Speaking up behavior and cognitive bias in hand hygiene: Competences of German-speaking medical students

Introduction Infection prevention and speaking up on errors are core qualities of health care providers. Heuristic effects (e.g. overconfidence) may impair behavior in daily routine, while speaking up can be inhibited by hierarchical barriers and medical team factors. Aim of this investigation was to determine, how medical students experience these difficulties for hand hygiene in daily routine. Methods On the base of prior investigations we developed a questionnaire with 5-point Likert ordinal scaled items and free text entries. This was tested for validity and reliability (Cronbach's Alpha 0.89). Accredited German, Swiss and Austrian universities were contacted and medical students asked to participated in the anonymous online survey. Quantitative statistics used parametric and non-parametric tests and effect size calculations according to Lakens. Qualitative data was coded according to Janesick. Results 1042 undergraduates of 12 universities participated. All rated their capabilities in hand hygiene and feedback reception higher than those of fellow students, nurses and physicians (p<0.001). Half of the participants rating themselves to be best educated, realized that faulty hand hygiene can be of lethal effect. Findings were independent from age, sex, academic course and university. Speaking-up in case of omitted hand hygiene was rated to be done seldomly and most rare on persons of higher hierarchic levels. Qualitative results of 164 entries showed four main themes: 1) Education methods in hand hygiene are insufficient, 2) Hierarchy barriers impair constructive work place culture 3) Hygiene and feedback are linked to medical ethics and 4) There is no consequence for breaking hygiene rules. Discussion Although partially limited by the selection bias, this study confirms the overconfidence-effects demonstrated in post-graduates in other settings and different professions. The independence from study progress suggests, that the effect occurs before start of the academic course with need for educational intervention at the very beginning. Qualitative data showed that used methods are insufficient and contradictory work place behavior in hospitals are frustrating. Even 20 years after "To err is human", work place culture still is far away from the desirable

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

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&rsquo;s own and others&rsquo; 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) &ldquo;experts&rdquo; (n1 = 43) with excellent knowledge and justifiable confidence in their proficiencies but still motivated for ongoing training, and (2) &ldquo;recruitables&rdquo; (n2 = 43) who are less competent with mild overconfidence and higher motivation to attend training, and (3) &ldquo;unawares&rdquo; (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&rsquo;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&rsquo;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