Mapping Emotions to Appraisals and Performance in Authentic Medical Learning Environments

• In Event: Emotions in Medical Education: Causes and Effects

Abstract

Rationale. Researchers have recently advocated for the use of control-value theory of achievement emotions as a guiding framework to understand the role of emotions in medical education (Artino et al., 2012). According to this theory, learners’ appraisals of how “in control” they are of their performance and how much they “value” the task influence their emotional states, which in turn impact cognitive processes and performance (Pekrun, 2006). Our research examines relations between medical trainees’ appraisals of control and value for medical learning tasks with emotional states, self-efficacy, and performance. Specifically, we asked: what are the relations between appraisals (control/value), emotions (positive/negative), and learning outcomes (self-efficacy/performance)? A unique contribution of this research is our focus on authentic learning environments (problem-based simulation, real-world training).

Method. Fifty medical trainees volunteered to participate in this research. Within the surgical environment (OR), 16 medical residents and final-year students (n=3 female) conducted a vein-harvest procedure within the OR under supervision. The mean age was 30.31 (SD=5.51); mean year of residency was 2.19 (SD=2.20). Within the computer-based learning environment, BioWorld (Lajoie, 2009), 15 medical students (n=10 female) solved virtual patient cases. The mean age was 24.33 (SD=3.44); mean year of medical school was 3.73 (SD=1.33). Within the deteriorating patient simulation environment (Wiseman & Labelle, 2015), 19 fourth-year medical students (n=14 female) participated in emergency care role-play simulations. The mean age was 27.53 (SD=4.06). Within each environment, participants completed the Medical Emotions Questionnaire (MEQ; Duffy et al., 2015) in reference to 3 time points (before, during, after task). The MEQ measured appraisals, emotions, and self-efficacy. Performance was assessed using context-specific measures for each environment (global rating scale for technical skills in the OR, accuracy in clinical reasoning for BioWorld, procedural knowledge test for DP case).

Results. Correlation analyses revealed that control appraisals were positively correlated with positive activating emotions (r= .24, p< .05) and positive deactivating emotions (r= .39, p< .01), and negatively correlated with negative activating emotions (r= -.37, p< .01) and negative deactivating emotions (r= -.29, p< .05). Value appraisals were positively correlated with positive activating emotions (r= .34, p< .01). Learning outcomes were significantly correlated with emotions. Specifically, self-efficacy beliefs after the task were positively correlated with positive deactivating emotions before the task (r= .25, p< .05) and negatively correlated with negative activating emotions during the task (r= -.27, p< .05). Performance was negatively related to negative activating emotions during (r= .26, p< .05) and after the task (r= -.27, p< .05), as well as negative deactivating emotions during the task (r= .43, p< .01). Hierarchical regression analysis revealed that a model including negative activating/deactivating emotions and control significantly predicted performance, F(4, 45)=2.60, p< .05, and accounted for 19% of the variance in performance (Adjusted R2= .12).

Significance. This research takes an important step towards establishing the utility of control-value theory of achievement emotions in understanding the role of emotions in medical training. Additional analyses will be reported that examine differences in discrete emotions across time, environment, and skill level, as well as antecedents identified through qualitative analyses of interviews.

Authors

• Melissa Duffy, McGill University

• Susanne P. Lajoie, McGill University

• Reinhard Pekrun, University of Munich

• Kevin Lachapelle, McGill University