Tarasova, Natalia

Abstract Purpose The Optimizing Performance Through Intrinsic Motivation and Attention for Learning (OPTIMAL) theory postulates that directing attention to the intended movement effect or outcome (external focus) is more effective than directing attention to the internal body motion or body part (internal focus). This study compared external versus internal focus of attention as novice students learned ultrasound-guided peripheral cannulation. The authors hypothesized that conditions promoting an external (vs internal) focus of attention would result in better performance on immediate and delayed (retention) testing. Method The authors conducted a randomized, experimental study from October 2022 to February 2023 comparing external and internal focus using ultrasound-guided peripheral venous cannulation followed by practice using an ultrasound training block. Undergraduate health science students performed 4 practice trials with instructions to focus on the needle tip (external focus) or their hands (internal focus), followed by immediate and delayed (retention) assessment 2 weeks later. The primary outcome was time to successful cannulation. Results were compared using Kaplan-Meier curves and parametric survival analysis regression (accelerated failure time) models. Results Seventy participants completed the immediate assessment. The external focus group completed successful cannulation a mean of 2.33 times faster (95% confidence interval [CI], 1.47–3.67; P < .001) than those in the internal focus group (median time, 12.0 vs 29.5 seconds). Results also favored the external focus group during practice, with the external focus group successfully completing the task a mean of 1.83 times faster (95% CI, 1.04–3.21; P = .04) than the internal focus group. In the retention assessment, the external focus group successfully completed the task a mean of 2.37 times faster (95% CI, 1.19–4.74; P = .02) than the internal focus group. Conclusions External focus of attention compared with internal focus of attention improves medical motor skill learning in novice learners.

Objective: The novel ultrasound magnetic needle navigation technique can visualize the entire needle and identify its projected trajectory. We hypothesized that this technique increases the first-attempt success rate of central venous puncture by novice learners compared with the conventional needle navigation technique. Methods: This prospective, randomized, controlled trial with a crossover design included 50 participants with limited prior experience in US-guided procedures. Participants were randomly assigned to novel or conventional technique groups and asked to perform central venous cannulation in a phantom task trainer. After the first successful attempt, participants were allocated to the other technique group. Results: Although participants in the novel technique group had a higher first-attempt success rate than did those in the conventional technique group, this difference was not statistically significant ( p = 0.17). The total number of attempts also did not significantly differ ( p = 0.16). The conventional technique group had more needle redirections ( p = 0.01) and a longer time to successful cannulation ( p = 0.01). The number of adverse effects ( p = 0.32) did not differ between groups. Participant confidence levels were higher in the novel technique group ( p < 0.001). Conclusions: Magnetic needle navigation can reduce the number of needle redirections, shorten the time to successful cannulation, and increase confidence levels by novice learners for successful US-guided central venous access.