Faking good: self-enhancement in medical school applicants

Medical Education 2012: 46 : 485–490 Objectives The problem of dissimulation by applicants when self‐report tests of personality are used for job selection has received considerable attention in non‐medical contexts. Personality testing is not yet widely used in medical student selection, but this may change in the light of recent research demonstrating significant relationships between personality and performance in medical school. This study therefore aimed to assess the extent of self‐enhancement in a sample of medical school applicants. Methods A within‐subjects design compared personality test scores collected in 2007 for 83 newly enrolled medical students with scores for the same students obtained on the same personality test administered during the selection process 4 months previously. Five factors of personality were measured using the International Personality Item Pool and mean differences in scores were assessed using paired t‐tests. Results At the time of selection, the personality scores of successful applicants were similar to those of candidates who were not accepted (n = 271). Once selected, the medical students achieved significantly lower scores on four of the five personality factors (conscientiousness, extroversion, openness to experience, agreeableness) and higher scores on the fifth factor (neuroticism). Of the selected students, 62.7% appeared to have ‘faked good’ on at least one of the five factors measured. Conclusions Applicants to medical school are likely to dissimulate when completing self‐report tests of personality used for selection. The authors review the evidence as to whether such dissimulation reduces construct and predictive validity and summarise methods used to reduce self‐enhancement in applicant samples.     

Personality factors and medical training: a review of the literature

Medical Education 2011: 45 : 132–140 Context It has been acknowledged that certain personality characteristics influence both medical students’ and doctors’ performance. With regard to medical students, studies have been concerned with the role of personality, and performance indicators such as academic results and clinical competence. In addition, the link between personality and vulnerability to stress, which has implications for performance, has been investigated at both undergraduate and postgraduate levels. Most of the studies cited in the literature were published before the year 2000. The authors therefore undertook a literature search to determine whether any prospective systematic studies have been published since 2000. Methods A review of the literature for 2000–2009 was performed, using the databases MEDLINE, PsycINFO and CINAHL. The search terms used were ‘personality’, ‘performance’, ‘stress’ and ‘medical student’. Specific inclusion criteria required studies to be cohort studies carried out over a minimum period of 2 years, which measured medical student scores on valid and reliable personality tests, and used objective measures of performance and stress. Results The authors identified seven suitable studies. Four of these looked at personality factors and academic success, one looked at personality factors and clinical competence, and two looked at personality factors and stress. The main personality characteristic repeatedly identified in the literature was conscientiousness. Conclusions The personality trait known as conscientiousness has been found to be a significant predictor of performance in medical school. The relationship between personality and performance becomes increasingly significant as learners advance through medical training. Additional traits concerning sociability (i.e. extraversion, openness, self‐esteem and neuroticism) have also been identified as relevant, particularly in the applied medical environment. A prospective national study with the collaboration of all medical schools would make it possible to further investigate these important but initial findings.     

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels

Medical Education 2011: 45 : 381–388 Objective This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students. Methods We carried out a multicentre, single‐blinded, randomised controlled trial with intention‐to‐treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block‐randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self‐report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow‐up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS). Results Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age‐matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (? 3.44, 95% confidence interval [CI] ? 6.20 to ? 0.68; p < 0.05) and the anxiety component of the DASS (? 2.82, 95% CI ? 4.99 to ? 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (? 3.69, 95% CI ? 7.38 to 0.01; p = 0.05). Follow‐up at 8 weeks post‐trial revealed that the effect was maintained. Conclusions Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self‐administered, evidence‐based intervention now exists to manage stress in this at‐risk population and should be widely utilised.     

Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study

CONTEXT: Physicians show an increased prevalence of mental health problems, the first postgraduate years being particularly stressful. OBJECTIVES: To study the prevalence of mental health problems during the fourth postgraduate year, and to investigate whether it is already possible to predict such problems at medical school. SUBJECTS: A cohort of medical students (n=396) from all Norwegian universities, who were approached in their graduating semester (baseline) and in their fourth postgraduate year. METHODS: A nationwide and longitudinal postal questionnaire survey, including measures of perceived mental health problems in need of treatment, personality, perceived stress and skills, and ways of coping. Data were analysed using logistic regression. RESULTS: Mental health problems in need of treatment during the fourth postgraduate year were reported by 17.2% (n=66), with no gender difference, possibly because of a higher prevalence among the men compared with the general population. A majority had not sought help. Univariate medical school predictors of mental health problems included: previous mental health problems; not being married/cohabitant; the personality traits 'vulnerability' (or neuroticism) and 'reality weakness'; perceived medical school stress, and lack of perceived diagnostic skills. In addition, the coping variables avoidance, blamed self and wishful thinking were univariate predictors. Multivariate analysis identified the following adjusted predictors: previous mental health problems; 'intensity' (extraversion); perceived medical school stress, and wishful thinking. Medical school variables were inadequate for predicting which individual students would experience postgraduate mental health deterioration. However, the perceived medical school stress instrument may be used for selecting a subgroup of students suitable for group-oriented interventions.     

