Expectation of Teaching and Self-Controlled KR in Motor Skills Acquisition: Are There Additive Effects?

Purpose: Recent evidence suggests learning a motor skill with the expectation of teaching it enhances motor learning. The mechanisms underlying this effect seem to be similar to those of another motor learning condition, the self-control of knowledge of results (KR). Considering the similarities between the mechanisms that underlie these conditions, we aimed to investigate the learning effects obtained through expected teaching and self-controlled conditions, and whether these effects would be additive. Methods: Participants practiced a dart-throwing task under one of the following conditions: a) expecting to teach the skill; b) controlling the KR request; c) combining the two previous conditions; and d) receiving KR in a yoked condition with self-controlled participants. In acquisition phase, motivational aspects, strategies for requesting KR and aspects related to the expectation of teaching were assessed according to each condition. Results: Participants with control over KR and/or with the expectation of teaching the skill showed superior learning of the task compared to the control condition. However, the combination of the experimental conditions did not result in additive learning benefits. Increased perceived competence was found in expecting to teach, self-controlled and combined conditions, compared to the yoked group. Additionally, expecting to teach also affected the way and the frequency learners requested KR. Conclusions: Our findings provide important insights toward understanding the effects of expecting to teach, in addition to demonstrating that expecting to teach affects self-controlled KR scheduling and its use during motor skill acquisition.

Optimizing Feedback Frequency in Motor Learning: Self-Controlled and Moderate Frequency KR Enhance Skill Acquisition.

The purpose of this study was to compare the relative effects of self-controlled knowledge of results (SCKR) to other KR schedules of varying relative frequency (25%, 50%, and 100% of acquisition trials) on motor skill learning. Participants received basic instructions on the soccer overhead throw and then performed 50 acquisition trials, during which KR was provided according to the assigned schedule, followed by a retention test, during which no KR was provided. Retention scores were highest for the SCKR and 50% KR frequency groups who shared comparable absolute KR frequency and distribution relative to successful versus unsuccessful trials. These results indicated that both self-control and moderate frequency feedback enhanced learning, supporting an inverted U-shaped effect of feedback frequency on skill acquisition.

Observational vs coaching feedback on non-dominant whole-body motor skill performance - application to technique training.

We studied the effect of peer- and self-observational feedback versus coaching feedback during technique training on performance in competitive adolescent cross-country skiers. Fifty-four skiers (14.3 ± 0.6 years) were divided into a control group and three intervention groups (dyad practice, video, or coaching feedback), which practiced in the asymmetrical uphill sub-technique G2 on one side (non-dominant side), but not the other (dominant side) for 6 × 30 min over a 5 weeks period, on roller skis outdoors. High-speed performance and skiing economy were assessed on a roller ski treadmill before and after the intervention, and a questionnaire was answered post-intervention. The video feedback (p = .025, d = .65) and coaching feedback (p = .007, d = .89) groups improved high-speed performance during the intervention and an ANCOVA showed a tendency for different change scores between interventions (F3,49  = 2.5, p = .068, η p 2  = .134), with a difference between the coaching feedback and dyad practice (p = .05). No change was seen in skiing economy in any group. Coaching feedback ranked higher on enjoyment compared with dyad practice (p < .001) and led to higher self-perception of improved technique compared with the control group (p = .038). Overall, feedback from a competent coach seems better than observation for improving performance in young athletes, although self-observation through video with attentional cues seems a promising tool for increasing individual feedback when coaching large groups.

The Effects of Manipulating Task Difficulty and Feedback Frequency on Children's Dart Throwing Accuracy and Consistency.

