Correlation between Overconfidence and Learning Motivation in Postgraduate Infection Prevention and Control Training

Abstract

Introduction: Training in hand hygiene for health care workers is essential to reduce hospital-acquired infections. Unfortunately, training in this competency may be perceived as tedious, time-consuming, and expendable. In preceding studies, our working group detected overconfidence effects in the self-assessment of hand hygiene competencies. Overconfidence is the belief of being better than others (overplacement) or being better than tests reveal (overestimation). The belief that members of their profession are better than other professionals is attributable to the clinical tribalism phenomenon. The study aimed to assess the correlation of overconfidence effects on hand hygiene and their association with four motivational dimensions (intrinsic, identified, external, and amotivation) to attend hand hygiene training. Methods: We conducted an open online convenience sampling survey with 103 health care professionals (physicians, nurses, and paramedics) in German, combining previously validated questionnaires for (a) overconfidence in hand hygiene and (b) learning motivation assessments. Statistics included parametric, nonparametric, and cluster analyses. Results: We detected a quadratic, u-shaped correlation between learning motivation and the assessments of one’s own and others’ competencies. The results of the quadratic regressions with overplacement and its quadratic term as predictors indicated that the model explained 7% of the variance of amotivation (R2 = 0.07; F(2, 100) = 3.94; p = 0.02). Similarly, the quadratic model of clinical tribalism for nurses in comparison to physicians and its quadratic term explained 18% of the variance of amotivation (R2 = 0.18; F(2, 48) = 5.30; p = 0.01). Cluster analysis revealed three distinct groups of participants: (1) “experts” (n1 = 43) with excellent knowledge and justifiable confidence in their proficiencies but still motivated for ongoing training, and (2) “recruitables” (n2 = 43) who are less competent with mild overconfidence and higher motivation to attend training, and (3) “unawares” (n3 = 17) being highly overconfident, incompetent (especially in assessing risks for incorrect and omitted hand hygiene), and lacking motivation for training. Discussion: We were able to show that a highly rated self-assessment, which was justified (confident) or unjustified (overconfident), does not necessarily correlate with a low motivation to learn. However, the expert’s learning motivation stayed high. Overconfident persons could be divided into two groups: motivated for training (recruitable) or not (unaware). These findings are consistent with prior studies on overconfidence in medical and non-medical contexts. Regarding the study’s limitations (sample size and convenience sampling), our findings indicate a need for further research in the closed populations of health care providers on training motivation in hand hygiene.

Self-Assessment and Learning Motivation in the Second Victim Phenomenon

“…This is contrary to our prior findings for hand hygiene [ 36 ] and basic life support [unpublished] using the same instruments and statistical analyses. However, the differences in rating oneself and others in SVP are much lower than for hand hygiene [ 23 ] as a very common and likely easier task than dealing with a complex psychological entity most physicians are not trained for. This can also be seen in the cluster analysis: Although we were able to confirm the three groups as in hand hygiene and in BLS, the differences between the groups were smaller compared to the preceding studies.…”

“…We designed and conducted a cross-sectional anonymous online examination in the German language on overconfidence and learning motivation. The instrument is based on prior investigations with the use of validated surveys on overconfidence and learning motivation in hand hygiene [ 23 ] and two not yet published studies on basic life support and dysphagia competencies.…”

“…Statistics were conducted according to the preceding study [ 23 ] using Pearson’s product-moment correlation matrix, the paired sample t -test and quadratic regressions with bootstrapping (95% confidence interval, based on 1000 samples). In addition, we performed two-step cluster analysis for the estimation of learning motivational groups.…”

“…Maximum credible risk to HCW, which can be caused by SVP, was added as a categorical variable in the analysis. The differentiation of the three patterns was conducted the same way as in our first study [ 23 ] to reveal if the different learning and motivational types are present in the sample. In addition, we compared the proposed cluster solution with the three cluster structures obtained in our previous studies: 1. confident experts (passing the tests), 2. overconfident recruitables (overconfident, motivated, but failing the tests) and unawares (overconfident, unmotivated and failing the tests).…”

“…In the last study on hand hygiene [ 23 ] and basic life support (BLS, unpublished), we identified three types of learning motivation [ 23 ]: “Experts” with justifiable confidence in their abilities, high competence and high learning motivation, “Recruitables” being overconfident and less competent but motivated and “Unawares” showed to be overconfident, less competent and not motivated to learn.…”