Self-assessment and learning motivation in emergency point-of-care ultrasound: an online pilot investigation in German physicians

Abstract

Introduction: Learning motivation is essential to obtain and maintain ultrasound competencies in emergency medicine. One's competencies herein and the need for ongoing training are best evaluated by self-assessment. This may be flawed by overconfidence effects - the belief to be better than others or better than tests reveal. This study aims to clarify the underinvestigated interaction of learning motivation and self-assessment in emergency point-of-care-ultrasound (POCUS).

Methods: In this cross-sectional multicenter project, physicians assessed their own and others' competence and learning motivation using the Situational Motivation Scale comprising intrinsic motivation, external and identified regulation, and amotivation. In addition, we presented eight ultrasound loops of different pathologies to emergency physicians of various specialties.

Results: Overall, the motivation to learn was high, while self-assessment showed no significant overconfidence in POCUS. The rate of correct diagnoses based on the loops was relatively low. As a result, we did not detect overconfidence effects in participants who completed questions (n = 86) and tests (n = 56). Overplacing oneself above peers negatively correlated with intrinsic learning motivation and identified regulation and positively correlated to amotivation. Further analyses indicated that learning motivation was associated with the interactions of the physicians' risk perception, speciality, and self-assessment.

Discussion: The absence of overconfidence effects, the complexity of learning motivation and their interaction show that prior findings in other contexts may not be easily transferable to POCUS and could be highly context-sensitive. In conclusion, this study highlights high levels of learning motivation but relatively low diagnostic accuracy in POCUS, which suggests the need for ongoing education and assessment. Ensuring that physicians continue to receive objective feedback and opportunities to refine their skills is critical for maintaining high standards of care. Despite the small sample size and other limitations of the study, the results primarily served to generate hypotheses for future research on emergency ultrasound education.

Keywords: EFAST; Learning; Overconfidence; POCUS; Sonography; Training metacognition; Ultrasound.

Fig. 1

Moderation Model for POCUS for all participants – In this study we examined the impact of risk assessment on learning motivation moderated by the speciality. The moderating effect of the speciality is itself moderated by self-assessment

Fig. 2

Moderating effect of specialist discipline on the relation between perceived risk and amotivation among physicians: a) with lower self-assessment of one’s own competencies (Mean (M) = 3 on an ascending Likert scale from 1 to 5) b) with moderate self-assessment of one’s own competencies (M = 3.5 on an ascending Likert scale from 1 to 5) c) with high self-assessment of one’s own competencies (M = 4.2 on an ascending Likert scale from 1 to 5) X-axis depicts perceived risk for patients after incorrectly performed POCUS procedure from 3 “medium”, 4 “critical” to 5 “lethal”. Left Y-Axis shows amotivation (1–7 points with 7 as maximum amotivation). The specialist disciplines displayed are anaesthesiology (blue), trauma surgery (green) and internal medicine (red). (a) and (b) Lower and moderate self-assessment show that anaesthesiologists’ amotivation lowers with higher risk-assessment. In contrast, surgeons’ amotivation rises with higher risk-assessment. There is no significant correlation between perceived risk and amotivation among internal medicine physicians. (c) Perceived risk does not correlate with amotivation among surgeons and internal medicine physicians with high self-assessment of one’s own competencies. Among anaesthesiologists the risk-perception is negatively correlated with amotivation