In the present study we investigated the effects of manipulating task difficulty (constant vs. progressive difficulty) and frequency of knowledge of results (KR) on the accuracy and consistency of children's performance of a novel fine motor coordination task (dart throwing). We assigned 69 right-handed physical education (PE) students (M age = 10.73, SD = 0.89 years) to progressive (PDG) or constant difficulty (CDG) groups. PDG and CDG were each split into three subgroups who received varying KR frequency (100%KR, 50%KR, and 33%KR), creating a total of six groups. We increased difficulty in the PDG by manipulating the distance to the target (2 m, 2.37 m, and 3.56 m), while distance to the target was constant for CDG throughout the experiment (2.37 m). We conducted performance assessments during familiarization (pre-test), acquisition (post-test), and retention (retention testing) learning phases under both normal condition (NC) and a time pressure condition (TPC). Repeated-measures analysis of variance revealed a significant effect of difficulty manipulation on skill learning under both NC and TPC. Further analyses revealed that skill learning was enhanced by progressive difficulty manipulation. However, learning was not affected by KR frequency changes. Progressive difficulty practice enhanced both accuracy and consistency, specifically at retention testing. These results suggest that motor learning in children may be enhanced by practicing with progressive increases in difficulty. PE teachers are encouraged to gradually introduce difficulty levels in motor learning tasks that require high accuracy.

Belief polarization in a complex world: A learning theory perspective.

We present two models of how people form beliefs that are based on machine learning theory. We illustrate how these models give insight into observed human phenomena by showing how polarized beliefs can arise even when people are exposed to almost identical sources of information. In our first model, people form beliefs that are deterministic functions that best fit their past data (training sets). In that model, their inability to form probabilistic beliefs can lead people to have opposing views even if their data are drawn from distributions that only slightly disagree. In the second model, people pay a cost that is increasing in the complexity of the function that represents their beliefs. In this second model, even with large training sets drawn from exactly the same distribution, agents can disagree substantially because they simplify the world along different dimensions. We discuss what these models of belief formation suggest for improving people's accuracy and agreement.

The influence of teacher-student proximity, teacher feedback, and near-seated peer groups on classroom engagement: An agent-based modeling approach.

Fostering students' classroom engagement is a research hotspot in classroom teaching management. Enhancing classroom engagement requires consideration of the interactive effects of physical and interpersonal environments. Considering the characteristics of physical space, the teacher gives feedback on student engagement in terms of different seating positions. Further, near-seated peer group engagement has an impact, though previous research has found this to be inconsistent. The teacher and near-seated peer groups have different paths of influence on classroom engagement, and there is interplay between them. However, based on realistic classroom scenarios, it is difficult for traditional research methods to reveal how spatially heterogeneous and non-linear micro-interactions among teachers, students, and near-seated peer groups evolve into dynamic changes in macro-classroom engagement. Hence, this study utilized agent-based simulation to explore the non-linear dynamic mechanism underlying how teacher-student proximity, teacher feedback, and near-seated peer groups affect classroom engagement, thereby shedding light on the evolutionary features of classroom engagement. According to the results, the teacher's positive feedback promoted an S-shaped increase in classroom engagement, and the closer a student sat to the teacher, the greater the increase was. The level and homogeneity of near-seated peer group engagement were predictors of changes in classroom engagement. Moreover, the proximity of students to the teacher, teacher feedback, and near-seated peer groups had a joint effect on student engagement. The compensation effect of the teacher's positive feedback on the impact of low-engagement, near-seated peer groups was weaker than that of highly engaged, near-seated peer groups on the effects of the teacher's negative feedback. This suggests that the model of teacher-student proximity and teacher feedback effects differed from that of near-seated peer group influence, and the two interacted and showed asymmetry.

Effect of Coach Feedback and Awareness of Head Impact Exposure on Practice Structure in Youth Football.