福建医科大学低年级学生压力应对特点

目的了解低年级医学生的压力现状及其应对特点，为医学院校学生心理健康教育工作提供依据。方法采用COPE量表调查福建医科大学低年级学生378人。结果低年级医学生的总体压力水平为中等，认为对自己身心健康影响程度为中度以上的占55．7％。低年级医学生的压力事件类型排在前3位的分别为学习压力问题，占33．5％；人际关系问题，占27．0％；未来发展问题，占14．7％。低年级医学生在应对各种压力时，普遍倾向于采用具有理智性和适应性的策略，很少采取消极性、非理智性的应对策略，尤其在对待学习压力问题上表现突出。其中，男生普遍更倾向于采用理智性的应对方式，女生更倾向于采取情感性策略。结论应注重对学生非理智性应对方式的指导，加强学生人际方面的辅导。     

Medical students' illness-related cognitions

Medical Education 2011: 45: 1241–1250 Context Doctors do not follow guidance when managing their own health and illness. This behaviour may start at medical school. This study aimed to investigate whether inappropriate responses to illness are an issue for medical students and, if so, to identify the determinants of students’ responses to illness. Methods We undertook a qualitative study using framework analysis to explore the views of medical students at two UK medical schools. Results Eight focus groups carried out with 35 medical students identified four main themes in students’ cognitions about their intended behaviour: not using usual patient pathways; informal consultation; self‐treatment, and keeping going when ill. The reasons or assumptions underlying these beliefs referred to: time and resources, including wider issues such as responsibility to colleagues; stigma and attitudes of others including regulatory bodies; beliefs about themselves in terms of taking on the patient role and issues relating to coping and self‐sufficiency; the behaviour and attitudes of peers; patient safety considerations; patients’ views about sick doctors; barriers to accessing care; the ease of self‐care, and uncertainty about ability to self‐care. Conclusions Many different factors related to medical students’ beliefs about illness. Conflicts occur among student needs to be seen as competent and dedicated to medicine, to protect personal privacy, to maintain convenience, and to seek care appropriately in order to be fair on colleagues and protect the public. These conflicts were complicated by perceptions of the system, peers and doctors as unsupportive of ill health except by facilitating informal access to care. Beliefs underlying intentions are similar between doctors and medical students, but further research is needed to fully determine how and when these beliefs are formed.     

Academic and personality correlates of career indecision in medical students entering training

The academic and personality correlates of medical career indecision were investigated in two separate studies. In the first, the effect of career indecision on academic performance was examined in a group of ninety-eight (eighty male, eighteen female) medical students entering Texas Tech University School of Medicine over a 2-year period. These medical students voluntarily completed the Medical Specialty Preference Inventory (MSPI) as part of a routine preadmission test battery. Subjects were assigned to one of three conditions—decided, high-interest undecided and low-interest undecided—based on results from the MSPI. As predicted, 'low-interest undecided' students achieved significantly lower initial medical school grades relative to 'decided' students, whereas 'high-interest undecided' students did not differ from the 'decided' students. The second study investigated the influence of career indecision upon personality. Subjects for this study were eighty-eight (sixty-six male, twenty-two female) medical students entering Texas Tech University School of Medicine over a 1-year period. These students voluntarily completed the MSPI and several personality measures as part of a pre-admission test battery. The results only partially supported the stated hypotheses. Although 'low-interest undecided' students demonstrated less personal integration compared with 'decided' students, they were no more anxious.     

