Goals of medical students participating in scholarly concentration programmes

Introduction

Worldwide, medical students participate in research activities as either required or elective components of the curriculum.[1-11] Often, this occurs within the structure of a scholarly concentration (SC) programme.[1, 2, 4, 12-15] SC programmes differ in length and structure, but share the goal of providing administrative support and guidance to students who carry out original research projects. Concentration areas vary, but commonly include clinical research, basic science, medical education and global health among others.[3] By facilitating students’ participation in scholarly projects, SC programmes aim to encourage critical thinking, increase familiarity with and interest in medical research throughout students’ future careers, and support lifelong learning.[1, 4, 12, 16, 17] Studies of SC programmes have found high student satisfaction rates,[1, 4, 5, 7, 10, 14, 16, 18-21] increased research productivity,[1, 18, 22] improved confidence in ability to carry out research[1, 8, 19] and increased interest in future participation in research.[1, 8, 14, 17-20, 23, 24]

SC programmes offer a unique way to mentor students’ professional development and self-directed learning skills, two important facets of growth that reach beyond enhancement of research skills. This one-to-one, often longitudinal, mentoring allows faculty members to understand and guide students’ motivation and learning. Such individualised mentorship can be approached through the lens of achievement goal theory. Achievement goal theory considers learning goals as falling into two major domains: mastery goals and performance goals. Mastery goals are those focused on mastering certain pieces of information or tasks, whereas performance goals relate to the demonstration of competence compared with others.[25, 26] When applied to students’ participation in SC programmes, mastery goals are those related to acquiring the skills needed to successfully develop, carry out and disseminate the results of scholarly work. These may also be considered process-related goals. In SC programmes, performance goals are those that highlight students’ accomplishments related to others, such as the dissemination of one's work and the status that dissemination adds to applications for residency training programmes. These may also be considered product-related goals. We hypothesise that the importance of these two types of goals is associated with student career aspirations as early as the first year of medical school. Understanding variation in student motivation is necessary for appropriate mentorship in SC activities, and may inform mentorship and instruction in other parts of the curriculum. To date, no study has considered these types of goals in relation to medical students’ participation in SC programmes.

In this study, we investigated the importance of both process-focused and product-focused goals among first-year students participating in the SC programmes at the University of Chicago Pritzker School of Medicine (PSOM) and the Icahn School of Medicine at Mount Sinai (ISMMS). We aimed to determine whether student characteristics and baseline interests were associated with different types of goals.

Methods

Results

Surveys were sent to 288 students: 161 students from PSOM and 127 students from ISMMS. We acquired 204 responses (70.8% overall response rate), with 125 respondents from PSOM (77.6% response rate) and 79 respondents from ISMMS (62.2% response rate). We excluded 18 students (11 PSOM, seven ISMMS): five were excluded for ranking all answers the same (indicating a possible lack of consideration), nine for failing to list specialty preferences, three for failing to indicate gender, and one for failing to indicate degree of interest in career-long research. The remaining 186 responses were included in our analysis. Of these, 104 were from women (55.9%) and 82 were from men (44.1%). Of these 186 students, 114 students (61.3%) were from PSOM (response rate, 70.8%) and 72 students (38.7%) were from ISMMS (response rate, 56.7%; Table 1).

Eighty-six students (46.2%) were interested in highly competitive residencies and 100 students were not (53.8%). Seventy-eight (41.9%) students were interested in career-long research, responding with the intention to be either exclusively involved or significantly involved with research. One hundred and eight students (58.1%) were not interested in career-long research (responded with somewhat involved, limited involvement or not involved; Table 1).

The skill composite had a mean = 31.98, SD = 4.20 and range = 21–40 with a normal distribution. The accomplishment composite had a mean = 16.11, SD = 2.79 and range of 6–20. The accomplishment composite displayed a non-normal distribution so we dichotomised at the median between 16 and 17. This yielded 118 (63.4%) students with a composite of 17 or greater who were categorised as placing a high degree of importance on accomplishment-related goals, and 68 (36.6%) in the cohort placing less importance on accomplishment-related goals. Forty-six students (24.7%) rated the development of the mentorship goal with a Likert score of 4 (important) or lower, 140 (75.3%) rated it 5 (very important) out of 5, and we used these groups for analysis.

Descriptive statistics for each goal's mean importance and standard deviation are provided in Table 2. Additionally, Cronbach's alpha was computed for goals grouped together to generate the skill composite score and the accomplishment composite score in order to measure the internal consistency of the goals within each group. The skill or process-focused goals grouping had α = 0.73 and the accomplishment or product-focused goals grouping had α = 0.79 (Table 2).

