Artino, Anthony R.

Purpose To evaluate the validity of scores from three instruments measuring achievement goal motivation-related constructs: a shortened version of Dweck’s Implicit Theories of Intelligence Scale (ITIS-S), measuring incremental and entity mindsets; Elliot’s Achievement Goal Questionnaire–Revised (AGQ-R), measuring mastery-approach, mastery-avoidance, performance-approach, and performance-avoidance achievement goals; and Midgley’s Patterns of Adaptive Learning Scales (PALS), measuring mastery, performance-approach, and performance-avoidance achievement goals. Method High school students participating in a medical simulation training activity in May 2017 completed each instrument. The authors evaluated internal structure using reliability and factor analysis and relations with other variables using the multitrait–multimethod matrix. Results There were 178 participants. Internal consistency reliability (Cronbach alpha) was > 0.70 for all subscores. Confirmatory factor analysis of ITIS-S scores demonstrated good model fit. Confirmatory factor analysis of AGQ-R scores demonstrated borderline fit; exploratory factor analysis suggested a three-domain model (approach, mastery-avoidance, performance-avoidance). Confirmatory factor analysis of PALS scores also demonstrated borderline fit; exploratory factor analyses suggested consistent distinction between mastery and performance goals but inconsistent distinction between performance-approach and performance-avoidance goals. Correlations among AGQ-R and PALS scores were large for mastery ( r = 0.72) and moderate for performance (≥ 0.45) domains; correlations among incremental and mastery scores were moderate (≥ 0.34). Contrary to expectations, correlations between entity and performance scores were negligible. Correlations between conceptually unrelated domains were small or negligible. Conclusions All instrument scores had good internal consistency and generally appropriate relations with other variables, but empirically determined domain structures did not consistently match theory.

Objective Measurement of motivation and cognitive load has potential value in health professions education. Our objective was to evaluate the validity of scores from Dweck's Implicit Theories of Intelligence Scale ( ITIS ), Elliot's Achievement Goal Questionnaire‐Revised ( AGQ ‐R) and Leppink's cognitive load index ( CLI ). Methods This was a validity study evaluating internal structure using reliability and factor analysis, and relationships with other variables using the multitrait‐multimethod matrix. Two hundred and thirty‐two secondary school students participated in a medical simulation‐based training activity at an academic medical center. Pre‐activity ITIS (implicit theory [mindset] domains: incremental, entity) and AGQ ‐R (achievement goal domains: mastery‐approach, mastery‐avoidance, performance‐approach, performance‐avoidance), post‐activity CLI (cognitive load domains: intrinsic, extrinsic, germane) and task persistence (self‐directed repetitions on a laparoscopic surgery task) were measured. Results Internal consistency reliability (Cronbach's alpha) was > 0.70 for all domain scores except AGQ ‐R performance‐avoidance (alpha 0.68) and CLI extrinsic load (alpha 0.64). Confirmatory factor analysis of ITIS and CLI scores demonstrated acceptable model fit. Confirmatory factor analysis of AGQ ‐R scores demonstrated borderline fit, and exploratory factor analysis suggested a three‐domain model for achievement goals (mastery‐approach, performance and avoidance). Correlations among scores from conceptually‐related domains generally aligned with expectations, as follows: ITIS incremental and entity, r = −0.52; AGQ ‐R mastery‐avoidance and performance‐avoidance, r = 0.71; mastery‐approach and performance‐approach, r = 0.55; performance‐approach and performance‐avoidance, r = 0.43; mastery‐approach and mastery‐avoidance, r = 0.36; CLI germane and extrinsic, r = −0.35; ITIS incremental and AGQ ‐R mastery‐approach, r = 0.34; ITIS incremental and CLI germane, r = 0.44; AGQ ‐R mastery‐approach and CLI germane, r = 0.48 (all p < 0.001). We found no correlation between the number of task repetitions (i.e. persistence) and mastery‐approach scores, r = −0.01. Conclusions ITIS and CLI scores had appropriate internal structures and relationships with other variables. AGQ ‐R scores fit a three‐factor (not four‐factor) model that collapsed avoidance into one domain, although relationships of other variables with the original four domain scores generally aligned with expectations. Mastery goals are positively correlated with germane cognitive load.