艾滋病医护人员工作压力源、应对方式与工作倦怠的关系

目的 了解艾滋病医护人员工作倦怠与工作压力源和应对方式的关系.方法 采用中式工作倦怠量表(CMBI),简易应对方武问卷(SCSQ)以及自编工作压力源问卷对342名艾滋病医护人员进行调查.结果 ①工作倦怠3个维度与工作压力源和应对方式的多个因素有显著相关关系(P＜ 0.05和0.01).②管理问题和职业风险的压力对情感耗竭以及职业风险对人格解体的预测作用均极其显著(P＜0.01);消极应对对于情感耗竭和人格解体具有显著正向预测作用(P＜ 0.01和0.05),而积极应对对成就感降低具有显著反向预测作用(P＜0.01).③Amos路径分析表明,职业风险的压力和消极应对方式直接影响情感耗竭和人格解体,人际排斥的压力直接影响成就感降低,而积极应对反向作用于成就感降低;消极应对在压力源和工作倦怠中起着部分的中介作用.结论 应当重视艾滋病医护人员的工作压力问题,指导他们使用积极的应对方式,以降低其工作倦怠水平,提高工作生活质量.     

The legacy of altruism in health care: the promotion of empathy, prosociality and humanism

Medical Education 2012: 46 : 317–325 Objectives This study aimed to examine concepts of altruism and empathy among medical students and professionals in conjunction with health care initiatives designed to support the maintenance of these qualities. Methods We searched for the terms ‘altruism’, ‘altruistic’, ‘helping’, ‘prosocial behaviour’ and ‘empathy’ in the English‐language literature published from 1980 to the present within the Ovid MEDLINE, PsycInfo and PubMed databases. We used conceptual analysis to examine the relationships among altruism, empathy and related prosocial concepts in health care in order to understand how such factors may relate to emotional and career burnout, cynicism, decreased helping and decreased patient‐centredness in care. Results Altruistic ideals and qualities of empathy appear to decrease among some medical students as they progress through their education. During this process, students face increasingly heavy workloads, deal with strenuous demands and become more acquainted with non‐humanistic informal practices inherent in the culture of medicine. In combination, these factors increase the likelihood that emotional suppression, detachment from patients, burnout and other negative consequences may result, perhaps as a means of self‐preservation. Alternatively, by making a mindful and intentional choice to endeavour for self‐care and a healthy work–life balance, medical students can uphold humanistic and prosocial attitudes and behaviours. Conclusions Promoting altruism in the context of a compensated health care career is contradictory and misguided. Instead, an approach to clinical care that is prosocial and empathic is recommended. Training in mindfulness, self‐reflection and emotion skills may help medical students and professionals to recognise, regulate and behaviourally demonstrate empathy within clinical and professional encounters. However, health care initiatives to increase empathy and other humanistic qualities will be limited unless more practical and feasible emotion skills training is offered to and accepted by medical students. Success will be further moderated by the culture of medicine’s full acceptance of empathy and humanism into its customs, beliefs, values, interactions and daily practices.     

Motivation, learning strategies, participation and medical school performance

Medical Education 2012: 46: 678–688 Context Medical schools wish to better understand why some students excel academically and others have difficulty in passing medical courses. Components of self‐regulated learning (SRL), such as motivational beliefs and learning strategies, as well as participation in scheduled learning activities, have been found to relate to student performance. Although participation may be a form of SRL, little is known about the relationships among motivational beliefs, learning strategies, participation and medical school performance. Objectives This study aimed to test and cross‐validate a hypothesised model of relationships among motivational beliefs (value and self‐efficacy), learning strategies (deep learning and resource management), participation (lecture attendance, skills training attendance and completion of optional study assignments) and Year 1 performance at medical school. Methods Year 1 medical students in the cohorts of 2008 (n = 303) and 2009 (n = 369) completed a questionnaire on motivational beliefs and learning strategies (sourced from the Motivated Strategies for Learning Questionnaire) and participation. Year 1 performance was operationalised as students’ average Year 1 course examination grades. Structural equation modelling was used to analyse the data. Results Participation and self‐efficacy beliefs were positively associated with Year 1 performance (β = 0.78 and β = 0.19, respectively). Deep learning strategies were negatively associated with Year 1 performance (β = ? 0.31), but positively related to resource management strategies (β = 0.77), which, in turn, were positively related to participation (β = 0.79). Value beliefs were positively related to deep learning strategies only (β = 0.71). The overall structural model for the 2008 cohort accounted for 47% of the variance in Year 1 grade point average and was cross‐validated in the 2009 cohort. Conclusions This study suggests that participation mediates the relationships between motivation and learning strategies, and medical school performance. However, participation and self‐efficacy beliefs also made unique contributions towards performance. Encouraging participation and strengthening self‐efficacy may help to enhance medical student performance.     