In linear regression controlling for site (PSOM versus ISMMS), we found that higher interest in career-long research had a significant correlation with a higher score on the skill composite, such that a one-point increase in interest in career-long research correlated with a 1.87 (95% confidence interval [CI], 1.03–2.71; p < 0.001) point increase in the skill composite. Interest in a highly competitive residency, gender and site were not related to the skill goals composite (Table 3). In logistic regression, we found that both interest in career-long research (odds ratio [OR], 1.71; 95% CI, 1.09 to 2.69; p = 0.02) and interest in a highly competitive residency (OR, 2.18; 95% CI, 1.15 to 4.11; p = 0.02) correlated with increased importance placed on accomplishment or product-focused goals (Table 3). Neither site nor gender was associated with the skills composite score or the accomplishment composite score.

In a separate logistic regression, we found that female students were significantly more likely to place high importance on development of a mentoring relationship (OR, 2.47; 95% CI, 1.23 to 4.97; p = 0.01) compared with male students (Table 3). Forty-one of 104 women (39.4%) and 45 of 82 men (54.9%) were interested in highly competitive residencies, a significant gender-based difference in career plans (chi-squared, p = 0.04). Thirty-eight of 104 women (36.5%) and 40 of 82 (48.8%) men were strongly interested in career-long research (intent for exclusive or significant involvement). This difference was not statistically significant (p = 0.09; Fig. 1).

Discussion

Ours is the first study to examine matriculating students’ goals related to participation in SC programmes. We surveyed first-year students in two SC programmes to assess the impact of interest in career-long research, interest in a competitive residency and gender on the importance placed on SC-related student goals. We used regression models to analyse three types of goals: skills or process goals, accomplishment or product goals, and development of a mentoring relationship with faculty members. We found that students with a high interest in pursuing career-long research placed higher importance on both skill-related goals and accomplishment-related goals than their peers without a strong intention to pursue career-long research. By contrast, students interested in highly competitive residencies placed higher importance only on accomplishment-focused goals compared with their peers, but did not value skill-based goals more than their peers. Women placed more importance on developing a strong mentoring relationship through participation in the SC programme compared with men. Finally, we found that men were significantly more likely than women to show interest in highly competitive residency placements.

It is not surprising that students interested in career-long research would place a high value on both skill- and accomplishment-focused goals as both of these composites represent factors that would benefit a future career involving research. Similarly, it is not surprising that students interested in highly competitive residencies place a high value on accomplishments, as dissemination of scholarly work is often a factor in successfully matching with these specialties.[31] However, it is eye-opening that students interested in highly competitive residencies placed increased importance only on accomplishment-related goals to the exclusion of valuing the corresponding skill-related goals. Valuing the product without valuing the process highlights conflicting motivations within students who feel the pressure of the residency match even in the first year of medical school. This disconnect also highlights an important opportunity to mentor the development of interest in mastering the critical thinking processes involved with research and creation of a completed work product, as these are critical skills for the practice of medicine. Specific instruction regarding the clinical practice-related relevance of skills developed through research activities may motivate students to value process-focused goals more highly.

Our gender-related findings were also interesting. The literature surrounding women and mentorship in medical education supports the finding that women consider mentorship a positive and valuable aspect of an SC programme.[32] However, we did not expect that men would value this mentorship opportunity less than women. Additional questions regarding mentorship may shed light on specific mentorship interactions or needs that students most value and related gender-based differences. A multicentre study of mentorship in SC programmes is underway to investigate this, including specific mentorship skills, match of student and mentor specialty interests, and prior student research experience. Last, we did not expect a gender-based difference in interest in highly competitive residencies given the gender near-equality seen in medical school admissions.[33]

Our data highlight the opportunity educators have to use SC programmes as a platform to mentor the development of self-directed learning skills. Such mentorship requires an appreciation of students’ existing learning goals and identification of goals that the student may not yet value, and also a process to imbue important additional learning goals with value. SC programmes are a perfect venue for deliberate teaching of the skills needed to be a lifelong, self-directed learner, a curricular component required for accreditation by the Liaison Committee on Medical Education (LCME).[34] SC students are generally mentored one-to-one over many months, allowing specific, short-term learning goals to be set and achieved, as well as longer-term goals to be discussed and prioritised. Training for SC mentors could benefit by highlighting external pressures, such as the competitiveness of certain specialties, on students’ initial learning goals so that mentors can address the importance of both process and product-focused goals in early meetings with their mentees. Given the amount of curricular time devoted to student research,[4, 12-15] leveraging mentorship within SC programmes to foster self-directed learning and goal development is a wise investment.