With the concern of concussion risk and repetitive head impacts in youth football, organizations have adopted rules that limit contact during practice. However, rule changes are not ubiquitous among organizations and are challenging to monitor and enforce. Ultimately, football practice activities are determined by coaches, but it is unknown whether providing objective data to coaches relating activities to their athletes' head impact exposure (HIE) would alter practice structure or help reduce HIE. This study evaluated the effect of coach awareness of HIE on practice structure over time. Head impact data from three intervention (56 players) and three control (38 players) teams were collected over two youth football seasons. Athletes were instrumented with the Head Impact Telemetry (HIT) System and time-synchronized video was recorded for practices and games. Impact frequencies and head accelerations were compiled into weekly HIE practice and game reports and shared with the head coach of each intervention team. Time per drill, impact rate, and impact magnitude were compared across three time frames (pre-season, mid-season, and late-season) using generalized linear models. Control teams had higher impact rates than intervention teams in all drills across time frames. Among all teams, 95th percentile linear and rotational accelerations were highest during mid-season. Among intervention teams, more time was spent on scrimmage and skill development from pre-season to late-season, with less time spent on tackling. This study suggests that receiving objective data informing HIE in practice may contribute to changes in practice structure and help inform intervention efforts to improve head impact safety in football.

Only Familiar Information is a "Curse": Children's Ability to Predict What Their Peers Know.

The ability to make inferences about what one's peers know is critical for social interaction and communication. Three experiments (n = 309) examined the curse of knowledge, the tendency to be biased by one's knowledge when reasoning about others' knowledge, in children's estimates of their peers' knowledge. Four- to 7-year-olds were taught the answers to factual questions and estimated how many peers would know the answers. When children learned familiar answers, they showed a curse of knowledge in their peer estimates. But, when children learned unfamiliar answers to the same questions, they did not show a curse of knowledge. These data shed light on the mechanisms underlying perspective taking, supporting a fluency misattribution account of the curse of knowledge.

Video-Based Guided Simulation without Peer or Expert Feedback is Not Enough: A Randomized Controlled Trial of Simulation-Based Training for Medical Students.

BACKGROUND: Feedback is a pivotal cornerstone and a challenge in psychomotor training. There are different teaching methodologies; however, some may be less effective. METHODS: A prospective randomized controlled trial was conducted in 130 medical students to compare the effectiveness of the video-guided learning (VLG), peer-feedback (PFG) and the expert feedback (EFG) for teaching suturing skills. The program lasted 4 weeks. Students were recorded making 3-simple stitches (pre-assessment and post-assessment). The primary outcome was a global scale (OSATS). The secondary outcomes were performance time, specific rating scale (SRS) and the impact of the intervention (IOI), defined as the variation between the final and initial OSATS and SRS scores. RESULTS: No significant differences were found between PFG and EFG in post-assessment results of OSATS, SRS scores or in the IOI for OSATS and SRS scores. Post-assessment results of PFG and EFG were significantly superior to VLG in OSATS and SRS scores [(19.8 (18.5-21); 16.6 (15.5-17.5)) and (20.3 (19.88-21); 16.8 (16-17.5)) vs (15.7 (15-16); 13.3 (12.5-14)) (p < 0.05)], respectively. The results of PFG and EFG were significantly superior to VLG in the IOI for OSATS [7 (4.5-9) and 7.4 (4.88-10) vs 3.5 (1.5-6) (p < 0.05)] and SRS scores [5.4 (3.5-7) and 6.3 (4-8.5) vs 3.1 (1.13-4.88) (p < 0.05)], respectively. CONCLUSION: The video-guided learning methodology without any kind of feedback is not enough for teaching suturing skills compared to expert or peer feedback. The peer feedback methodology appears to be a viable alternative to handling the emerging demands in medical education.

Intrasession Real-time Ultrasonography Feedback Improves the Quality of Transverse Abdominis Contraction.

