Are There Detrimental Effects From Proficiency-Based Training in Fundamentals of Laparoscopic Surgery Among Novices? An Exploration of Goal Theory

Abstract

Introduction: Goal theory states that novices may experience unintended, detrimental learning effects, with decreased performance, when given performance goals on complex tasks. In these situations, it may be more appropriate to give novices learning goals to help avoid these negative consequences. The purpose of this study was to see whether this tenant of goal theory applied to novices learning 2 tasks of fundamentals of laparoscopic surgery (FLS).

Materials and methods: Medical and physician assistant students were randomized to a performance goals group and a learning goals group. The performance goals consisted of the published proficiency standards of FLS. Both groups were pretested on perception of surgery, self-efficacy, and general affect. Each group underwent a practice session for the peg transfer task. They were tested and scored per the published standards of FLS. The participants completed NASA Task Load Index, task complexity, and postaffect questionnaires related to the peg transfer task. This was repeated with the suture with intracorporeal knot task. Posttest perception of surgery and self-efficacy questionnaires were completed.

Results: In total, 48 students participated in the study: 23 in the performance goals group and 25 in the learning goals group. Most of the participants (n = 40) were first-year medical and physician assistant students. There were no significant differences between the groups in perception of surgery, affect, goal commitment, subjective task complexity, subjective workload, and self-efficacy. There were no differences between the groups concerning overall FLS score for both the peg transfer and suturing tasks. Both groups exhibited significant increases in self-efficacy and perception of surgery (p < 0.05).

Conclusion: FLS skills can be given to novice learners without concern for detrimental effects as might be expected by other work on goal theory. Given that performance was the same for both groups, surgical educators may have multiple pathways to educational success when incorporating goals into training programs for basic surgical skills.

Keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; educational goals; simulation; surgical education.