The Journal of Bone and Joint Surgery (American). 2005;87:1031-1037.
doi:10.2106/JBJS.D.02434
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Leopold, S. S.
Right arrow Articles by Wolf, F. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Leopold, S. S.
Right arrow Articles by Wolf, F. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Impact of Educational Intervention on Confidence and Competence in the Performance of a Simple Surgical Task

Seth S. Leopold, MD1, Hannah D. Morgan, MD1, Nancy J. Kadel, MD1, Gregory C. Gardner, MD1, Douglas C. Schaad, PhD2 and Fredric M. Wolf, PhD2

1 Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356500, Seattle, WA 98195. E-mail address for S.S. Leopold: leopold{at}u.washington.edu
2 Department of Medical Education and Biomedical Informatics, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 357240, Seattle, WA 98195

Investigation performed at the Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Zimmer, Inc.) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Many complex new procedures involve a learning curve, and patients treated by individuals who are new to a procedure may have more complications than those treated by a practitioner who has performed the intervention more frequently. Still, at some point on the learning curve, each individual must decide that he or she is qualified to perform a procedure, presumably on the basis of his or her level of confidence, background, education, and skill. To evaluate the interrelationship of these factors, we designed a study in which we assessed the performance of a simulated knee joint injection.

Methods: Ninety-three practitioners attending a continuing medical education session on knee injection were randomized to receive skills instruction through the use of a printed manual, a video, or hands-on instruction; each performed one injection before and after instruction. The participants completed pre-instruction and post-instruction questionnaires gauging confidence and also provided self-assessments of their performances of injections before and after instruction. Self-assessments were compared with objective performance standards measured by custom-designed knee models with electronic sensors that detected correct needle placement.

Results: Before instruction, the participants' confidence was significantly but inversely related to competent performance (r = –0.253, p = 0.02); that is, greater confidence correlated with poorer performance. Both men and physician-practitioners displayed higher pre-instruction confidence (p < 0.01), which was not correlated with better performance. After instruction, performance improved significantly in all three training groups (p < 0.001), with no significant differences in efficacy detected among the three groups (p = 0.99). After instruction, confidence correlated with objective competence in all groups (r = 0.24, p = 0.04); however, this correlation was weaker than the correlation between the participants' confidence and their self-assessment of performance (r = 0.72, p = 0.001).

Conclusions: Even low-intensity forms of instruction improve individuals' confidence, competence, and self-assessment of their skill in performing the fairly straightforward psychomotor task of simulated knee injection. However, men and physicians disproportionately overestimated their skills both before and after training, a finding that worsened as confidence increased. The inverse relationship between confidence and competence that we observed before the educational intervention as well as the demographic differences that we noted should raise questions about how complex new procedures should be introduced and when self-trained practitioners should begin to perform them.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JAMAHome page
D. A. Davis, P. E. Mazmanian, M. Fordis, R. Van Harrison, K. E. Thorpe, and L. Perrier
Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.
JAMA, September 6, 2006; 296(9): 1094 - 1102.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
J. R. Lynch, G. A. Schmale, D. C. Schaad, and S. S. Leopold
Important Demographic Variables Impact the Musculoskeletal Knowledge and Confidence of Academic Primary Care Physicians
J. Bone Joint Surg. Am., July 1, 2006; 88(7): 1589 - 1595.
[Abstract] [Full Text] [PDF]