OBJECTIVE: The purpose of this study was to compare changes in thickness of the transverse abdominis during performance of the hollowing exercise guided by feedback using ultrasonography images together with verbal guidance and using verbal guidance alone. We also determined the minimal detectable change and agreement between normalized pressures and muscle thickness. METHODS: Twenty participants without lumbar pain performed the hollowing exercises with or without ultrasonography feedback: 7 men and 13 women, mean (SD) age = 25 (5) years, height = 166 (10) cm, body mass = 64 (6) kg, body mass index = 22.2 (5.8) kg/m2. The thickness of the transverse abdominis was quantified during the exercise using musculoskeletal ultrasonography. Basal and 3 repetitions guided by an evaluator were performed. Pressure was determined using a lumbar cushion. Data were compared with a mixed-model analysis of variance and Bonferroni post hoc test (P < .05). Minimal detectable changes were identified and Bland-Altman analysis performed considering normalized thickness and pressure. RESULTS: Ultrasonography feedback resulted in larger thickness changes (P < .05). The lowest minimal detectable changes were achieved using ultrasonography feedback. Nonagreement was found between normalized thickness and pressure. CONCLUSION: Contraction of the transverse abdominis is improved using real-time ultrasonography together with verbal feedback. Low changes in muscle contraction estimated by thickness showed nonagreement with a pressure cushion.

A Survey of Perceptions of Surgical Trainees on Feedback During Training in West Africa.

BACKGROUND: Feedback has become an integral part of learning within the medical profession, particularly as training becomes more trainees'-centered. Feedback from the trainees about their training and trainers is essential for effective and high-quality training. The purpose of this survey was to evaluate trainees' perceptions on feedback on their postgraduate training and trainers in West Africa. METHODS: Cross-sectional self-administered written survey of junior and senior registrar attending the annual revision and update course of the West African College of Surgeons. Information sought included sociodemographic variables, perception on feedback, opportunity to give feedback, trainee-trainers relationship and their opinion on different aspects of the postgraduate program where they would like to give feedback. RESULTS: The response rate was 81.5% (66/81). Median age was 33 years. Sixty trainees (90.9%) were junior registrars. Sixty-four (97%) trainees would like to give feedback about their training and trainers. Only 18 (27.3%) trainees have had opportunity of giving feedback about their training. Most trainees (90.9%) would like to give feedback on patient care and learning environment; 89.4% would like to give feedback on their training curriculum and 87.9% would like to give feedback on their operating room experiences. Most trainees (81.8%) believed trainee feedback is of critical importance to training. With regard to trainees-trainer relationship, 39 (59.1%) trainees were either unsatisfied or reported just a fair relationship. CONCLUSIONS: This study has shown that many of the trainees lack opportunity of giving feedback on their training but considered feedback critical to their training. Trainees would like to give feedback on patient care, curriculum, learning environment and operative room experience. Trainee feedback should be encouraged in surgical training in West Africa.

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students.

THEORY: Self-regulated learning theory suggests that individualized learning plans can benefit medical trainees by providing a structured means of goal setting, self-monitoring, and self-evaluation. External feedback also plays an important role in affecting learner motivations, perceptions, and self-evaluations. Accordingly, having learners share individualized learning plans with preceptors might promote self-regulated learning by helping align the feedback they receive with their learning goals. Hypothesis: We hypothesized having medical students share individualized learning plans with attendings and residents would improve the quality of the feedback they received, increase the likelihood that feedback correlated to their learning goals, and improve their perceptions of feedback received. Method: In this multisite study, third-year medical students on their pediatric clerkship created individualized learning plans and shared them with residents and attendings by writing a learning goal on at least one of their required faculty feedback forms. The quality of feedback on forms with versus without a learning goal written on top was scored using a validated scoring tool and compared using a Wilcoxon signed-ranks test, and the frequency with which feedback directly correlated to a student learning goal on forms with versus without a learning goal written on top was compared using a chi-square test. Students completed a post-clerkship survey rating the quality of feedback and teaching they received, perceptions of the individualized learning plans, progress toward achieving learning goals, and whether or not they received teaching and/or feedback related to learning goals. Results: Thirty-six students completed a total of 108 learning goals and 181 feedback forms, of which 42 forms (23.2%) had a learning goal written on top. The mean (SD) feedback score between forms with [3.9 (0.9)] versus without [3.6 (0.6)] a learning goal written on top was not different (p = .113). Feedback on forms with a learning goal written on top was more likely to correlate to a student learning goal than feedback on forms without a learning goal (92.9% vs 23.0% respectively, p < .001). Student perceptions of the usefulness of learning goals did not differ between students who reported receiving teaching or feedback related to a learning goal and those who did not. Conclusions: Sharing individualized learning plans with preceptors helped align feedback with learning goals but did not affect the quality of feedback. Further research should examine the bidirectional relationship between individualized learning plans and feedback in light of other contextual and interpersonal factors.

