Background
Point-of-Care Ultrasound (POCUS) is a core competency for patient safety in emergency and critical care. It is used by medical teams in pre-hospital settings, emergency departments, operating rooms, labour wards, and neonatal, paediatric, and adult intensive care units to identify life-threatening pathologies rapidly. POCUS provides valuable information for integrated care, especially in shock, trauma, peri-arrest situations, and after the return of spontaneous circulation [1–5].
Providers must receive regular training in using and interpreting POCUS to acquire and maintain competence. As attending training alone is no guarantee for proficiency, providers must ensure life-long learning motivation to deepen and preserve their competencies [6]. Efficient learning depends on the motivation to learn, which in turn is based on the self-assessment of knowledge, skills, problem-solving abilities, attitudes, and behaviour [7]. Unfortunately, self-assessment is prone to bias [8], particularly regarding the mismatch between subjective and objective knowledge or skills, also known as over- or underconfidence.
Overconfidence can be observed in a wide range of everyday skills (e.g., driving a car, quitting smoking, investments, non-medical learning, gambling, and many more) [9–14]. It can be divided into overplacement (relative overconfidence, believing you are better than others), overestimation (absolute overconfidence, believing you are better than tests show)[14], and overprecision (believing you know the truth).
Another related bias is the phenomenon of clinical tribalism. This in-group bias leads to the assumption that one`s own social group is superior to other groups, which affects team interaction and patient safety [15].
Motivation to learn can be described by the self-determination theory [16], which distinguishes between intrinsic motivation (“I want to learn POCUS”), identified regulation (“I need to learn POCUS because I am an emergency physician”), extrinsic motivation (“My supervisor wants me to learn something about POCUS”), and amotivation (“I do not want to learn about POCUS”). More specifically, Pellacia described three key motivators regarding medical education and training attendance [17]: benefit (“What do I get from the course?”), controllability (“Can I control the course?”), and self-efficacy (“Can I learn how I want to?”).
To date, there is little information on the correlation between learning motivation for POCUS and overconfidence effects that might influence learning motivation by inhibiting metacognition: the ability to think about thinking [18].
Previous projects conducted by our working group have identified overconfidence and clinical tribalism in various critical care competencies such as hand hygiene [19, 20], basic life support [21], management of the second victim phenomenon [22], and management of dysphagia [unpublished]. In these projects, we were able to identify three different types of learners [23]: motivated, confident, and competent “experts”, motivated but incompetent and overconfident “recruitables”, and unmotivated, incompetent, and overconfident “unawares”. The distinction between experts and unawares is consistent with the definition of a “Matthews effect” [24], with physicians that are interested in and frequently attend training don’t need it and physicians that require training don’t attend.
Objective
This study aims to assess the presence of overconfidence in POCUS in emergency medicine and its correlation with learning motivation measured by the Situational Motivation Scale (SIMS). We hypothesised that overconfidence effects are present (H1a for overplacement and H1b for overestimation) and correlate with learning motivation (H2). Furthermore, in line with previous studies, we hypothesise that physicians can be grouped into three distinct clusters of experts, recruitables, and unawares (H3).
This manuscript furthermore provides medical educators, supervisors, and curriculum developers with insights to improve their refresher training courses.