and accurate apposition, again all in group 1. The only significant improvement in group 2 was in an organized approach to the task, also observed in group 1. Knot-tying security deteriorated after feedback in group 2 but not in group 1.

Conclusion

The addition of video feedback can improve the acquisition of surgical skills, and could be incorporated into formal surgical curricula.

Feedforward self-modeling enhances skill acquisition in children learning trampoline skills

The purpose of this research was to examine whether children would benefit from a feedforward self-modeling (FSM) video and to explore possible explanatory mechanisms for the potential benefits, using a self-regulation framework. To this end, children were involved in learning two five-skill trampoline routines. For one of the routines, a FSM video was provided during acquisition, whereas only verbal instructions were provided for the alternate routine. The FSM involved editing video footage such that it showed the learner performing the trampoline routine at a higher skill level than their current capability. Analyses of the data showed that while physical performance benefits were observed for the routine that was learned with the FSM video, no differences were obtained in relation to the self-regulatory measures. Thus, the FSM video enhanced motor skill acquisition, but this could not be explained by changes to the varied self-regulatory processes examined.

Video modeling by experts with video feedback to enhance gymnastics skills

The effects of combining video modeling by experts with video feedback were analyzed with 4 female competitive gymnasts (7 to 10 years old) in a multiple baseline design across behaviors. During the intervention, after the gymnast performed a specific gymnastics skill, she viewed a video segment showing an expert gymnast performing the same skill and then viewed a video replay of her own performance of the skill. The results showed that all gymnasts demonstrated improved performance across three gymnastics skills following exposure to the intervention.

The impact of self-as-a-model interventions on children's self-regulation of learning and swimming performance

We compared two self-as-a-model interventions: self-modelling (viewing oneself perform an adaptive behaviour) and self-observation (viewing oneself perform at current skill level). Operating within Zimmerman's (1989, 2000) theory of self-regulated learning, we examined the effect of the modelling interventions on three self-regulatory processes (self-efficacy, intrinsic motivation, and self-satisfaction), as well as physical performance. Thirty-three children were randomly assigned to one of three experimental groups. The two self-as-a model groups received the modelling intervention just before physical practice, whereas the control group received physical practice only. Analyses of the retention scores revealed significant differences for all dependent measures. Post hoc testing showed consistently that the self-modelling group performed better than the self-observation and control groups, and that the two latter groups performing similarly. These results provide support for the implementation of self-modelling interventions with children when teaching motor skills.

The measurement of competitive anxiety during balance beam performance in gymnasts

The purpose of the present study was to investigate competitive anxiety during balance beam performance in gymnasts. Competitive anxiety was assessed continuously by heart rate monitoring and by retrospective self-report of nervousness in eight female national level gymnasts during their balance beam routine during one competition and two training sessions. A significant negative correlation was found between the score of the retrospective self-report of nervousness and performance during the routine. There were no significant differences in performance score by the judges between the three test sessions. There were also no differences in the retrospective self-report of nervousness. However, heart rate was significantly higher during the competition session than during the training sessions. The potential value of the retrospective report of nervousness for the study of critical events during gymnastic performance is illustrated. The results are discussed in the light of catastrophe theory.

The effectiveness of video feedback in the acquisition of orthopedic technical skills

BACKGROUND

The addition of video feedback to bench model training offers residents the opportunity to see themselves perform a surgical task. Videotaped feedback therefore promotes self-evaluation, a critical learning skill, and also has the potential to influence how a resident executes a skill once they have had the opportunity to see themselves perform the task.

METHODS

Twenty-nine surgical residents were video recorded while performing three technical skills. They then were randomly assigned to receive either no feedback, video feedback alone, or video feedback with the help of an expert, an orthopedic surgeon. The surgical task was then repeated. Orthopedic surgeons evaluated the videotapes using the global rating scale and technical checklist form.

RESULTS

One-way between-subject analysis of variance comparing the pretest and post-test difference scores on three different measures for each of the three tasks revealed no statistically significant differences. After controlling for rater variance, the global rating scores across the three surgical tasks did not reveal any statistically significant differences.

CONCLUSIONS

This study failed to demonstrate an improvement in technical skills based on utilization of video feedback.

Mechanisms of attentional cueing during observational learning to facilitate motor skill acquisition

We examined the effectiveness of different cueing conditions during observational learning of a soccer accuracy pass. Sixty participants (30 males, 30 females) were randomly assigned and stratified by sex into one of six groups: discovery learning, verbal instruction, video model with visual cues, video model with verbal cues, video model with visual and verbal cues, and video model only. Each participant completed eight blocks of 10 trials each, with trial blocks 1 and 2 representing the practice phase (no manipulation), trial blocks 3, 4, 5 and 6 the acquisition phase (manipulation administered) and trial blocks 7 and 8 the retention phase (24 h after acquisition, with no manipulation). Absolute error, variable error and kicking form were recorded. The results indicated that those who used video modelling with visual and verbal cues collectively displayed less error and more appropriate form across acquisition and retention trial blocks compared with other groups. Our findings suggest that verbal information in addition to visual cues enhances perceptual representation and retention of modelled activities to improve task reproduction capabilities. Future research directions are proposed with implications for both direct and indirect perception accounts of skill acquisition through observed behaviours.

Videotape review leads to rapid and sustained learning

BACKGROUND

Performance review using videotapes is a strategy employed to improve future performance. We postulated that videotape review of trauma resuscitations would improve compliance with a treatment algorithm.

METHODS

Trauma resuscitations were taped and reviewed during a 6-month period. For 3 months, team members were given verbal feedback regarding performance. During the next 3 months, new teams attended videotape reviews of their performance. Data on targeted behaviors were compared between the two groups.

RESULTS

Behavior did not change after 3 months of verbal feedback; however, behavior improved after 1 month of videotape feedback (P <0.05) and total time to disposition was reduced by 50% (P <0.01). This response was sustained for the remainder of the study.

CONCLUSIONS

Videotape review can be an important learning tool as it was more effective than verbal feedback in achieving behavioral changes and algorithm compliance. Videotape review can be an important quality assurance adjunct, as improved algorithm compliance should be associated with improved patient care.

Goal orientation and the modeling process: an individual's focus on form and outcome

One's achievement goal orientation (e.g., task, ego) is suggested to reflect a differential focus on skill mastery and performance outcome (Duda, 1992). Goal orientation has further been suggested to be an important observer characteristic in the observational learning of motor skills (McCullagh, Weiss, & Ross, 1989). This study assessed the relationship between goal orientation and a focus on form and outcome aspects of a motor skill demonstration with college students (N = 30) having low perceived ability, knowledge, and experience in tennis. Participants viewed several videotaped demonstrations of a correctly performed tennis forehand and then visual recognition and verbal recall accuracy of form and outcome task characteristics were assessed. A canonical correlation analysis revealed a nonsignificant relationship between goal orientation and recall and recognition of form and outcome task characteristics. These results provide preliminary evidence to suggest that goal orientation may not be an important observer characteristic in the learning phase of the modeling process. Also, achievement goal orientations may not be associated with a differential focus on skill mastery or performance outcome but instead remain a reflection of divergent processes of success evaluation.