Impact of Flawed Self-Assessment on Learning Motivation in Emergency Point-of- Care Ultrasound

Abstract Introduction: Learning motivation is essential to obtain and maintain ultrasound competencies in emergency medicine. Where refresher training is not mandatory, self-assessment is required to evaluate one’s competencies and the need for further training. This can be flawed by overconfidence effects, which inhibits learners´ metacognition and possibly learning motivation. Methods: In this cross-sectional multicentre project, we presented eight ultrasound loops of different pathologies to emergency physicians of different specialities. In addition, the physicians assessed their own and others’ competence and learning motivation using the Situational Motivation Scale comprising intrinsic motivation, external and identified regulation, and amotivation. Results: We were unable to detect generalized overconfidence effects in 86 physicians. However, the subgroup analysis revealed that some specialist physicians with completed training were overconfident, while those still in training were not. Overplacement negatively correlated with intrinsic learning motivation and identified regulation and positively correlated to amotivation. Further analyses revealed that learning motivation was associated with the interactions of the physicians’ risk perception, speciality, and self-assessment. Discussions Our results show that some overconfidence effects are present even in the advanced skill of emergency ultrasound. However, an absence of feedback can lead to a misjudgement of own competencies and even reduce their willingness to participate in training. Particularly trainers and experts whose skills are not further assessed could pose a risk to the patient as they may overconfidently train learners incorrectly. Therefore, lifelong training in emergency ultrasound should include ongoing expert training to avoid misconceptions and ensure patient safety.