Presenter: Yoi Tibbetts, Ph.D. Research Director at Motivate Lab and Assistant Professor of Education at the University of Virginia
Zach Himmelberger, Ph.D. Lead Data Science Manager at Motivate Lab
Kenn Barron, Ph.D. Fellow at Motivate Lab and Professor of Psychology and Director of the Motivation Research Institute at James Madison University
[The following blog was generated by Susan Ely and Doug McKell]
Student Motivation and Well-Being in Medical School and the Resilient Mindsets in Medicine Initiative
The Learning Objectives for the fourth Spring 2024 IAMSE Webinar series on Teaching and Learning in Medical and Health Professions Education includes the following: First, identify and understand the challenges to medical student well-being, focusing on burnout. Second, describe a possible solution using the Mindset GPS concept and review the data supporting this approach. Third, review ways to implement a solution, specifically the Resilient Mindsets in Medicine Initiative.
Dr. Barron began the webinar by asking the attendees to respond to two questions about working with medical students. First, attendees were asked about their experience in increasing students’ motivation and, second, what conceptual model or framework they used. After completing the polling, he reviewed the webinarās three objectives again, listing how he and his colleagues would frame their presentations. Dr. Himmelberger began by describing comprehensive AACOM survey data on medical student well being. Next, Dr. Tibbetts described a motivation framework called Mindset GPS. Finally, Dr. Barron concluded by reviewing the Resilient Mindsets in Medicine Initiative program.
Dr. Himmelberger began by describing the burnout crisis that is a significant driver of poor mental health among healthcare professionals. He acknowledged that the COVID pandemic increased burnout, with an estimated 40% of healthcare professionals affected in 2021. The problem predates COVID, however, and physician burnout hasnāt dropped post-pandemic. He indicated that COVID might have worsened professional burnout but that it isn’t a problem caused by COVID. It is, instead, a persistent and multifaceted system problem seen for many years; it is both a societal and an ethical problem. Dr. Himmelberger continued to stress that solutions must be multifaceted. Because the root cause of this problem is at the system level, solutions need to address how we train physicians and support them in the workforce. This problem starts very early. Physicians who enter the workforce are already experiencing burnout. Residents and medical students face high burnout as well. In particular, medical students are facing higher rates of emotional exhaustion, an aspect of burnout where one feels both physically and emotionally drained, often as a result of consistent stress over a long period. Because medical school creates consistent stress over a long period, the result is documented poor mental health in medical students with very high rates of depression.
Dr. Himmelberger continued by presenting data collected through a partnership with the American Association of Colleges of Osteopathic Medicine (AACOM) that surveyed all matriculating and graduating osteopathic medical students in the United States during the 2022-23 academic year. The survey included 75.5% (N = 7407) of all matriculating students and 50.1% (N = 3996) of all graduating students. It revealed that burnout was significantly associated with moderate-to-severe psychological symptoms. It also demonstrated that students who failed COMLEX Level 1 or COMLEX Level 2 on their first attempt had significantly higher burnout scores than students who passed either exam on their first attempt. They also more often failed to match into desired residency positions.
In conclusion, Dr. Himmelberger stated that medical students face significant burnout, which seems to worsen throughout medical school. These findings are consistent with those of allopathic medical students and students in other healthcare professions. Burnout is associated with poor mental health, worse performance on board exams, and a lower likelihood of getting a top residency match.
Dr. Tibbetts began his presentation by describing learning mindsets, which are studentsā beliefs about themselves and the learning environment. His research at Motivate Lab has focused on three characteristics that create the acronym GPS; much like a cellphone GPS, this helps users locate and map where they want to go. The G stands for Growth Mindset, the theory that intelligence can be developed through hard work, practical strategies, and help from others as needed. According to this theory, mistakes are not an indictment of oneās intelligence. The Growth Mindset promotes room for growth and improvement. It emphasizes that students can learn from their mistakes if they work hard and implement effective strategies. The P in Mindset GPS stands for Purpose and Relevance, reinforcing the belief that oneās schoolwork is valuable because it is connected to a larger purpose and is relevant to oneās life. The S stands for Sense of Belonging, the belief that one is connected to and respected by peers, cared for by teachers and mentors, and fits with the culture. The Motivate Lab research focuses on these three specific mindsets or motivational constructs. It is based on compelling evidence from decades of research demonstrating that learning mindsets are meaningful concepts related to academic success and studentsā well-being.
