The effect of assessments on student motivation for learning and its outcomes in health professions education: A review

Purpose: In health professions education (HPE) the effect of assessments on student motivation for learning and its consequences have been largely neglected. This is problematic because assessments can hamper motivation and psychological well-being. The research questions guiding this review were: How do assessments affect student motivation for learning in HPE? What outcomes does this lead to in which contexts? Method: In October 2020, the authors searched PubMed, Embase, APA PsycInfo, ERIC, CINAHL, and Web of Science Core Collection for “assessments” AND “motivation” AND “health professions education/students.” Empirical papers or literature reviews investigating the effect of assessments on student motivation for learning in HPE using quantitative, qualitative, or mixed methods from January 1, 2010–October 29, 2020, were included. The authors chose the realist synthesis method for data analysis to study the intended and unintended consequences of this complex topic. Assessments were identified as stimulating autonomous or controlled motivation using sensitizing concepts from self-determination theory and data on context-mechanism-outcome were extracted. Results: Twenty-four of 15,291 articles were ultimately included. Assessments stimulating controlled motivation seemed to have negative outcomes. An example of an assessment that stimulates controlled motivation is one that focuses on factual knowledge (context), which encourages studying only for the assessment (mechanism) and results in surface learning (outcome). Assessments stimulating autonomous motivation seemed to have positive outcomes. An example of an assessment that stimulates autonomous motivation is one that is fun (context), which through active learning (mechanism) leads to higher effort and better connection with the material (outcome). Conclusions: These findings indicate that students strategically learned what was expected to appear in assessments at the expense of what was needed in practice. Therefore, health professions educators should rethink their assessment philosophy and practices and introduce assessments that are relevant to professional practice and stimulate genuine interest in the content

Exploring implications of context specificity and cognitive load in residents

Introduction: Context specificity (CS) refers to the variability in clinical reasoning across different presentations of the same diagnosis. Cognitive load (CL) refers to limitations in working memory that may impact clinicians’ clinical reasoning. CL might be one of the factors that lead to CS. Although CL during clinical reasoning would be expected to be higher in internal medicine residents, CL’s effect on CS in residents has not been studied. Methods: Internal medicine residents watched a series of three cases portrayed on videos. Following each case, participants filled out a post-encounter form and completed a validated measure of CL. Results: Fourteen residents completed all three cases. Across cases, self-reported CL was relatively high and there were small to moderate correlations between CL and performance in clinical reasoning (r’s = .43, -.33, -.23). In terms of changing CL across cases, the correlations between change in CL and change in total performance were statistically significantly only in moving from case 1 to case 2 (r = -.54, p =.05). Discussion and Conclusion: Residents self-reported measurements of CL were relatively high across cases. However, higher CL was not consistently associated with poorer performance. We did observe the expected associations when looking at case-to-case change in CL. This relationship warrants further study

Contextual factors and clinical reasoning: differences in diagnostic and therapeutic reasoning in board certified versus resident physicians

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background The impact of context on the complex process of clinical reasoning is not well understood. Using situated cognition as the theoretical framework and videos to provide the same contextual “stimulus” to all participants, we examined the relationship between specific contextual factors on diagnostic and therapeutic reasoning accuracy in board certified internists versus resident physicians. Methods Each participant viewed three videotaped clinical encounters portraying common diagnoses in internal medicine. We explicitly modified the context to assess its impact on performance (patient and physician contextual factors). Patient contextual factors, including English as a second language and emotional volatility, were portrayed in the videos. Physician participant contextual factors were self-rated sleepiness and burnout.. The accuracy of diagnostic and therapeutic reasoning was compared with covariates using Fisher Exact, Mann-Whitney U tests and Spearman Rho’s correlations as appropriate. Results Fifteen board certified internists and 10 resident physicians participated from 2013 to 2014. Accuracy of diagnostic and therapeutic reasoning did not differ between groups despite residents reporting significantly higher rates of sleepiness (mean rank 20.45 vs 8.03, U = 0.5, p < .001) and burnout (mean rank 20.50 vs 8.00, U = 0.0, p < .001). Accuracy of diagnosis and treatment were uncorrelated (r = 0.17, p = .65). In both groups, the proportion scoring correct responses for treatment was higher than the proportion scoring correct responses for diagnosis. Conclusions This study underscores that specific contextual factors appear to impact clinical reasoning performance. Further, the processes of diagnostic and therapeutic reasoning, although related, may not be interchangeable. This raises important questions about the impact that contextual factors have on clinical reasoning and provides insight into how clinical reasoning processes in more authentic settings may be explained by situated cognition theory

Relationship between clinical experiences and internal medicine clerkship performance

This study was conducted to assess the associations between several clerkship process measures and students' clinical and examination performance in an internal medicine clerkship.We collected data from the internal medicine clerkship at one institution over a 3-year period (classes of 2010-2012; n = 507) and conducted correlation and multiple regression analyses. We examined the associations between clerkship process measures (student-reported number of patients evaluated, percentage of core problems encountered, total number of core problems encountered, total number of clinics attended) and four clerkship outcomes (clinical points [a weighted summation of a student's clinical grade recommendations], ambulatory clinical points [the out-patient portion of clinical points], examination points [a weighted summation of scores on three clerkship examinations], and National Board of Medical Examiners examination score).After controlling for pre-clerkship ability and gender, percentage of core problems was significantly associated with ambulatory clinical points (b = 3.84, total model R(2) = 0.14). Further, number of patients evaluated was significantly associated with clinical points (b = 0.19, total model R(2) = 0.22), but only for students who undertook first-quarter clerkships, who reported higher numbers of patients.Notwithstanding a few positive (but small) associations, the results from this study suggest that clinical exposure is, at best, weakly associated with internal medicine clerkship performance.? Blackwell Publishing Ltd 2012

Medical Teacher How to write an educational research grant: AMEE Guide No. 101 How to write an educational research grant: AMEE Guide No. 101

Abstract Writing an educational research grant in health profession education is challenging, not only for those doing it for the first time but also for more experienced scholars. The intensity of the competition, the peculiarities of the grant format, the risk of rejection, and the time required are among the many obstacles that can prevent educational researchers with interesting and important ideas from writing a grant, that could provide the funding needed to turn their scholarly ideas into reality. The aim of this AMEE Guide is to clarify the grant-writing process by (a) explaining the mechanics and structure of a typical educational research grant proposal, and (b) sharing tips and strategies for making the process more manageable