Critical review: medical students' motivation after failure

Persistence as a mediator between motivation and performance accomplishment among medical students: a mixed method approach

This study examined the relationship between motivation, performance accomplishment, and persistence as a mediator among medical students. Quantitative and qualitative data were collected through a two-stage sequential design to investigate the hypothesised model. A sample of 645 medical undergraduates participated in the quantitative stage, responding to an electronically structured questionnaire. Confirmatory factor analysis and structural equation modelling were utilised to analyse the data and assess the fit of the conceptual model. In the qualitative stage, semi-structured interviews were conducted with a purposeful sample of twelve medical students, and thematic analysis was employed to explore the qualitative findings. The results indicated a well-fitting model, with significant positive relationships observed among motivation, persistence, and performance accomplishment. Notably, including persistence as a mediator reinforced the relationship between motivation and performance achievement. The qualitative data supported and further emphasised the importance of persistence in the medical student population. The findings have practical implications for medical students, educators, and universities, highlighting the significance of promoting and enhancing learners' persistence. Suggestions for future research include developing additional statistical models, conducting experimental studies, and undertaking longitudinal investigations. By expanding the understanding of the relationships between motivation, persistence, and performance accomplishment, future studies can contribute to developing effective interventions and strategies to support medical students in their educational journey.

Conscientious, competent and caring: producing the junior doctor of the future

This article is based on the Association for the Study of Medical Education Gold Medal Plenary for 2022, given by the first author. It outlines different ways in which medical training can be approached, based on his career and his work with colleagues. Among the attributes that it would be desirable to promote in future doctors are conscientiousness, competence and care for patients as individuals. This article explores each of these in separate sections. The first demonstrates that the trait of conscientiousness can be observed in first and second year medical students by their compliance in routine low level tasks such as attendance and submission of required work on time. A 'conscientiousness index' calculated on this basis is a statistically significant predictor of later events such as performance in exams, the prescribing safety assessment, and the UK situational judgement test in subsequent years, and also in postgraduate assessments such as Royal college exams and the annual reviews of competence progression. The second proposes that competence in tasks undertaken by junior doctors is better achieved by teaching on medical imaging, clinical skills and living anatomy than by cadaveric dissection. The final section argues that the incorporation of arts and humanities teaching into medical education is likely to lead to better understanding of the patient perspective in later practice.

Educational Videos Versus Question Banks: Maximizing Medical Student Performance on the United States Medical Licensing Examination Step 1 Exam

Objective The aim of this research was to determine if medical students' use of the active study strategy of working practice questions is associated with improved performance on the United States Medical Licensing Examination (USMLE) Step 1 exam when compared to students who used the passive study strategy of watching educational videos. Methods The study used a correlational design. Participants were students from two cohorts in a United States medical school (N=164 and N=163) who completed their first two years and took the USMLE Step 1 exam. Data collected retrospectively included the number of practice questions completed, educational videos watched, Step 1 exam scores, average scores on in-class exams, and scores on the Medical College Admission Test (MCAT). Results The number of videos watched was negatively and significantly correlated with the Step 1 score for cohort 2022 (r= -0.294, α=0.01) and cohort 2023 (r= -0.175, α=0.05). The number of practice questions worked was positively and significantly correlated with the Step 1 score for cohort 2022 (r=0.176, α=0.05) and cohort 2023 (r=0.143 though not significant). The number of practice questions was a significant positive predictor of Step 1 score for cohort 2022 (β=0.141, p=0.017) and cohort 2023 (β=0.133, p=0.015). Videos were significant negative predictors for cohort 2023 (β= -0.118, p=0.034). Conclusions Answering practice questions appears to be a more effective study method than passively watching videos. Though other studies have supported the use of active learning methods, this study is unique in finding a negative correlation between test scores and the number of educational videos watched. Medical students should be urged to make the most effective use of study time by incorporating working practice questions and limiting watching educational videos.

Twelve tips for medical students experiencing an interruption in their academic progress

For every commencing cohort of medical students, a small but significant number will experience an interruption to their academic progression because of academic difficulties, health concerns or external influences outside of the students' control. During the process of researching the factors surrounding difficulties with academic progression, students told us many ways that they have learned from that experience, which then allowed most of them to graduate. This paper combines the shared experiences of students who have had an interruption, and those of the authors as medical educators.

Ambivalent professional identity of early remedial medical students from Generation Z: a qualitative study

BACKGROUND

Supporting professional identity development in medical students undergoing remediation in the first few years of their studies is an important topic. However, there is a lack of research on developing an effective and individualised process for successful remediation that targets learner identities. This study examined the identities of Generation Z remedial medical students through the lens of professional identity formation, focusing on the difficulties they faced and the support they sought.

