Neurology clerkship goals and their effect on learning and satisfaction

Abstract

Objective: To define medical student goals in the neurology clerkship and explore the association between goal setting and student performance, clerkship satisfaction, self-directed learning (SDL), and interest in neurology.Methods: A 4-year prospective study of consecutive second-to fourth-year medical students rotating through a required 4-week neurology clerkship was conducted. A goal-generating cohort (first 2 years) was enrolled to describe the breadth of student-derived goals. A goal-evaluating cohort (second 2 years) was used to evaluate the frequency of goal achievement and assess associations with performance (e.g., National Board of Medical Examiners [NBME], examination), satisfaction, and SDL behaviors (both based on 5-point Likert scale).Results: Of 440 evaluable students, 201 were goal-generating and 239 goal-evaluating. The top 3 goals were (1) improvement in neurologic examination, (2) understanding neurologic disease, and (3) deriving a differential diagnosis. More than 90% (n 5 216/239) of students reported achieving goals. Achievers reported significantly higher clerkship satisfaction (4.2 6 0.8 vs 2.8 6 1.0, p , 0.0001), greater interest in neurology (71% vs 35%, p 5 0.001), and higher observed tendency toward SDL (4.5 6 0.5 vs 4.1 6 0.8, p , 0.0001). After adjusting for age and training, NBME scores were 1.7 points higher in achievers (95% confidence interval 0.1-3.2, p 5 0.04). Conclusion:Students consistently generated similar goals for a required neurology clerkship.Goal achievers had better adjusted standardized test scores, higher satisfaction, and greater tendency toward SDL. This student-generated, goal-setting program may be particularly appealing to clinicians, educators, and researchers seeking resource-lean mechanisms to improve student experience and performance in the clinical clerkships. Neurology ® 2016;86:684-691 GLOSSARY CI 5 confidence interval; NBME 5 National Board of Medical Examiners; NCC 5 neurology core clerkship; SDL 5 selfdirected learning.Goal setting is an essential component of medical practice. Physicians and patients routinely set treatment goals, therapists and physiatrists begin rehabilitation with shared team goal setting, health care teams work to establish goals of care, and numerous practitioners use goal setting to change social and behavioral habits to improve health. Goal setting is also an important component of medical education. Goal-setting theory has influenced student, teacher, and curricular design for more than 4 decades. 1 The importance of goal setting is not new to education. Learning objectives in the clerkships have long represented instructor-generated expectations and provide the basis for assessment.2,3 Student-derived goals also provide a crucial method for self-reflection, motivation, and verbalization of student expectations. 4 Numerous studies have evaluated the effects of goal setting on nonmedical learners, 4,5 firstyear and senior medical students, and residents. [6][7][8][9][10][11] Two studies evaluating goal setting in ...

Tying knots: an activity theory analysis of student learning goals in clinical education

“…1 Although learners spontaneously generate informal learning goals, 2,3 emphasis on the importance of SRL in professional development has led to many formal written learning goal programmes in various education settings. [4][5][6][7][8][9] These programmes have had mixed success, [4][5][6][7][8][9] raising questions about how written learning goals are incorporated into clinical education practice and what factors influence their usefulness.…”

“…We investigated how written learning goals were incorporated into students’ and supervisors’ clinical work. Like many other learning goal programmes, the programme we investigated was developed to operationalise the social cognitive principles of SRL. However, as we analysed participants’ descriptions of the programme and how they used learning goals in their clinical work, we found that we needed a framework that more fully accounted for the material role of the written learning goals, as well as interpersonal and contextual dynamics.…”

“…Typically, learning goal programmes or individualised learning plans are examined in relation to how they help trainees develop into more self‐regulated lifelong learners, sometimes termed ‘master learners’ . Previous analyses of SRL have shown that the social environment provides important feedback and support for learners .…”

“…In one cyclical model of SRL, for example, learners: (i) develop goals; (ii) monitor their performance; (iii) reflect on how outcomes align with their goals, and (iv) determine how old goals should be modified and new ones created as the cycle begins again . Although learners spontaneously generate informal learning goals, emphasis on the importance of SRL in professional development has led to many formal written learning goal programmes in various education settings . These programmes have had mixed success, raising questions about how written learning goals are incorporated into clinical education practice and what factors influence their usefulness.…”

Expanding the definition of learning: from self to social to system

“…Despite the proclaimed importance of SRL skills, research on these types of interventions shows mixed results. Although some investigators have reported success with learning goals, other studies found that most learners had trouble remembering their goals, did not gain insight about learning through their goals, and did not feel that their goals were worth the time and effort . The results of these studies suggest that to produce the learning we want, we may need to move beyond an emphasis on individual processes.…”