title: How effective is self-guided learning of clinical technical skills? It's all about process.
abstract: OBJECTIVE
  Mounting evidence suggests that trainees acquire psychomotor skills better when they are allowed self-guided access to instructional material and when they set goals that are related to performance processes rather than performance outcomes. The present study assessed whether self-guided access to instruction and the setting of process goals lead to better acquisition of clinical technical skills.
  
  
  METHODS
  To learn wound closure skills, 48 medical students were randomly assigned to one of four groups in a 2 x 2 study design. Self-guided participants were able to access the instructional video freely, whereas control participants were restricted to watching only those video segments accessed by their matched self-guided participant. Each group was further divided into two subgroups, comprising a process goal subgroup, where participants set goals focused on performance mechanisms, and an outcome goal subgroup, where participants set goals focused on performance products. Performance on pre-, post-, retention and transfer tests was assessed with hand motion measures and expert evaluations. Group differences were evaluated using one-way anovas.
  
  
  RESULTS
  The self-guided group with process goals showed greater skill retention than its matched control group, whereas the self-guided group with outcome goals did not. Furthermore, the groups with process goals performed better on the transfer test than the outcome goal groups. Outcome goal participants accessed the instructional video most frequently.
  
  
  CONCLUSIONS
  Our findings advance the study of independent learning in medical education. Trainees used interactive and structured instructional materials to effectively self-guide their learning of clinical technical skills. However, a self-guided benefit was demonstrated only when trainees set process goals.
authors.affiliation: Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Brydges
authors.forename: Heather
authors.initials: H
authors.lastname: Carnahan
authors.forename: Oleg
authors.initials: O
authors.lastname: Safir
authors.forename: Adam
authors.initials: A
authors.lastname: Dubrowski
mesh_terms: D001296:Audiovisual Aids; D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education; D003479:Curriculum; D004502:Education, Medical, Continuing / Q000379:methods* / Q000592:standards; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D012647:Self-Assessment; D013223:Statistics as Topic; D013647:Task Performance and Analysis