JOURNAL OF NEUROSCIENCE AND NEUROSURGERY (ISSN:2517-7400)

Needs-specific goal setting is a key tool used in high-performing organizations, such asworld-class athletes and professionals, to maximize performance and the probability of achieving a desired goal or success criteria [1]. As with elite athletes, medical students have a huge volume of components to internalize and perfect to perform clinical procedures and examinations to a proficient standard. An emerging area of professional career development is the use of goal-setting using computer software [2,3]. This project investigates the potential benefits of implementing of goal setting software in the clinical skills setting to increase medical students’ performance in Objective Structured Clinical Examinations (OSCEs).

Goal setting aids the identification of components that underpin success in a given skill. Knowing the progress in each of these components and the relative priority for their improvement is crucial to allow forward progress of the skill in question, as per the ‘SMART’ goal-setting process [4]. In addition to an objective measure of performance, goalsetting increases self-awareness of the priorities needed for success [5]. The mere act of evaluating performance can also have positive benefits, as per the Hawthorne effect [6,7]. Furthermore, mapping progress objectively using goal-setting techniques has a positive effect on motivation to improve further [8]. Despite such suggested benefits of implementation, no robust goal setting method used by medical students to improve performance exists in the current literature [9].

The software used in this study was Goalscape^TM, a goal setting software programme developed by the German Olympic sailing team that in recent years has been released into the public domain. The software uses a multi-level pie chart display involving a central, ultimate goal (Figure 1). The user can break this goal down into an infinite number of ‘subgoals’ that together constitute the components required to achieve the ultimate goal (Figure 2). Subgoals can also be broken down into further, infinite levels of detail in order to allow the user to target improvement interventions on small, detailed, measurable components (Figure 3) that when aggregated together, contribute significantly to the cumulative achievement towards the central ultimate goal. The software allows effective visualization of priorities and progress for each subgoal, thus allowing the user to direct revision priority to the components of most importance. In complex systems that require high levels of competency in each component (such as clinical skills training in medical undergraduates), priorities can often become unclear due to the sheer number of components involved in the skills they must master. The use of goal setting software clarifies the respective priorities of components so that the user can adopt a methodical approach to improvement that is both goal-specific and time-effective [10]. By changing the priority of subgoals on the software, the percentage area of the pie chart each subgoal corresponds to can be changed. The progress of each sub goal can be changed and logged by the user, and the overall accumulation of progress towards the ultimate goal can be measured.

Ethical approval for the study was granted by the University of Dundee Research Ethics Committee (UREC). The study followed an RCT design, whereby 42 medical students in their third year at Dundee Medical School undertook a mock Neurology OSCE station (cerebellar examination, total 12 marks). Fourteen days prior to the OSCE, students were randomly allocated into two groups. Group 1 was given Goalscape^TM software with a present template designed by Dundee neurologists to help direct study focus. Group 2 used traditional study methods. The difference in mock OSCE score between group 1 and 2 was compared by student t-test using SPSS 22. A questionnaire evaluating students’ perceptions of goal setting was given to participants in Group 1 after completing the OSCE station (Figure 4).

The OSCE scores (mean, median [SD, IQR]) were 10.26, 10.00 [1.28, 1.50] in the software group and 9.59, 10.00 [1.56, 2.00] in the non-software group (p= 0.186, Mann Whitney U Test) (Figure 5). Questionnaire feedback from students revealed a mean participantreported score of 7.00 and 6.67 on a 0-10 analogue scale when students were asked ‘How useful is Goalscape^TM for visualising components on neurology clinical skills?’ and ‘How useful is goalsetting to medical students?’ respectively (Table 1, Figure 6,7).