This study has several limitations. Because we developed the survey tool ourselves, we do not have formal reliability and validity previously established. Although we did not assess test–retest reliability, we did assess internal consistency of the tool using Cronbach's alpha. As reported, the goals’ groupings had strong alpha scores (0.73 for the eight skill-related goals and 0.79 for the four accomplishment-related goals). In addition, the alpha for all 13 skills (including mentorship) was 0.81, indicating that the students are goal driven. In light of the strong alpha value for all skills combined, the finding that student career intentions are associated with differential valuation of goals is interesting. The validity of the survey tool is based on two features. First, one of the key survey items was taken from the AAMC Graduation Questionnaire, which has used this item for many years. The goals were generated by programme faculty staff with years of experience administering an SC programme and identifying goals of participants, providing evidence of face validity. Second, construct validity is supported by the fact that students who intend to include research in their career do in fact value research-related goals more than their peers.

Other limitations are also apparent. We used data from two US medical schools; however, both institutions are research focused and consistently ranked in the top 25 US research medical schools,[35] and students accepted into and choosing to enroll at these schools may not reflect the national or global sample. Further, the SC programmes at PSOM and ISMMS are of similar design, which limits generalisability to the wide range of other programmes in place elsewhere. In addition, PSOM had a significantly higher response rate than ISMMS, which we suspect reflected the fact that the recruitment e-mails were sent from PSOM faculty staff. Further, although our overall response rate was quite good for this type of study, we prioritised anonymity to insure more truthful responses and therefore cannot describe demographics of responders versus non-responders to insure generalisability. We assumed that first-year students are aware that different residencies vary in their selectivity and, thus, the level of accomplished research expected of their applicants. Although we did not query students’ awareness of residency selectivity, our data suggest that students do know that highly competitive specialties consider research success in selection of future residents. Our grouping of goals into skill-related and accomplishment-related goals was tested for internal consistency using Cronbach's alpha, but we note that these groupings have not been previously validated. In addition, our analysis of the importance of development of a mentoring relationship was based on a single question, rather than a composite score. Last, these data are a snapshot of first-year students’ goals, without attention to whether these goals remained important to graduating students reflecting back on their SC experience, or whether these goals were attained through participation in the SC programme. Following these students to graduation would provide useful information regarding programme effectiveness and maturation of students’ perspectives over time.

Students’ initial learning goals in SC programmes are related to their career aspirations in the first year of medical school. Appreciation of this phenomenon will allow faculty mentors to maximally use the unique mentorship structure of SC programmes to foster self-directed learning skills among medical students. Deliberate identification of relevant process- and product-focused learning goals and appreciation of their value in the setting of student research may help students engage in self-directed learning across their medical education. In this way, SC programmes may enhance students’ professional development in a manner that reaches far beyond research productivity and skill development to truly support the growth of lifelong learners.

Contributors

KA contributed substantially to data acquisition, analysis and interpretation, drafted and revised the manuscript, gave final approval of the version to be published and agrees to be accountable for all aspects of the work. VA contributed substantially to the design of the work, as well as data analysis and interpretation. She also revised the manuscript critically for important intellectual content and gave final approval of the version to be published, and agrees to be accountable for all aspects of the work. KZ contributed substantially to the acquisition of data, revised the manuscript critically for important intellectual content, gave final approval of the version to be published and agrees to be accountable for all aspects of the work. RW contributed substantially to conception and design of the work, as well as data acquisition, analysis and interpretation. She also drafted and revised the work, gave final approval of the version to be published and agrees to be accountable for all aspects of the work.

Acknowledgements and Funding

The authors acknowledge the PSOM Summer Research Program, the ISMMS Summer Research Investigators Program, Medical Student Training in Aging Research, the Patricia Levinson Summer Fellowship Program, the Center for Community and Minority Affairs (CMCA) and the Arnhold Institute for Global Health for funding and support.

Conflicts of interest

We have no conflicting interests to report.

Ethical approval

Approval was obtained from the Institutional Review Boards of the University of Chicago Pritzker School of Medicine (IRB 15-0270) and the Icahn School of Medicine at Mount Sinai (HSM 15-00458). Both IRBs gave this study exempt status.