title: Different Goals, Different Pathways: The Role of Metacognition and Task Engagement in Surgical Skill Acquisition.
abstract: BACKGROUND
  The purpose of this study is to understand why learning goals and performance goals may produce different outcomes in surgical skills training for novices, with specific attention to metacognition and task engagement.
  
  
  METHODS
  Third-year medical students were randomized to a performance or learning-goal condition during a knot tying and suturing training program. Performance was assessed by blinded videotaped review. Demographics, goal orientation, and metacognition were captured with pre- and posttraining questionnaires.
  
  
  RESULTS
  A total of 90 students participated in the training program. Trainees in the learning goals group demonstrated better performance on knot tying (4.30 ± 0.78 vs 3.86 ± 0.95; p < 0.05) and suturing (4.10 ± 0.77 vs 3.54 ± 0.73; p < 0.001). Participants in the learning goals group reported higher task engagement during both knot tying (4.32 ± 0.66 vs 3.90 ± 0.52; p < 0.001) and suturing (4.48 ± 0.42 vs 4.01 ± 0.46; p < 0.001). Additionally, the learning goals group also reported higher metacognition during both knot tying (3.88 ± 0.75 vs 3.59 ± 0.52; p < 0.05) and suturing (3.96 ± 0.75 vs 3.68 ± 0.48; p < 0.05).
  
  
  CONCLUSIONS
  Our findings suggest that learning goals may be optimal for trainees learning new surgical tasks because they elicit increased task engagement and metacognition among trainees.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: aimee.gardner@utsouthwestern.edu.
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Gardner
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ibrahim J
authors.initials: IJ
authors.lastname: Jabbour
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Williams
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Sergio
authors.initials: S
authors.lastname: Huerta
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D013502:General Surgery / Q000193:education*; D006040:Goals; D006801:Humans; D008297:Male; D000067489:Metacognition
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; education; engagement; goals; metacognition