Students tell us what good written feedback looks like.

Feedback can be an important element of learning, but only if students engage with it. Students are only likely to engage with feedback that they find useful. This study aimed to identify characteristics of written feedback perceived by students as effective. We used a mixed-method approach, integrating quantitative and qualitative data that were collected through the analysis of feedback that was identified by students as good, a student questionnaire, as well as interviews and a focus group exploring students' views on what good feedback looks like. Although the results show that length and composition of 'good' feedback can be extremely variable, some common characteristics could be identified, leading to a set of recommendations for staff marking written assessments. According to students, good feedback should be detailed and specific, and it should tell students how they can improve. Students also find it important that feedback is honest and constructive. In addition, positive reinforcement was identified as important by the focus group, although few examples of good written feedback on the assignment contained any direct praise. Surprisingly, feedforward which might help students in other modules did not feature highly in students' perceptions of good feedback, possibly indicating a focus by students on improving the current assignment rather than on future assignments.

Progress monitoring and feedback delivered in routine psychiatric care: Beneficial but not reaching those thought to need it most.

Objective: The study evaluated the use and effectiveness of a progress monitoring system routinely operational in a private mental health care setting. Method: In a nonrandomized trial in which 778 consecutively admitted patients underwent a 2-week cognitive behavioral therapy intervention, the effectiveness of therapists choosing to use progress monitoring feedback to frame therapist-patient discussions about individuals' progress was evaluated. Results: Patients engaged in discussions involving progress monitoring feedback during the intervention achieved a more consistent recovery rate. Furthermore, individuals that were not-on-track to achieve a positive outcome experienced a boost to recovery immediately after receiving feedback. However, evidence suggested that therapists were not using progress monitoring to primarily focus additional resources on not-on-track patients. Conclusion: Progress monitoring feedback benefited patient recovery. However, guidelines could improve the system by directing therapists to use feedback primarily with patients not on course for a positive therapeutic outcome.

The effect of real-time feedback on learning lumbar spine joint mobilization by entry-level doctor of physical therapy students: a randomized, controlled, crossover trial.

OBJECTIVE: To examine the effects of real-time, objective feedback on learning lumbar spine joint mobilization techniques by entry-level Doctor of Physical Therapy (DPT) students. METHODS: A randomized, controlled, crossover design was used. Twenty-four 1st Year DPT students were randomized into two groups. Group 1 (n = 12) practiced with the real-time feedback device first and then without it, while Group 2 (n = 12) practiced without the device first and then with it. Both practice periods with and without the device were 4 weeks long. Data were collected at Baseline, 5 weeks, 11 weeks, and 16 weeks. The crossover period was 5 weeks long, during which neither group practiced with or without the device. Eight force parameters were measured: R1 force; R2 force; Grade III and Grade IV mean peak force, frequency, and amplitude. RESULTS: When students practiced with the real-time feedback device, they more closely matched the reference standard for two outcomes: 1) the mean difference in R2 force between student and reference standard was better with device (38.0 ± 26.7 N) than without it (51.0 ± 38.5 N); P = .013; and 2) the mean difference in Grade III peak to peak amplitude force was also better with device (8.9 ± 9.3 N) than without it (11.8 ± 11.0); P = .026. All other force parameters improved when students practiced with the real-time feedback device, however, the differences between when they practiced without the device were not statistically significant. DISCUSSION: Real-time, objective feedback using a direct force measurement device improved learning for some aspects of lumbar spine joint mobilization by entry-level physical therapy students. LEVEL OF EVIDENCE: 2b.

