Anthony Artino, PhD Ting Dong, PhD

Kent DeZee, MD, MPH William Gilliland, MD

Donna Waechter, PhD David Cruess, PhD

Steven Durning, MD, PhD

November 7, 2012

Achievement Goal Structures & Self-Regulated Learning: Relationships and Changes in Medical School

Annual Meeting of the

RIME 2011 RIME 2012

Background • Understanding the factors that lead to success in medicine

is challenging • Cognitive factors are typically emphasized

• Fields outside of medical have recently stressed “non-cognitive” factors… – Affect (motivation and emotion) – Behavioral components of self-regulated learning (SRL)

Cognitive Factors

Academic Achievement &

Clinical Performance

Cognitive Factors

Academic Achievement &

Clinical Performance

Affective Factors

SRL Behaviors + +

Learning Environment

RIME 2011 RIME 2012

Theoretical Framework

Learning Environment (perceptions of the learning environment)

Personal Factors

Task Value Beliefs

Self-Efficacy

Beliefs

Achievement Goals

Motivational Beliefs

Achievement Emotions

Outcomes

Academic Achievement

Clinical

Performance

reciprocal linkages

Personal Behaviors

Metacognition

Help-Seeking

Behaviors

Procrastination

Positive Emotions

Negative Emotions

Self-Regulated Learning Strategies

Achievement-Goal Structures

Mastery Goal

Structures

Performance- Approach Goal

Structures

Performance- Avoid Goal Structures

Figure. A social-cognitive model of academic motivation, emotion, and self-regulation (adapted from Pekrun, 2006).

RIME 2011 RIME 2012

Study Objectives

Objective 1: – Assess students’ perceptions of the medical school learning

environment (i.e., the achievement-goal structures)

Objective 2: – Determine how these achievement-goal structures relate to students’

SRL behaviors, academic achievement, and clerkship performance

Objective 3: – Examine differences in achievement-goal structures and students’

SRL behaviors from MS-1 to MS-4

RIME 2011 RIME 2012

Method

• Instructional Context – Uniformed Services University

• Traditional curriculum (2+2)

– Survey administered in Spring (Apr/May) of 2011

• Sample – All students (classes 2011 to 2014) invited to

participate (N = 678) – No exclusion criteria

RIME 2011 RIME 2012

Method

Part 1

Mastery Goal Structures (5 items; α = .83)

• “In preclinical courses at USU, really understanding the material is the main goal.” • “In USU clerkships, really understanding…”

Performance-Approach Goal Structures (3 items; α = .78)

• “In preclinical courses at USU, getting good grades is the main goal.” • “In USU clerkships, getting good grades…”

Performance-Avoid Goal Structures (5 items; α = .88)

• “In preclinical courses at USU, it’s important that you don’t make mistakes in front of everyone.” • “In USU clerkships, it’s important…”

Part 2

Metacognition (8 items; α = .82)

• “In preclinical courses at USU, how often do you set goals for yourself in order to direct your activities?” • “In USU clerkships, how often do you…”

Procrastination (4 items; α = .91)

• “In preclinical courses at USU, how often do you postpone doing course readings until the last minute?” • “In USU clerkships, how often do you…”

Avoidance of Help-Seeking (5 items; α = .84)

• “In preclinical courses at USU, how often do you avoid asking for help, even when the course workload is too hard to manage on your own?” • “In USU clerkships, how often do you…”

Survey (30 items)

5-point response scale: extremely untrue extremely true 5-point response scale: almost never almost all the time

RIME 2011 RIME 2012

Method

all students

clerkship students

(MS-3 to 4)

IM clerkship outcomes

• Achievement/performance outcomes 1. Medical school GPA (cumulative) 2. NBME “shelf” examination in medicine 3. Clinical points

Clerkship clinical grades 4. Exam points

Average of two locally developed exams (MCQs) 5. Dept of Medical Education Cmte (DOMEC) referral

Less than passing clinical grade or NBME shelf exam failure

• Analysis – CFA, Pearson correlations, ANOVAs

RIME 2011 RIME 2012

Results

• 304 students (45%) completed the survey – 180 preclinical students (53%) – 124 clinical students (37%)

