Association Between Family Medicine Residents’ Mindsets and In-Training Exam Scores

Abstract

Introduction: In medical practice, a mastery mindset is important for engaging in lifelong learning. The objective of this study was to examine the association between family medicine residents’ scores on mindset measures and their performance on in-training examinations (ITE). Methods: This was a secondary data analysis of a cohort of family medicine residents. Following ethics approval, residents’ ITE scores from each of the 2 years of residency were linked with residents’ responses to a mindsets survey that they had taken at the midpoint of residency training. Multiple regression analysis was used to investigate the relationship between residents’ mindset scores and their ITE scores. Of 85 residents, 46 (54%) had complete data for the three data collection points. Results: Residents’ ITE scores in year 1 were most predictive of their ITE scores in year 2 (β=0.72; P<.001). Mastery mindset scores were negatively associated with residents’ performance on the ITE in year 2 (β=-0.29; P=.004). Conclusion: While the observed negative relationship between residents’ mastery mindset scores and their ITE performance may be disconcerting, it is not surprising. In clinical settings, residents are individually coached by preceptors and provided with specific, actionable feedback to support their learning. With respect to formative assessments, residents likely require explicit training on how to use their assessment results (ITE scores) to support their self-directed learning. This finding has practical implications for residency programs in using ITEs as formative assessments.

The Association Between Length of Training and Family Medicine Residents’ Clinical Knowledge: A Report From the Length of Training Pilot Study

“…The knowledge family physicians need for effective clinical practice is continually expanding. Educational innovations often influence training approaches, 11,18 and several factors including gender and marital status affect examination scores in residency, [19][20][21][22] all of which were accounted for in our analyses. It is likely that PGY1 scores reflect factors that predate residency, such as medical school curricular content, teaching methods, and emphasis on test preparation.…”

“…3,4 Studies that have examined factors that predict ITE scores have found that being married and having higher prior examinations scores (eg, United States Medical Licensing Exam Step 1 and Step 2) were predictive of higher ITE scores, [5][6][7][8] while having a high debt load, being an international medical school graduate, having trained in an osteopathic versus allopathic program, and underrepresented race/ethnicity were predictive of lower ITE scores. 9,10 Studies of ITE in family medicine have examined how predictive scores are when taken in the first year of residency compared to the second year 11 or beyond, 2 the impact of educational interventions for at-risk residents, 12 and how educational innovations in residency training affected ITE scores. 13 O'Neill et al 2 specifically examined how resident performance on the ITE differed over time and found that exam scores tend to increase annually, though the average increase lessens in each successive year.…”

Development of Measurement Instruments for Teachers’ Lifelong Learning Mindset, Learning Habits and Self-Directed Learning

“…Lifelong Learning Mindset (LLM): Rooted in Dweck's (2006) seminal work on the "growth mindset," this concept distinguishes individuals who believe in positive development, from those entrenched in a fixed mindset. Individuals with a growth mindset demonstrate receptivity to self-development, a propensity to embrace challenges, and a foundation conducive to personal and professional growth and accomplishment (Drewery, Pretti, & Church, 2020;Sloychuk et al, 2020;Sproule, Drewery & Pretti, 2019;Valtierra & Siegel, 2022).…”

Keeping Score of the Scores: Additional Perspectives on the Decline of Family Medicine ITE Scores

“…Though harder to measure, it may be helpful to consider the attitudes and/or "mastery mindset" of residents as another possible factor in this decline. 2 The article draws attention to the importance of delineating the significance of ITEs. If the ITE is considered a "lowstakes" examination compared with the American Board of Family Medicine Certification (ABFM) examination, residents may be content with declining ITE scores when their probability of passing their FM boards are greater than 95%.…”

“…1 In the published study "The Association Between Family Medicine Residents' Mindsets and In-Training Examination Scores" there was, surprisingly, a negative or inverse relationship between ITE performance and the mastery mindset scores of second year residents. 2 This may be due to the increased focus on clinical and experiential learning. Though residencies often support resident learning with immediate feedback and guidance clinically, explicit training on self-directed learning and using the ITE examination as a tool for self-study would be extremely valuable.…”