Different Goals, Different Pathways: The Role of Metacognition and Task Engagement in Surgical Skill Acquisition

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.