IAMSE Spring 2024 Webcast Audio Series – Week 4 Highlights

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 webinar’s 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 hasn’t 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 students’
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 one’s 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 one’s schoolwork is valuable because it is
connected to a larger purpose and is relevant to one’s 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 students’ well-being.

Dr. Tibbetts then shifted his presentation to four reasons to support learning mindsets.
They are Meaningful and related to academic success and students’ well-being. They are
Measurable – they can be accessed and tracked. They are Malleable – 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 student’s 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 “psychological air” 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. Barron’s 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 “exam wrapper“ 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
didn’t. 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. Barron’s
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 Lang’s book, Teaching Small (2016, Jossey-Bass), as an excellent
example of making incremental changes in teaching approaches to produce significant
results in student learning.

References

  1. Sexton JB, Adair KC, Proulx J, et al. Emotional Exhaustion Among US Health Care Workers
    Before and During the COVID-19 Pandemic, 2019-2021. JAMA Netw Open.
    2022;5(9):e2232748. doi:10.1001/jamanetworkopen.2022.32748
  2. Agerbo, E., Gunnell, D., Bonde, J. P., Mortensen, P. B., & Nordentoft, M. (2007). Suicide
    and occupation: the impact of socio-economic, demographic and psychiatric differences.
    Psychological medicine, 37(8), 1131–1140. https://doi.org/10.1017/S0033291707000487
  3. Shanafelt, Tait D. MD; Balch, Charles M. MD†‡; Bechamps, Gerald MD†§; Russell, Tom MD†; Dyrbye, Lotte MD; Satele, Daniel BA; Collicott, Paul MD†; Novotny, Paul J. MS;
    Sloan, Jeff PhD*; Freischlag, Julie MD†‡. Burnout and Medical Errors Among American
    Surgeons. Annals of Surgery 251(6):p 995-1000, June 2010. | DOI:
    10.1097/SLA.0b013e3181bfdab3
  4. Fares, J., Al Tabosh, H., Saadeddin, Z., El Mouhayyar, C., & Aridi, H. (2016). Stress, Burnout
    and Coping Strategies in Preclinical Medical Students. North American journal of medical
    sciences, 8(2), 75–81.
    https://doi.org/10.4103/1947-2714.177299
  5. Fitzpatrick, O., Biesma, R., Conroy, R. M., & McGarvey, A. (2019). Prevalence and
    relationship between burnout and depression in our future doctors: a cross-sectional study
    in a cohort of preclinical and clinical medical students in Ireland. BMJ open, 9(4), e023297.
    https://doi.org/10.1136/bmjopen-2018-023297
  6. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms,
    and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis.
    JAMA. 2016;316(21):2214–2236. doi:10.1001/jama.2016.17324