Control-value theory: using achievement emotions to improve understanding of motivation, learning, and performance in medical education: AMEE Guide No. 64

In this AMEE Guide, we consider the emergent theoretical and empirical work on human emotion and how this work can inform the theory, research, and practice of medical education. In the Guide, we define emotion, in general, and achievement emotions, more specifically. We describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun 2006), and we distinguish between different types of achievement emotions, their proximal antecedents, and their consequences for motivation, learning, and performance. Next, we review the empirical support for control-value theory from non-medical fields and suggest several important implications for educational practice. In this section, we highlight the importance of designing learning environments that foster a high degree of control and value for students. Finally, we end with a discussion of the need for more research on achievement emotions in medical education, and we propose several key research questions we believe will facilitate our understanding of achievement emotions and their impact on important educational outcomes.     

Can achievement emotions be used to better understand motivation, learning, and performance in medical education?

In this article, we consider an emergent theory of human emotion. The overarching purpose of the article is to introduce medical education researchers to the notion of achievement emotions and provide a brief overview of how this work can inform the theory, research, and practice of medical education. First, we define achievement emotions and describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun R. 2006. The control-value theory of achievement emotions: Assumptions, corollaries, and implications for educational research and practice. Educ Psychol Rev 18:315-341.). Next, we distinguish between different types of achievement emotions, their proximal causes, and their consequences for motivation, learning, and performance, and we discuss several implications for educational practice. Finally, we end with a call for more research on achievement emotions in medical education to facilitate our understanding of emotions and their impact on important educational outcomes.     

Opening the black box of clinical skills assessment via observation: a conceptual model

Medical Education 2011: 45 : 1048–1060 Objectives This study was intended to develop a conceptual framework of the factors impacting on faculty members’ judgements and ratings of resident doctors (residents) after direct observation with patients. Methods In 2009, 44 general internal medicine faculty members responsible for out‐patient resident teaching in 16 internal medicine residency programmes in a large urban area in the eastern USA watched four videotaped scenarios and two live scenarios of standardised residents engaged in clinical encounters with standardised patients. After each, faculty members rated the resident using a mini‐clinical evaluation exercise and were individually interviewed using a semi‐structured interview. Interviews were videotaped, transcribed and analysed using grounded theory methods. Results Four primary themes that provide insights into the variability of faculty assessments of residents’ performance were identified: (i) the frames of reference used by faculty members when translating observations into judgements and ratings are variable; (ii) high levels of inference are used during the direct observation process; (iii) the methods by which judgements are synthesised into numerical ratings are variable, and (iv) factors external to resident performance influence ratings. From these themes, a conceptual model was developed to describe the process of observation, interpretation, synthesis and rating. Conclusions It is likely that multiple factors account for the variability in faculty ratings of residents. Understanding these factors informs potential new approaches to faculty development to improve the accuracy, reliability and utility of clinical skills assessment.     

Maternal dietary intake during pregnancy and its association to birth size in rural Malawi: A cross‐sectional study

In low‐resource settings, such as rural Malawi, pregnant women are prone to energy and micronutrient deficiencies with the consequence of delivering low‐birth weight infants with higher risks of morbidity and mortality. This study aimed to examine the association between maternal dietary intakes during pregnancy and infant birth size. Dietary intakes of 203 pregnant women were assessed between 28 and 35 weeks of gestation and their infants' (n = 132) birth size measured. Intakes of energy, macronutrients, and 11 micronutrients were estimated using a 3‐day interactive 24‐hr diet recall. Semiquantitative data on food intakes for four additional days were also collected to assess food patterns. Using multilevel linear regression modeling, maternal intakes of carbohydrate were negatively associated with neonate length (β: ?0.1; 95% CI: ?0.2, 0.0 cm/E%) and abdominal circumference (β: ?0.1, 95% CI: ?0.2, 0.0 cm/E%), whereas intakes of fat were positively associated with neonate length (β: 0.1; 95% CI: 0.0, 0.2 cm/E%) and abdominal circumference (β: 0.1; 95% CI: 0.0, 0.2 cm/E%). Vitamin C intakes were positively associated with birth weight (β: 1.4; 95% CI: 0.5, 2.3 g/mg). The frequency of milk intake was positively associated with birth weight (β: 75.3; 95% CI: 13.6, 137.0 g/day). These findings offer practical suggestions for food‐based interventions in the study area to promote inclusion of fat, vitamin C‐rich foods, and milk in pregnancy.     

Making self-assessment more effective

Self-assessment has been held out as an important mechanism for lifelong learning and self-improvement for health care professionals. However, there is growing concern that individual learners often interpret the results inaccurately. This idea has led to skepticism that self-assessment in its current form can ever be truly useful for lifelong professional development. We examine the proposal that self-assessment can and should be made more effective. First, relevance should be improved. The process should be tied more explicitly to the individual's actual practice profile, rather than being loosely relevant to broader constructs around the permitted scope of practice (eg, certification or licensure). In addition, self-assessment should include not only knowledge and reasoning but also what is done every day in practice, thereby broadening from competence in simulated settings to performance in real settings. Second, the impact of self-assessment should be substantially strengthened by periodic external validation of self-assessment results, together with goals set as a result and plans for further improvement. This offers to the individual the very tangible benefit of satisfying external mandates (eg, licensure and certification). In addition, impact should be reinforced by linking the results of self-assessment to subsequent learning activities including Continuing Medical Education (CME). Although these enhancements individually may not cure all of what ails self-assessment, they might ensure greater effectiveness for the purposes of lifelong learning.