Lack of association between resident doctors' well-being and medical knowledge

Medical Education 2010: 44 : 1224–1231 Objectives Resident doctors' (residents) well‐being impacts on the medical care they provide. Despite the high prevalence of resident doctors' distress, the relationship between their well‐being and the specific competencies defined by the Accreditation Council for Graduate Medical Education is poorly understood. We evaluated the association of resident well‐being with medical knowledge as assessed on both a standardised test of general medical knowledge and at the end of web‐based courses on a series of focused topics. Methods We conducted a repeated cross‐sectional study of associations between well‐being and medical knowledge scores over time for internal medicine residents from July 2004 to June 2007. Well‐being measures included linear analogue self‐assessment (LASA) scales measuring quality of life (including overall quality of life, mental, physical and emotional well‐being, and fatigue), the Medical Outcome Study Eight‐Item Short Form Health Survey (SF‐8) assessment of mental and physical well‐being, the Maslach Burnout Inventory and the PRIME‐MD two‐item depression screen. We also measured empathy using the perspective taking and empathic concern subscales of the Interpersonal Reactivity Index. Medical knowledge measures included scores on web‐based learning module post‐tests and scores on the national Internal Medicine In‐Training Examination (IM‐ITE). As data for each association were available for at least 126 residents, this study was powered to detect a small‐to‐moderate effect size of 0.3 standard deviations. Results No statistically significant associations were observed between well‐being and either web‐based learning module post‐test score or IM‐ITE score. Parameter estimates of the association of well‐being variables with knowledge scores were uniformly small. For all well‐being metrics, meaningful differences were associated with knowledge score difference estimates of < 1 percentage point. Conclusions Resident well‐being appears to have limited association with competence in medical knowledge as assessed following web‐based courses on specific topics or using standardised general medical examinations.     

Health‐related quality of life of medical students

Medical Education 2010: 44 : 227–235 Objectives Mental problems such as stress, anxiety and depression have been described among medical students and are associated with poor academic and professional performance. It has been speculated that these problems impair students’ quality of life (QoL). The authors aimed to assess the health‐related QoL (HRQL) of medical students throughout their 6 years of training at a school with a traditional curriculum. Methods Of a total of 490 students attending our institution’s medical school, 38 were surveyed in February 2006 (incoming Year 1 group, surveyed when students were in the second week of Year 1 classes) and 352 were surveyed in February 2007 (students in Years 1–6). Students self‐reported their HRQL and depressive symptoms using the Short‐Form Health Survey (SF‐36) and the Beck Depression Inventory (BDI). Comparisons were performed according to year in training, presence of depressive symptoms, gender, living arrangements and correlations with family income. Results The students’ ages ranged from 18 to 31 years (median 22.3 years). Students in Years 2, 3, 4 and 6 had lower scores for mental and physical dimensions of HRQL compared with the incoming Year 1 group (P < 0.01), with the largest difference observed for Year 3 students. Students with depressive symptoms had lower scores in all domains of the SF‐36 (P < 0.01). Female students had lower HRQL scores than males (P < 0.01). No differences were observed for students living with versus without family and no correlation with family income was found. Conclusions Major impairments in HRQL were observed among Year 3 students, students with depressive symptoms and women. Medical schools should institute efforts to ensure that students’ HRQL and emotional support are maintained, particularly during critical phases of medical training.     

Do prior knowledge,personality and visual perceptual ability predict student performance in microscopic pathology?

Medical Education 2010: 44: 621–629 Objectives There has been long‐standing controversy regarding aptitude testing and selection for medical education. Visual perception is considered particularly important for detecting signs of disease as part of diagnostic procedures in, for example, microscopic pathology, radiology and dermatology and as a component of perceptual motor skills in medical procedures such as surgery. In 1968 the Perceptual Ability Test (PAT) was introduced in dental education. The aim of the present pilot study was to explore possible predictors of performance in diagnostic classification based on microscopic observation in the context of an undergraduate pathology course. Methods A pre‐ and post‐test of diagnostic classification performance, test of visual perceptual skill (Test of Visual Perceptual Skills, 3rd edition [TVPS‐3]) and a self‐report instrument of personality (Big Five Personality Inventory) were administered. In addition, data on academic performance (performance in histology and cell biology, a compulsory course taken the previous year, in addition to performance on the microscopy examination and final examination) were collected. Results The results indicated that one personality factor (Conscientiousness) and one element of visual perceptual ability (spatial relationship awareness) predicted performance on the pre‐test. The only factor to predict performance on the post‐test was performance on the pre‐test. Similarly, the microscopy examination score was predicted by the pre‐test score, in addition to the histology and cell biology grade. The course examination score was predicted by two personality factors (Conscientiousness and lack of Openness) and the histology and cell biology grade. Conclusions Visual spatial ability may be related to performance in the initial phase of training in microscopic pathology. However, from a practical point of view, medical students are able to learn basic microscopic pathology using worked‐out examples, independently of measures of personality or visual perceptual ability. This finding should reassure students about their abilities to improve with training independently of their scores on tests on basic abilities and personality.     