Dr. Tibbetts then shifted his presentation to four reasons to support learning mindsets. They are Meaningful and related to academic success and studentsā well-being. They are Measurable – they can be accessed and tracked. They are Malleable ā they can be altered through targeted activities and changes in the educational context, and they are More Effective – meaning that learning mindset interventions can be powerful and improve outcomes for students from traditionally marginalized groups (e.g., Black, Latine, Indigenous, and 1st generation college attendees). How is this measured? The first way to measure learning mindsets is to attempt to understand what’s happening in the studentās head. To what extent do they endorse a growth mindset? Are they perceiving purpose or relevance? Do they feel a sense of belonging? The second is to assess the āpsychological airā around them, i.e., does the classroom context support a growth mindset purpose and a sense of belonging? Is it evident that the instructors believe in a growth mindset and that mistakes are viewed as an opportunity for growth? Is the purpose and relevance of the curriculum apparent?
Based on the AACOM survey data, about 30% of entering osteopathic medical students are already reporting moderate to severe psychological symptoms that are associated with psychiatric disorders. When they graduate, over half of these medical students report moderate to severe psychological symptoms related to psychiatric disorders. This underscores the belief that the psychological air within the medical school context doesn’t seem to be very adaptive, particularly when we’re looking at the psychological symptoms related to psychiatric disorders. Dr. Tibbetts concluded his portion of the webinar by emphasizing that faculty whose teaching and assignments employed GPS strategies had students’ feelings of burnout decrease by as much as 30-40%, with a concomitant reduction in maladaptive psychological symptoms.
Dr. Barron concluded the session by repeating the evidence that these measures of GPS are even more effective for students from historically marginalized backgrounds. He stressed that the stronger the perceptions of purpose and relevance that can be created for students, the more purpose and relevance they perceive within their studies, and the more psychological symptoms diminish. He described implementing the Resilient Mindsets in Medicine program to address what faculty and administration identified as the most significant medical school stressors, i.e., exams for courses during the first semester and the first licensing exam (COMLEX Level 1 or Step 1). Given this information, Dr. Barronās team created a program explicitly designed to build better student learning connections to master the material for early exams and pass the first licensing exam. The faculty training program for this initiative is divided into two parts, the most significant being online training modules. The first part of the course introduces the learning mindset GPS and how to adopt it in instructional strategies and messaging, emphasizing knowledge and skill. They are currently piloting a program to help faculty implement these ideas.
Dr Barron then described the four specific activities in the faculty course. The first is to develop a transparent preparation guide to share with students to provide information about assignments and exams. The second activity is course communication, i.e., announcements regarding exams and communications with struggling students. He noted the importance of using encouraging language to give students hope that they can succeed. The third activity is the creation of an āexam wrapperā for use both before and after exams. This involves conceptually wrapping the exam between how the student prepared for it and then, after the exam, helping them reflect on what worked and what didnāt. The fourth task is a connections activity that helps students answer the following questions: What am I learning in any given course? How is that connected to other classes? How is what I am learning linked to prepare me for board exams? Dr. Barronās research group created these four strategies for their faculty training course to address low medical student motivation, improve mental well-being, and reduce stress.
Dr. Barron concluded the webinar by saying that faculty should consider adopting an active learning strategy that promotes a G or P or an S or use any other pedagogy already supporting GPS. He ended by listing several active learning resources, including a curated list by D. Kevin Yee of 289 Active Learning Techniques; www.usf.edu/atle/documents/handout-interactive-techniques.pdf. He also recommended James Langās book, Teaching Small (2016, Jossey-Bass), as an excellent example of making incremental changes in teaching approaches to produce significant results in student learning.
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