A growth mindset approach to preparing trainees for medical error

Klein, Jill G.; Delany, Clare; Fischer, Michael D.; Smallwood, David M.; Trumble, Steve

doi:10.1136/bmjqs-2016-006416

Cited by 40 publications

(34 citation statements)

References 19 publications

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“…48 Further, this learning can lead to denial and blaming others, 20 rationalisations akin to those found in response to the experience of dissonance. Consistent with recent trends to more openly discuss error as part of medical training, 49,50 and calls to make hidden curriculum messages more conducive to desired professional behaviour, 51 perhaps modelling a healthy response to dissonance-inducing situations can also play a constructive role in improving clinical culture. A study of medical student perceptions of senior doctor responses to error showed that students admired and wanted to emulate supervisors who were honest and open about errors.…”

Section: Modelling a Healthy Response To Mistakesmentioning

confidence: 83%

Cognitive dissonance: how self‐protective distortions can undermine clinical judgement

Klein

McColl

2019

Medical Education

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Context When errors occur in clinical settings, it is important that they are recognised without defensiveness so that prompt corrective action can be taken and learning can occur. Cognitive dissonance – the uncomfortable tension we experience when we hold two or more inconsistent beliefs – can hinder our ability to respond optimally to error. Objectives The aim of this paper is to describe the effects of cognitive dissonance, a construct developed and tested in social psychology. We discuss the circumstances under which dissonance is most likely to occur, provide examples of how it may influence clinical practice, discuss potential remedies and suggest future research to test these remedies in the clinical context. Methods We apply research on cognitive dissonance from social psychology to clinical settings. We examine the factors that make dissonance most likely to occur. We illustrate the power of cognitive dissonance through two medical examples: one from history and one that is ongoing. Finally, we explore moderators at various stages of the dissonance process to identify potential remedies. Results We show that there is great opportunity for cognitive dissonance to distort judgements, delay optimal responses and hinder learning in clinical settings. We present a model of the phases of cognitive dissonance, and suggestions for preventing dissonance, reducing the distortions that can arise from dissonance and inhibiting dissonance‐induced escalation of commitment. Conclusions Cognitive dissonance has been studied for decades in social psychology but has not had much influence on medical education research. We argue that the construct of cognitive dissonance is very relevant to the clinical context and to medical education. Dissonance has the potential to interfere with learning, to hinder the process of coping effectively with error, and to make the accepting of change difficult. Fortunately, there is the potential to reduce the negative impact of cognitive dissonance in clinical practice.

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Section: Modelling a Healthy Response To Mistakesmentioning

confidence: 83%

Cognitive dissonance: how self‐protective distortions can undermine clinical judgement

Klein

McColl

2019

Medical Education

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“…23,24 Teunissen and Bok argue that both individual and organisational efforts that support a learning outlook are required to support lifelong learning. 24 Klein et al 25 suggest that although schools can teach students to have a growth mindset orientation, if the culture of the clinical setting is competitive, with individuals primarily valued for their performances, any gains in supporting a learning perspective will be lost. In addition, settings that are primarily focused on performance lead to poorer outcomes amongst those with both learning and performance orientations.…”

Section: Institutionsmentioning

confidence: 99%

Beyond ‘driving’: The relationship between assessment, performance and learning

Scott

2019

Medical Education

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Objective Is the statement ‘assessment drives learning’ a myth? Background Instructors create assessments and students respond to these assessments. Although such responses are often labelled indications of learning, the responses educators observe can also be considered a performance. When responses are aligned with generating stable changes, then assessment drives learning. When responses are not aligned with stable changes, we must consider them to be something else: a performance put on partially or fully for the sake of implying capability rather than actual learning. The alignment between the assessments educators create and the way students respond to these assessments is determined by the actions students take in our curriculum, in preparation for our assessments and after engaging with our assessments. Conclusions Not all assessments need to or should support learning, but when we assume all assessments ‘drive learning’, we endorse the myth that assessment is necessarily a formative aspect of our curricula. When we create assessments that encourage performance activities such as cramming, competing for tutorial airtime and impression management in the clinical setting we drive students to a performance. By thinking about how our students, institutions, curricula and assessments support learning and how well they support performance, we can modify and more fully align our curricular and assessment efforts to support learners in achieving their (and our) desired outcome. So, is the phrase ‘assessment drives learning’ a myth? This paper will conclude that it often is but we as educators must, through our leadership, move this myth towards a reality.

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“…Learners can contribute to building rapport by adopting a growth mindset and considering feedback as a gift. Recalling that the preceptor cares about the learner's growth and development and is taking time and effort to help them improve and achieve their goals may help the learner better appreciate the feedback.…”

Section: Be‐smart Frameworkmentioning

confidence: 99%