#KeyLIMEPodcast 257: Do you have what you have or have what you learn?

Growth mindset is a hot topic right now, and one that has been discussed on the blog as well as in past episodes of the KeyLIME podcast. But can it be applied to affective attributes as well as cognitive ones? This week’s article took a closer look by surveying 40 clinical investigators across 3 different specialties.  Check out the episode here! 


KeyLIME Session 257

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Reference

New KeyLIME Podcast Episode Image

Pal NE et. al., Teachers’ mindsets in medical education: A pilot survey of clinical supervisors. Medical Teacher.2020 Mar;42(3):291-298.

Reviewer

Linda Snell (@LindaSMedEd)

Background

In CBME the assumption is that competencies are learnable, and presupposes a growth mindset, yet some suggest that not all attributes (e.g. empathy, compassion) are teachable, especially the affective components. We tend to teach the cognitive and behavioral components of some competencies and omit the affective component.

A mindset (or implicit theory) is a belief about whether an attribute is learnable or fixed. It may be domain-specific.

Learner mindsets influence learner behavior. Teachers’ mindsets impact their teaching and assessment practices, e.g. evaluation based on initial score vs development; comfort vs encouragement oriented feedback, teachers less likely to detect change… so validity of assessments is threatened.

Little work has looked at mindsets in medical education. The authors suggest that clinical supervisors may perceive some components of competencies as fixed – therefore influencing their approach to teaching, assessing, and monitoring progression. Given the developmental approach of CBME, they suggest we explore how clinical supervisors understand competencies and their components as fixed or learnable, i.e. to examine clinical supervisors’ mindsets regarding the malleability of human attributes related to medical education.

Purpose

To examine clinical supervisors’ mindsets of two cognitive attributes (intelligence and clinical reasoning) and two affective attributes (moral character and empathy). These 4 attributes are key components of the competencies of communication, professionalism and medical expert.

Key Points on the Methods

Clinical supervisors (n=40) from three specialties (ORL, Neuro, ObGyn) completed an online survey to measure mindsets using 2 validated items for intelligence and moral character and 18 new items for clinical reasoning and empathy. The survey items were modeled after Dweck’s instrument – statements with Likert 1-6 strongly agree to strongly disagree.

Properties of new items explored with various correlations.

Scores for each item and across items calculated: fixed (average score across three items <3), growth (average score across three items 3-4), and indeterminate (average score across three items falls between 3 and 4)

Of note: 2 other invited specialties declined (anesthesia and psychiatry). Other disciplines not used as they were being ‘saved for future studies’!

~32% RR

Key Outcomes

All items for the new scales – empathy and clinical reasoning mindsets – had satisfactory psychometric properties.

Mindsets about the malleability of the four attributes were domain-specific, although moral character and empathy mindsets were strongly correlated.

The majority of clinical supervisors held growth mindsets for clinical reasoning; For the remaining three attributes, supervisors held more fixed mindsets than growth: intelligence, empathy, moral character

The authors suggest we consider how clinical teachers responsible for the implementation of educational models, and teaching and assessment practices, understand the attributes highlighted as educational targets and performance dimensions within these models. If prevalent fixed mindsets regarding empathy and moral character–components of the communication and professionalism competencies – could have significant influence. Why expend time and resources to teach attributes that are perceived to be fixed? Why provide feedback to improve a presumably fixed trait? Why remediate?

Next steps: are mindsets associated with suboptimal teaching and assessment strategies and more importantly learning outcomes? Are there interventions to mitigate these impacts. (Fac Dev?)

Key Conclusions

The authors conclude…

This study provides validation support for the use of two new scales measuring mindsets in medical education.

Clinical supervisors hold both fixed and growth mindsets for the attributes of empathy, moral character and intelligence. Most hold growth mindsets for clinical reasoning.

Fixed mindsets contradict current educational models that characterize these attributes as learnable.

Future research is needed to investigate how mindsets may be impacting teaching and assessment in medical education.

Spare Keys – other take home points for clinician educators

Think validation when developing an instrument.

Think of the many threats to validity in assessment.

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