• 223 men (73%) and 81 women

• Study participants vs. non-participants – MCAT scores and medical school GPA did not differ

between the two groups: F(2, 633) = .72, P = .49

RIME 2011 RIME 2012

Descriptive Statistics / Correlation Analysis (N = 304)

Results

Mastery Perf-App Perf-Avoid Metacog Procrast Avoid Help Cum GPA

Mastery − -.01 -.04 .26** -.16** -.24** .09

Perf-App − .47** .07 .01 .05 .14*

Perf-Avoid − -.01 .04 .24** -.001

Metacog − -.12* -.03 .10

Procrast − .36** -.09

Avoid Help − -.23**

Cum GPA −

Mean 3.99 3.32 3.20 3.33 2.61 2.01 3.17

SD 0.80 0.88 0.93 0.66 0.97 0.82 0.44

*P < .05, **P < .01 Survey response options ranged from 1 to 5

RIME 2011 RIME 2012

Correlation Analysis (Clerkship Students, n = 126)

Results

Mastery Perf-App Perf-Avoid Metacog Procrast Avoid Help

NBME -.05 -.16 -.04 .01 -.01 -.15

Exam Points -.02 -.20* -.11 -.01 -.06 -.22*

Clinical Points .03 -.12 -.20* .11 -.21* -.34**

DOMEC -.19* .04 .11 -.04 .11 .20*

Note. DOMEC coded 1 = referred to committee; 0 = not referred to committee *P < .05, **P < .01

RIME 2011 RIME 2012

Results

Achievement-Goal Structures: Changes Across Medical School (N = 304)

2

2.5

3

3.5

4

4.5

5

MS-1 MS-2 MS-3 MS-4

Sel

f-Effi

cacy

Res

pons

e O

ptio

ns

Mastery Goal Structures

Performance- Avoid Goal Structures d = 0.24

d = 0.21

d = 0.46 d = 0.29 d = 0.34

RIME 2011 RIME 2012

Discussion

• Perceptions of mastery goal structures are associated with adaptive SRL behaviors

• Perceptions of performance-avoid goal structures are associated with maladaptive behavior

Perform-Avoid

Structures

Help Avoidance

+

Mastery Structures

Metacognition +

Procrastination

Help Avoidance

-

-

RIME 2011 RIME 2012

Discussion

• Maladaptive behaviors are associated with lower academic achievement and poorer clinical performance

Help Avoidance

CumulativeGPA

-

IM Exam Points

IM Clinical Points

DOMEC Referral

-

-

+

Procrastination -

RIME 2011 RIME 2012

Discussion

• Students’ perceptions of the learning environment (achievement-goal structures) appear to change from MS-1 to MS-4 – Mastery goal structures decline in MS-2,

and then recover to MS-1 levels in clinical years – Performance-avoid goal structures steadily rise from MS-1

to MS-3

• Why? – Educational context – Nature of content and skills being taught/learned – Other factors?

Mastery Structures

MS-1

MS-2

MS-1

MS-2

Perform-Avoid

Structures

MS-3

RIME 2011 RIME 2012

Limitations

• Data not longitudinal – Differences observed across medical school should

not be over-interpreted

• Self-reported SRL behaviors – Assessing behaviors can be problematic

• Limited generalizibility – Medical students at one institution

RIME 2011 RIME 2012

Learning Environment

Implications

• Provides conceptual framework for understanding factors that may influence SRL in medical school

• Findings may help medical educators appreciate…

Classroom

Environment

Clinical Settings

Teacher Behaviors

SRL Behaviors

Academic Achievement

Clinical Performance

Anthony Artino, PhD anthony.artino@usuhs.edu

Ting Dong, PhD Kent DeZee, MD, MPH William Gilliland, MD Donna Waechter, PhD

David Cruess, PhD

Questions?

Annual Meeting of the

RIME 2011 RIME 2012

Next Steps

• Measure beliefs, emotions, and behaviors longitudinally across UME/GME

• “Zoom in” on what students think, feel, and do during specific learning activities – Validate self-regulated learning micro-analytic

technique