At-risk medical students: implications of students' voice for the theory and practice of remediation

Medical Education 2010: 44 : 1038–1047 Objectives A mandatory remedial programme for students who repeat their first semester at medical school has resulted in large gains in academic performance and greatly reduced attrition. Here, we explore the students’ views of this in order to clarify understanding of optimal remediation practice. Methods Using a mixed‐methods approach, quantitative and qualitative data were gathered from student surveys (n = 333) and three in‐depth focus groups. Results were analysed for emergent themes. Results Remedial programmes for at‐risk medical students should be mandatory, but should respect students’ identity as repeaters. Attitude and motivation are key, and working in stable groups provides essential emotional and cognitive support. The learning environment needs to foster changes in students’ ways of thinking and their development as flexible, reflective learners. These endeavours require support from honest teachers with rigorous expectations and good facilitation skills. Conclusions Successful remediation needs to challenge students’ conceptions of learning, works best in groups with skilled facilitators, and must take into account a blend of cognitive and affective factors and the complex interplay between learner and environment. Given a carefully designed programme, at‐risk medical students can learn to make effective and lasting changes to their approach to study, and their views of learning can come to converge with influential ideas in the education literature.     

医学生心理健康状况及人格特征调查

目的探讨医学生心理健康状况及人格特征,为有针对性实施心理健康教育提供依据。方法采用症状自评量表(SCL-90)、卡特尔16项人格因素量表(16PF)为测试工具,对377名不同年级在校医学生进行测评,有效样本375份。结果医学生SCL-90因子分明显高于国内青年常模;不同年级医学生SCL-90测评结果呈显著性差异,16PF测评结果差异无显著性;男女生SCL-90敌对、偏执、精神病性因子得分,差异有显著性;SCL-90任一因子分≥2的学生和SCL-90任一因子分<2的学生16PF测试在乐群性、稳定性、兴奋性、敢为性、忧虑性、怀疑性、独立性、紧张性、内向与外向型、感情用事与安详机警、心理健康因素、有专业成就人格因素、适应与焦虑型、创造力上,差异有显著性(P<0.05或P<0.01)。结论应注重学生人格特征倾向,扬长避短,培养学生良好的心理调节能力,更有效地提高医学生心理健康水平。     

Emotional Intelligence Medical Education: Measuring the Unmeasurable?

The construct of emotional intelligence (EI) has gained increasing popularity over the last 10 years and now has a relatively large academic and popular associated literature. EI is beginning to be discussed within the medical education literature, where, however, it is treated uncritically. This reflections paper aims to stimulate thought about EI and poses the question: Are we trying to measure the unmeasurable? The paper begins with an outline of the relevance and meaningfulness of the topic of EI for doctors. It continues with an overview of the main models and measures of EI. We then critique the psychometric properties of EI measures and give an illustrative case study where we tested the psychometric properties of the ECI-U with medical students. After our critique, we present an alternative model of EI and outline possible future directions for educational research.     

Developmental challenges,stressors and coping strategies in medical residents: a qualitative analysis of support groups