METHODS

An exploratory qualitative case study was conducted within a constructivist paradigm. Twenty-two medical students (14 males and 8 females) who had experienced remediation in their first few years of medical university participated in this study. All participants were members of Generation Z. Qualitative data were collected through face-to-face, semi-structured interviews and analysed using thematic analysis.

RESULTS

Medical students undergoing remediation in the first few years experienced resistance to the medical profession and conflict due to the gap between the ideal and the reality they experienced after entering medical university. Students' professional identities were closely intertwined with their pre-university identities; this affected the process of professional identity formation after entering medical university. They preferred assurances of confidentiality as a prerequisite and immediately sought advice through social networks to support their professional identity development.

CONCLUSIONS

When planning professional identity development support for Generation Z medical students undergoing remediation in the first few years, it is necessary to carefully select integrative interaction methods, focus on the context of individual learners, and collaboratively discuss specific responses between students and faculty. The results of this study could be useful to faculty in developing support systems for future remedial medical students that focuses on professional identity development and mentoring of remedial medical students.

Emotion in remediation: A scoping review of the medical education literature

OBJECTIVES

Remediation can be crucial and high stakes for medical learners, and experts agree it is often not optimally conducted. Research from other fields indicates that explicit incorporation of emotion improves education because of emotion's documented impacts on learning. Because this could present an important opportunity for improving remediation, we aimed to investigate how the literature on remediation interventions in medical education discusses emotion.

METHODS

The authors used Arksey and O'Malley's framework to conduct a scoping literature review of records describing remediation interventions in medical education, using PubMed, CINAHL Complete, ERIC, Web of Science and APA PsycInfo databases, including all English-language publications through 1 May 2020 meeting search criteria. They included publications discussing remediation interventions either empirically or theoretically, pertaining to physicians or physician trainees of any level. Two independent reviewers used a standardised data extraction form to report descriptive information; they reviewed included records for the presence of mentions of emotion, described the mentions and analysed results thematically.

RESULTS

Of 1644 records, 199 met inclusion criteria and were reviewed in full. Of those, 112 (56%) mentioned emotion in some way; others focused solely on cognitive aspects of remediation. The mentions of emotion fell into three themes based on when the emotion was cited as present: during regular coursework or practice, upon referral for remediation and during remediation. One-quarter of records (50) indicated potential intentional incorporation of emotion into remediation programme design, but they were non-specific as to how emotions related to the learning process itself.

CONCLUSION

Even though emotion is omnipresent in remediation, medical educators frequently do not factor emotion into the design of remediation approaches and rarely explicitly utilise emotion to improve the learning process. Applications from other fields may help medical educators leverage emotion to improve learning in remediation, including strategies to frame and design remediation.

Final-year medical students' competence profiles according to the modified requirement tracking questionnaire

BACKGROUND

Undergraduate medical education is supposed to equip medical students with basic competences to select any specialty of their choice for postgraduate training. Medical specialties are characterized by a great diversity of their daily work routines and require different sets of competence facets. This study examines the self-assessed competence profiles of final-year undergraduate medical students and their specialty choice for postgraduate training. Students' profiles, who wish to choose anaesthesiology, internal medicine, or paediatrics, are compared with the physicians' competence profiles from these three disciplines.

METHODS

In this study, 148 volunteer final-year undergraduate medical students completed the modified requirement-tracking (R-Track) questionnaire for self-assessment of their competence profiles. The R-Track questionnaire contains 63 competence facets assigned to six areas of competence: "Mental abilities", "Sensory abilities", "Psychomotor & multitasking abilities", "Social interactive competences", "Motivation", and "Personality traits". The expression of the different competence facets had to be assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Additionally, socio-demographic data and the participants' first choice of a medical speciality for postgraduate education were collected. We used analysis of variance (ANOVA) for mean score comparison of subgroups and least significant difference (LSD) tests for post hoc analysis.

RESULTS

The competence area with the highest rating was "Motivation" (3.70 ± 0.47) while "Psychomotor & multitasking abilities" received the lowest rating (3.34 ± 0.68). Individual facets of competence ranked from "In need of harmony" (4.36 ± 0.72), followed by "Tactfulness" (4.26 ± 0.64), and "Cooperation/Agreeableness" (4.24 ± 0.53) to "Risk orientation" (2.90 ± 0.92), "Mathematical reasoning" (2.87 ± 1.25), and "Sanctioning" (2.26 ± 0.93). The students' competence profiles showed 100 % congruence with physicians' competence profiles of the postgraduate specialty of their choice for internal medicine, 33.3 % for paediatrics, and 0 % for anaesthesiology.

