The growth mindset for changing medical education culture

Theard, Marie Angele; Marr, Mollie; Harrison, Rebecca

doi:10.1016/j.eclinm.2021.100972

Cited by 16 publications

(3 citation statements)

References 4 publications

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“…Physicians with high self-efficacy view issues at work as challenges that should be managed rather than avoided due to perceptions of inadequate skills [ 91 ]. This aligns with the concepts of resilience and a growth mindset, as physicians possessing these qualities have the resources to deal with adversities and see them as an opportunity to learn and grow [ 93 , 94 ]. When physicians believe in themselves and grow as leaders, they are more willing to expand their leadership roles.…”

Section: Discussionmentioning

confidence: 87%

Linking leadership development programs for physicians with organization-level outcomes: a realist review

Debets

Jansen

Lombarts

et al. 2023

BMC Health Serv Res

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Background Hospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization’s performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing. Objective To investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes. Methods We conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O). Results In total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories ‘culture’, ‘quality improvement’, and ‘the leadership pipeline’: 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes. Conclusions LDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.

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Section: Discussionmentioning

confidence: 87%

Linking leadership development programs for physicians with organization-level outcomes: a realist review

Debets

Jansen

Lombarts

et al. 2023

BMC Health Serv Res

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“…Additional lessons include the value of appreciative inquiry to redirect individual student concerns about having “failed” 27 . Strengths-based coaching strategies build towards improved CS and learning while fostering a growth mindset 28 , 29 . Group coaching allowed students to adjust to the pilot with their peers, while individual sessions at clerkship sites provided coaching in settings integral to daily clinical learning.…”

Section: Discussionmentioning

confidence: 99%

A pilot clinical skills coaching program to reimagine remediation: a cohort study

Klig¹,

Kettyle²,

Kosowsky³

et al. 2023

MedEdPublish

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Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME). The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME). Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning. Methods A six-month CS coaching pilot was conducted at Harvard Medical School (HMS) as a destigmatized remedial learning environment for clerkship and post-clerkship students identified as ‘at risk’ based on objective structured clinical examinations (OSCE). The pilot entailed individual and group coaching with five faculty, direct bedside observation of CS, and standardized patient encounters with video review. Strengths-based coaching principles and appreciative inquiry were emphasized. Results Twenty-three students participated in the pilot: 14 clerkship students (cohort 1) and 9 post-clerkship students (cohort 2). All clerkship students (cohort 1) demonstrated sustained improvement in CS across three OSCEs compared to baseline: at pilot close, at 6-months post pilot, and at 21-24 months post-pilot all currently graduating students (10/10, 100%) passed the summative OSCE, an HMS graduation requirement. All post-clerkship students (cohort 2) passed the HMS graduation OSCE (9/9,100%). Feedback survey results included clerkship students (9/14; 64%) and post-clerkship students (7/9; 78%); all respondents unanimously agreed that individual coaching was “impactful to my clinical learning and practice”. Faculty and leadership fully supported the pilot as a destigmatized and effective approach to remediation. Conclusion Remediation has an essential and growing role in medical schools. CS coaching for remedial learning can reduce stigma, foster a growth mindset, and support sustained progress for ‘at risk’ early clerkship through final year students. An “implementation template” with suggested tools and timelines can be locally adapted to guide CS coaching for UME remediation. The CS coaching pilot model is feasible and can be generalized to many UME programs.

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“…When considering the path forward for mindset theory in medical education, we want to acknowledge important contributions that would help to develop cultures that promote growth mindsets. In particular, we want to highlight existing recommendations at individual, relational, and systems levels that can be optimized in the ongoing transition to competency-based medical education, 13 efforts to apply the growth mindset framework to foster antiracism in medical education, 35 and recommendations to formally incorporate growth mindsets into learner assessment systems 36 . We have built upon these efforts by highlighting specific strategies that can help medical educators avoid the pitfalls of false growth mindset and apply lessons gleaned from critiques of mindset theory (Table 1).…”

Section: Looking Forwardmentioning

confidence: 99%

Beware False Growth Mindset: Building Growth Mindset in Medical Education Is Essential but Complicated

Memari,

Gavinski,

Norman

2023

Acad Med

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Mindset theory explains how learners’ beliefs about intelligence and learning affect how they perceive effort, react to failure, and respond to feedback in challenging learning contexts. Mindset theory distinguishes between growth mindset (the belief that human capacities can be developed over time) and fixed mindset (the belief that human capacities are inherent and unchangeable). Efforts to develop growth mindset in learners have shown a wide range of benefits, including positive effects on students’ resilience, commitment to lifelong learning, and persistence in a field of study, with notable impacts on learners who are struggling, learners from minoritized groups, and women in scientific fields. In recent years, mindset theory interventions have caught the interest of medical educators, who recognize that traditional medical education, with its emphasis on grades, standardized examination performance, and high perceived cost of failure, may actually reinforce fixed mindsets and thus erode resilience among learners. However, the increased popularity of mindset theory must be met with a more nuanced understanding of the theory, including increased awareness of the concept of “false growth mindset,” a term coined by Carol Dweck to refer to common pitfalls in the theory’s application. In this article, the authors highlight important findings from mindset interventions in medical education, identify common pitfalls of false growth mindset in the context of medical learners, and offer suggestions for how educators and institutions can better instigate changes to promote growth mindsets within medical education.

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The growth mindset for changing medical education culture

Cited by 16 publications

References 4 publications

Linking leadership development programs for physicians with organization-level outcomes: a realist review

Linking leadership development programs for physicians with organization-level outcomes: a realist review

A pilot clinical skills coaching program to reimagine remediation: a cohort study

Beware False Growth Mindset: Building Growth Mindset in Medical Education Is Essential but Complicated

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