Increased cognitive load during acquisition of a continuous task eliminates the learning effects of self-controlled knowledge of results.

Previous research has demonstrated that providing learners with self-control over some aspect of practice enhances motor learning (for a review see Wulf, 2007). One explanation for the self-control effect is that learners engage in deeper information processing when they are allowed to make choices during practice. Recent research has supported this line of thinking by showing that the self-control effect was eliminated for learners who engaged in a cognitive load task during the interval following completion of discrete task trials (Carter & Ste-Marie, 2017). The current study tested the effects of imposing a cognitive load task during the completion of continuous task trials. Participants (N = 48) were divided into self-control (SC), self-control with load (SCL), and two corresponding yoked (YK, YKL) groups. Participants learned a continuous tracing task and then performed 24-hour retention and transfer tests. Retention and transfer test movement times were significantly faster for SC compared to YK participants within the No Load condition but did not differ between these participants within the Load condition. Errors were similar among all groups in retention and transfer. These results provide support for the importance of information processing in regards to the self-controlled learning benefit.

Feedback based simulator training reduces superfluous forces exerted by novice residents practicing knot tying for vessel ligation.

BACKGROUND: Technological advances have led to the development of state-of-the-art simulators for training surgeons; few train basic surgical skills, such as vessel ligation. METHODS: A novel low-cost bench-top simulator with auditory and visual feedback that measures forces exerted during knot tying was tested on 14 surgical residents. Pre- and post-training values for total force exerted during knot tying, maximum pulling and pushing forces and completion time were compared. RESULTS: Mean time to reach proficiency during training was 11:26 min, with a mean of 15 consecutive knots. Mean total applied force for each knot were 35% lower post-training than pre-training (7.5 vs. 11.54 N (N), respectively, p = 0.039). Mean upward peak force was significantly lower after, compared to before, training (1.29 vs. 2.12 N, respectively, p = 0.004). CONCLUSIONS: Simulator training with visual and auditory force feedback improves knot-tying skills of novice surgeons.

Facilitating action planning within audit and feedback interventions: a mixed-methods process evaluation of an action implementation toolbox in intensive care.

BACKGROUND: Audit and feedback (A&F) is more effective if it facilitates action planning, but little is known about how best to do this. We developed an electronic A&F intervention with an action implementation toolbox to improve pain management in intensive care units (ICUs); the toolbox contained suggested actions for improvement. A head-to-head randomised trial demonstrated that the toolbox moderately increased the intervention's effectiveness when compared with A&F only. OBJECTIVE: To understand the mechanisms through which A&F with action implementation toolbox facilitates action planning by ICUs to increase A&F effectiveness. METHODS: We extracted all individual actions from action plans developed by ICUs that received A&F with (n = 10) and without (n = 11) toolbox for 6 months and classified them using Clinical Performance Feedback Intervention Theory. We held semi-structured interviews with participants during the trial. We compared the number and type of planned and completed actions between study groups and explored barriers and facilitators to effective action planning. RESULTS: ICUs with toolbox planned more actions directly aimed at improving practice (p = 0.037) and targeted a wider range of practice determinants compared to ICUs without toolbox. ICUs with toolbox also completed more actions during the study period, but not significantly (p = 0.142). ICUs without toolbox reported more difficulties in identifying what actions they could take. Regardless of the toolbox, all ICUs still experienced barriers relating to the feedback (low controllability, accuracy) and organisational context (competing priorities, resources, cost). CONCLUSIONS: The toolbox helped health professionals to broaden their mindset about actions they could take to change clinical practice. Without the toolbox, professionals tended to focus more on feedback verification and exploring solutions without developing intentions for actual change. All feedback recipients experienced organisational barriers that inhibited eventual completion of actions. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02922101 . Registered on 26 September 2016.