CONCLUSIONS

Undergraduate medical students could define their competence profiles with the modified R-Track questionnaire and compare them with the profile of their desired specialty for postgraduate training to discover possible learning gaps or to detect good specialty matches. A combination of students' competence self-assessment with an external assessment of students' facets of competence could provide curricular planners with useful information how to design learning opportunities for specific facets of competence.

Understanding Excellence: a Qualitative Analysis of High-Performing Learner Study Strategies

INTRODUCTION

Remediation in medical education tends to focus on the struggling learner. However, understanding successful learners may provide valuable insights to problematic academic behavior. This study explored core study strategies reported by high-performing medical school students.

METHOD

In the Fall of 2018 and 2019, high-performing first- and second-year medical students, defined as those who had performed over 90% on a national standardized assessment, were requested via e-mail to describe the study strategies that they believe contributed to their success. Student responses were analyzed using a template-driven approach, which drew upon common frameworks from cognitive learning theory.

RESULTS

Thirty-seven high-performing students provided brief unstructured descriptions of their study strategies. Retrieval practice-the cognitive learning strategy of attempting to draw out information to active recall, typically through means of self-quizzing, practice questions, or flashcards-was the most commonly endorsed strategy, followed by spaced repetition. Use of outside commercial resources was commonly referenced, and approximately one-third endorsed a perception that some form of regularly practiced self-care contributed to their academic success.

DISCUSSION

Retrieval practice, particularly combined with some form of spaced repetition, is often attributed as contributing to the success of high-performing learners. The use of commercial resources bears further exploration and consideration. Finally, the finding that self-care was identified as a contribution to academic performance goes beyond a focus on self-care solely for medical student well-being. This is an important distinction for both medical education and future research in this area.

Factors to improve academic publishing success of physicians engaged in scientific research

INTRODUCTION

Scientific evidence in medicine is based on data generated from research. Recently, the number of scientifically active physicians has decreased, which has led to the development of the Clinician Scientist Programs. To better structure and focus the research of young physicians, we aimed to investigate the impact of collaborations and other factors on the quality and output of scientific publications.

METHODS

The abstracts of three annual congresses of the German Society of Urology were systematically analysed regarding content, collaborations, and study design. Full-text publications and journals were identified through a MEDLINE® search. Impact factors (IFs) were identified using Journal Citation Reports™. To identify factors which predict publication and IFs, χ² and Wilcoxon rank-sum tests were used. Uni- and multivariable logistic regression analyses were performed to assess the best model for publication success for an abstract as well as the achievement of a high IF.

RESULTS

1,074 abstracts were reviewed. The publication rate of subsequent peer-reviewed full-text publications was 52.5%. Collaborations with at least one institution (odds ratio (OR) 2.02, 95% confidence interval (CI) 1.48-2.76, p <0.0001), statistical analysis (OR 1.92, 95% CI 1.41-2.60, p <0.0001), study design (prospective vs. retrospective: OR 1.43, 95% CI 1.06-1.93, p=0.021), and national collaborations (OR 1.43, 95% CI 1.04-1.98, p=0.029) increased the likelihood of publication in a peer-reviewed journal in a multivariable logistic regression analysis. Experimental design (OR 2.77, 95% CI 1.32-5.84, p=0.007), international collaborations (OR 2.26, 95% CI 1.23-4.15, p=0.009), oncologic topics (OR 1.94, 95% CI 1.23-3.07, p=0.005), prostate disease (OR 1.75, 95% CI 1.08-2.84, p=0.023), and statistical analysis (OR 1.68, 95% CI 1.06-2.64, p=0.026) were associated with a higher IF.

CONCLUSION

Abstracts resulting from collaborative research projects had a higher likelihood of subsequent full-text publication and a higher IF. More full-text publications were reported when abstracts included a statistical analysis. Hence, intensive networking (e. g. at congresses and workshops) of researching physicians as well as statistical/biometrical classes could be key factors to improve academic success.

Supporting students with academic difficulties

INTRODUCTION

Up 15% of health professions students experience academic difficulties. We describe an early tracking system that effectively identifies and supports students with performance deficiencies. The objectives of this study were to discuss changes made in an academic success system at our new college of pharmacy, describe effectiveness of the updated program after one-year of use, and present changes that are being discussed based on the faculty and student feedback.