Medical Education 2010: 44 : 908–916 Objectives Stress and burnout are endemic in postgraduate medical training, but little research is available to guide supportive interventions. The identification of the longitudinal emotional and developmental coping needs of internal medicine residents could assist in the better design and implementation of supportive interventions. Methods In this retrospective, exploratory study, six internal medicine resident support groups (n = 62; residents in postgraduate years [PGY] 1–3) were followed for a period of 2 years. Qualitative data were extracted from monthly support group process notes to identify common themes, stressors, emotions, coping strategies and developmental challenges faced during training. Quantitative questionnaire data were collected on burnout, group attendance and resident satisfaction. Results Using professional identity development models and classic stress and coping theory as a starting point, a derivation of grounded theory was used to identify common themes and emotions documented in support group process notes. The most common themes included understanding resident roles and responsibilities, developing an identity as a resident and doctor, building professional confidence, cognitive and behavioural responses to stress, and concerns about flaws in local and national health care training and delivery systems. Anxiety and guilt were the most commonly reported emotions, followed by positive emotions and anger. Burnout scores were highest for the second half of PGY1, but improved over subsequent training years. Support group attendance and satisfaction were both high. Residents overwhelmingly pointed to peer relationships as the most critical source of support throughout postgraduate training. Conclusions Developmentally informed programmatic adaptations could better support the emotional growth and personal and professional development of postgraduate medical trainees. Future directions should include a controlled trial of resident support groups, assessments of ‘active ingredients’ (i.e. to establish which supportive interventions are most effective), and evaluations of programmatic adaptations.     

The Motivated Strategies for Learning Questionnaire: score validity among medicine residents

Medical Education 2011: 45 : 1230–1240 Context The Motivated Strategies for Learning Questionnaire (MSLQ) purports to measure motivation using the expectancy‐value model. Although it is widely used in other fields, this instrument has received little study in health professions education. Objectives The purpose of this study was to evaluate the validity of MSLQ scores. Methods We conducted a validity study evaluating the relationships of MSLQ scores to other variables and their internal structure (reliability and factor analysis). Participants included 210 internal medicine and family medicine residents participating in a web‐based course on ambulatory medicine at an academic medical centre. Measurements included pre‐course MSLQ scores, pre‐ and post‐module motivation surveys, post‐module knowledge test and post‐module Instructional Materials Motivation Survey (IMMS) scores. Results Internal consistency was universally high for all MSLQ items together (Cronbach’s α = 0.93) and for each domain (α ≥ 0.67). Total MSLQ scores showed statistically significant positive associations with post‐test knowledge scores. For example, a 1‐point rise in total MSLQ score was associated with a 4.4% increase in post‐test scores (β = 4.4; p < 0.0001). Total MSLQ scores showed moderately strong, statistically significant associations with several other measures of effort, motivation and satisfaction. Scores on MSLQ domains demonstrated associations that generally aligned with our hypotheses. Self‐efficacy and control of learning belief scores demonstrated the strongest domain‐specific relationships with knowledge scores (β = 2.9 for both). Confirmatory factor analysis showed a borderline model fit. Follow‐up exploratory factor analysis revealed the scores of five factors (self‐efficacy, intrinsic interest, test anxiety, extrinsic goals, attribution) demonstrated psychometric and predictive properties similar to those of the original scales. Conclusions Scores on the MSLQ are reliable and predict meaningful outcomes. However, the factor structure suggests a simplified model might better fit the empiric data. Future research might consider how assessing and responding to motivation could enhance learning.     

Second-year medical students' motivational beliefs, emotions, and achievement

Medical Education 2010: 44 : 1203–1212 Context A challenge for medical educators is to better understand the personal factors that lead to individual success in medical school and beyond. Recently, educational researchers in fields outside medicine have acknowledged the importance of motivation and emotion in students’ learning and performance. These affective factors have received less emphasis in the medical education literature. Objectives This longitudinal study examined the relations between medical students’ motivational beliefs (task value and self‐efficacy), achievement emotions (enjoyment, anxiety and boredom) and academic achievement. Methods Second‐year medical students (n = 136) completed motivational beliefs and achievement emotions surveys following their first and second trimesters, respectively. Academic achievement was operationalised as students’ average course examination grades and national board shelf examination scores. Results The results largely confirmed the hypothesised relations between beliefs, emotions and achievement. Structural equation modelling revealed that task value beliefs were positively associated with course‐related enjoyment (standardised regression coefficient [β] = 0.59) and were negatively related to boredom (β = ? 0.25), whereas self‐efficacy beliefs were negatively associated with course‐related anxiety only (β = ? 0.47). Furthermore, student enjoyment was positively associated with national board shelf examination score (β = 0.31), whereas anxiety and boredom were both negatively related to course examination grade (β = ? 0.36 and ? 0.27, respectively). The overall structural model accounted for considerable variance in each of the achievement outcomes: R² = 0.20 and 0.14 for the course examination grade and national board shelf examination score, respectively. Conclusions This study suggests that medical students’ motivational beliefs and achievement emotions are important contributors to their academic achievement. These results have implications for medical educators striving to understand the personal factors that influence learning and performance in medical training.