Objective To succinctly summarise five contemporary theories about motivation to learn, articulate key intersections and distinctions among these theories, and identify important considerations for future research. Results Motivation has been defined as the process whereby goal‐directed activities are initiated and sustained. In expectancy‐value theory, motivation is a function of the expectation of success and perceived value. Attribution theory focuses on the causal attributions learners create to explain the results of an activity, and classifies these in terms of their locus, stability and controllability. Social‐ cognitive theory emphasises self‐efficacy as the primary driver of motivated action, and also identifies cues that influence future self‐efficacy and support self‐regulated learning. Goal orientation theory suggests that learners tend to engage in tasks with concerns about mastering the content (mastery goal, arising from a ‘growth’ mindset regarding intelligence and learning) or about doing better than others or avoiding failure (performance goals, arising from a ‘fixed’ mindset). Finally, self‐determination theory proposes that optimal performance results from actions motivated by intrinsic interests or by extrinsic values that have become integrated and internalised. Satisfying basic psychosocial needs of autonomy, competence and relatedness promotes such motivation. Looking across all five theories, we note recurrent themes of competence, value, attributions, and interactions between individuals and the learning context. Conclusions To avoid conceptual confusion, and perhaps more importantly to maximise the theory‐building potential of their work, researchers must be careful (and precise) in how they define, operationalise and measure different motivational constructs. We suggest that motivation research continue to build theory and extend it to health professions domains, identify key outcomes and outcome measures, and test practical educational applications of the principles thus derived.

ABSTRACT Background: Sleep deprivation and fatigue have been associated with medical errors, clinical performance decrements, and reduced quality of life for both practicing physicians and medical students. Greater understanding of the impact of sleep quantity on clinical reasoning could improve patient care. The purpose of our pilot study was to examine relationships between clinical reasoning (assessed by functional magnetic resonance imaging) and sleep time (measured in different ways by actigraphy) while answering multiple-choice questions (MCQs) from licensing agencies. Methods: Residents and faculty were administered a clinical reasoning exercise (MCQs from licensing bodies) during functional magnetic resonance imaging. Usual sleep patterns were sampled with actigraphy. Covariate analysis was used to examine the relationship between sleep duration (mean sleep, minimum sleep, maximum sleep) and brain activity during clinical reasoning (solving MCQs from licensing bodies). Results: The mean sleep time over the duration of monitoring for the group was 7.19 hours (SD 0.66) with a range of 6.1 to 8.1 hours (internal medicine faculty 7.1 hours, SD 0.41; internal medicine residents 7.27 hours, SD 0.92). There was a negative relationship between activation in the prefrontal cortex and minimum sleep time while reflecting on MCQs. Conclusion: Our findings provide evidence that the quantity of sleep can modulate brain activity while completing a clinically meaningful task that should be confirmed in larger studies. Our findings suggest that the construct of sleepiness may be more complex than appreciated by many and that the most important of these sleep measures in terms of outcomes remains to be determined.

AbstractIntroductionUnderstanding clinical reasoning is essential for patient care and medical education. Dual‐processing theory suggests that nonanalytic reasoning is an essential aspect of expertise; however, assessing nonanalytic reasoning is challenging because it is believed to occur on the subconscious level. This assumption makes concurrent verbal protocols less reliable assessment tools.MethodsFunctional magnetic resonance imaging was used to explore the neural basis of nonanalytic reasoning in internal medicine interns (novices) and board‐certified staff internists (experts) while completing United States Medical Licensing Examination and American Board of Internal Medicine multiple‐choice questions.ResultsThe results demonstrated that novices and experts share a common neural network in addition to nonoverlapping neural resources. However, experts manifested greater neural processing efficiency in regions such as the prefrontal cortex during nonanalytical reasoning.ConclusionsThese findings reveal a multinetwork system that supports the dual‐process mode of expert clinical reasoning during medical evaluation.