METHODS

We conducted in-person faculty interviews using open-ended questions to evaluate the effectiveness of our original program for supporting students with academic difficulties called the Early Tracking System (ETS). We then developed a new program titled the Individualized Plan for Academic Success System (IPASS). We conducted more faculty interviews and a student survey after the implementation of IPASS to evaluate its effectiveness.

RESULTS

In the 2018-2019 academic year at our institution, IPASS was activated 291 times, of which there were 27 course failures. The results of our study indicated a pass rate of 90.72% post-IPASS for all pharmacy students.

CONCLUSIONS

The goal of this study was to revise and implement an early tracking system that all faculty members, students, and administrators can utilize efficiently and effectively. This study demonstrated that students with academic difficulties have the potential for progression if their deficiencies are detected early. We described a unique system by which we addressed the needs of the at-risk students. The interview of faculty and survey of students indicated satisfaction with IPASS.

Early identification of struggling learners: using prematriculation and early academic performance data

INTRODUCTION

A perennial difficultly for remediation programmes in medical school is early identification of struggling learners so that resources and assistance can be applied as quickly as is practical. Our study investigated if early academic performance has predictive validity above and beyond pre-matriculation variables.

METHODS

Using three cohorts of medical students, we used logistic regression modelling and negative binomial regression modelling to assess the strength of the relationships between measures of early academic performance and outcomes-later referral to the academic review and performance committee and total module score.

RESULTS

We found performance on National Board of Medical Examiners (NBME) exams at approximately 5 months into the pre-clerkship curriculum was predictive of any referral as well as the total number of referrals to an academic review and performance committee during medical school (MS)1, MS2, MS3 and/or MS4 years.

DISCUSSION

NBME exams early in the curriculum may be an additional tool for early identification of struggling learners.

Quelle est la motivation des internes de la première promotion du DES de médecine d’urgence ?

Objectif : La motivation en formation étant positivement corrélée à l’implication, à la persévérance et aux performances des apprenants, nous avons souhaité identifier le profil motivationnel des étudiants de la première promotion du diplôme d’études spécialisées (DES) en médecine d’urgence (MU), afin d’identifier des leviers motivationnels et d’actions pour les enseignants permettant d’améliorer la qualité de la formation.

Matériel et méthodes : Nous avons mené une étude observationnelle descriptive multicentrique auprès des internes de première année de DES. Un questionnaire autoadministré en ligne a été envoyé à tous les internes. Cinq composantes de la motivation étaient explorées : la motivation intrinsèque (MI), la motivation extrinsèque (ME), la perception de valeur à la tâche (PVT), la perception de contrôlabilité (PCO) et le sentiment d’efficacité personnel (SEP).

Résultats : Trois cent soixante-quinze internes de la promotion 2017–2018 ont répondu, soit un taux de participation de 81,5 %. La MI était nettement supérieure à laME (5,7 versus 3,8). Parmi les autres composantes de la motivation, la PVT était la plus élevée (5,9) devant la PCO (5,2) et le SEP (5,2). Il n’y avait pas de corrélation entre les différentes composantes de la motivation et le rang de classement à l’ECN (épreuves classantes nationales) ni selon le fait que la MU était ou non leur premier choix.

Conclusion : La première promotion d’internes de MU obtient globalement des scores élevés de motivation. Deux leviers, sur lesquels les enseignants peuvent essayer d’agir prioritairement, ont été identifiés afin d’améliorer la motivation des internes.

Factors Facilitating Academic Success in Dental Students After Initial Failure: A Qualitative Study

Most previous research on academic failure has sought to understand the reasons students failed. The aim of this study was to identify factors that led to academic success for dental students who had previously failed written examinations, using interviews based on Appreciative Inquiry (AI). The AI approach led the investigators to focus on positive aspects of what helped students overcome failure, rather than the reasons for it. Students in this qualitative study, conducted in 2016 at a dental college in India, completed a questionnaire with six open-ended questions and participated in individual semi-structured interviews. Purposive sampling identified 25 students as possible participants; 21 volunteered to participate; and data saturation was reached after interviews with 15. Four key themes were identified in the data collected. On the theme of learning strategies, participants mentioned modifying their attitude toward studying and making it learning-oriented. On the theme of resources, participants reported strategies for obtaining books, others' notes, and teachers' guides to help with studying. In the third theme, psychological aspects, students reported methods used to motivate themselves to succeed after failing. The fourth theme, environmental factors, concerned the key means of support provided by parents, teachers, and seniors/peers. All the students reported that the failure had been a turning point and that overcoming it had boosted their self-confidence. One student said he learned to "never give up and keep trying till you succeed," and most spoke of continuing the best practices they learned. These findings suggest that knowledge-oriented studying, conceptual learning, appropriate study material, internal motivation, and support of parents, teachers, and peers may help dental students overcome failure.

Learning Analytics in Medical Education Assessment: The Past, the Present, and the Future

With the implementation of competency-based medical education (CBME) in emergency medicine, residency programs will amass substantial amounts of qualitative and quantitative data about trainees' performances. This increased volume of data will challenge traditional processes for assessing trainees and remediating training deficiencies. At the intersection of trainee performance data and statistical modeling lies the field of medical learning analytics. At a local training program level, learning analytics has the potential to assist program directors and competency committees with interpreting assessment data to inform decision making. On a broader level, learning analytics can be used to explore system questions and identify problems that may impact our educational programs. Scholars outside of health professions education have been exploring the use of learning analytics for years and their theories and applications have the potential to inform our implementation of CBME. The purpose of this review is to characterize the methodologies of learning analytics and explore their potential to guide new forms of assessment within medical education.

[A Massive Open Oneline Course (MOOC) on pratical histology: A goal, a tool, a large public ! Return on a first experience]

A goal ! The MOOC entitled "Introduction to Histology, A Human Tissue Exploration" correspond to our vision of the practice of General Histology, which is based on the ability to diagnose 5 families of biological tissues. Ultimately, participants must be able to recognize the different types of cells and all the surrounding elements in order to understand how they organize themselves to form tissues with specific functions. A tool ! This know-how is based on reasoning from observations of microscopic structures. Learners are therefore invited to manipulate a virtual microscope to explore biological samples on histological slides digitized. Annotations, comments, drawings or photos are associated with landmarks that enrich the study of these histological sections. A target audience ! Two educational paths allow deepening the subject in a different way and thus matching the goals or motivations of each one. After a first year of experience, usage statistics and surveys of our learners show that the MOOC Histo has allowed each of them to find an interest and federate a community of motivated learners.

Motivation in medical education. MEDICAL TEACHER 2017;39:136-140. [PMID: 27866457 DOI: 10.1080/0142159x.2016.1248924]

Motivation is a concept which has fascinated researchers for many decades. The field of medical education has become interested in motivation recently, having always assumed that medical students must be motivated because of their commitment to highly specific training, leading to a very specific profession. However, motivation is a major determinant of the quality of learning and success, the lack of which may well explain why teachers sometimes observe medical students who are discouraged, have lost interest or abandon their studies, with a feeling of powerlessness or resignation. After describing the importance of motivation for learning in medicine, this Guide will define the concept of motivation, setting it within the context of a social cognitive approach. In the second part of this Guide, recommendations are made, based upon the so-called "motivational dynamic model", which provides a multitude of various strategies with positive effects on students' motivation to learn.

The Swiss Master in Chiropractic Medicine Curriculum: Preparing Graduates to Work Together With Medicine to Improve Patient Care

OBJECTIVE

In 2007, chiropractic became 1 of the 5 medical professions in Switzerland. This required a new chiropractic program that was fully integrated within a Swiss medical school. The purpose of this article was to discuss the Master in Chiropractic Medicine (MChiroMed) program at the University of Zürich, including advantages, opportunities, and challenges.

DISCUSSION

In 2008, the MChiroMed program began with its first student cohort. The MChiroMed program is a 6-year Bologna model 2-cycle (bachelor and master) "spiral curriculum," with the first 4 years being fully integrated within the medical curriculum. A review of the main features of the curriculum revealed the advantages, opportunities, and challenges of this program in comparison with other contemporary chiropractic educational programs. Advantages and opportunities include an integrated curriculum within a university, medical school, and musculoskeletal hospital, with their associated human and physical resources. Many opportunities exist for high-level research collaborations. The rigorous entrance qualifications and small student cohorts result in bright, motivated, and enthusiastic students; appropriate assessments; and timely feedback on academic and clinical subjects. Early patient contact in hospitals and clinical facilities encourages the integration of academic theory and clinical practice. The main challenges faced by this program include difficulty recruiting a sufficient number of students because of the rigorous entrance requirements and curriculum overload resulting from undertaking a full medical curriculum and chiropractic modules.

CONCLUSIONS

The MChiroMed program is a unique chiropractic curriculum that integrates medical and chiropractic education within a spiral curriculum at a world-class Swiss university medical school. The expectation is that graduates, with their expanded diagnostic and therapeutic knowledge, skills, and experience, will become future experts in primary spine care in Switzerland. It is hoped that this curriculum model will be adopted by other countries and jurisdictions seeking to enhance the role of chiropractic in health care.