THE ASSOCIATION BETWEEN CANMEDS ROLE-SPECIFIC IMPLICIT THEORIES OF INTELLIGENCE AND PLANNING FOR RESIDENT REMEDIATION

This thesis explores two components of motivational theory that have been unexplored in the context of medical education. First, we applied the notion of motivational dimensionality to physician competence. Previous research on implicit theories of intelligence demonstrated that people hold different beliefs regarding different aspects of intelligence/ability, instead of a global mindset. We applied this to the CanMEDS Framework and showed that respondents held different theories of intelligence regarding the Professional and Medical Expert Role. Second, we aimed to determine if one’s implicit theories are related to their decisions around remediation planning. We hypothesized that respondents would view remediation as either an opportunity for a resident to develop competence or as an opportunity for them to demonstrate their fundamental lack of ability. Here, we showed that one’s own beliefs, or theories of intelligence, not only mediate how they behave in the training environment, but also mediate how they manage others. In the first of two studies, we measured implicit theories amongst residents, faculty, and experts in medical education at McMaster University regarding both the Professional and Medical Expert CanMEDS Roles and asked them how much effort would be required for a resident to remediate performance deficits in either Role. The second study took place at University of Toronto and involved a similar design. Residents and faculty in the Department of Obstetrics and Gynaecology were invited to participate in a study that measured implicit theories of intelligence and then asked respondents to develop remediation plans for residents described in case vignettes. Drawing on experience in the Board of Examiners, 6 cases were developed, 3 that represented Medical Expert deficits, and 3 that described Professional deficits. The results showed that respondents viewed the Professional Role as relatively more “fixed” than the Medical Expert Role. Those views corresponded to stricter remediation planning, characterized by a short duration of remediation, stricter consequences of failure, and a lower perceived likelihood of success paired with a higher perceived likelihood of Professional deficits in the future. These results supported the hypotheses that the implicit theories of intelligence differ according to the dimension of physician competence in question. Professional was considered to be more fixed, relative to Medical Expert, and in keeping with the theorization, the resultant remediation plans appeared more as an opportunity to demonstrate a fundamental lack of ability than an opportunity for the resident to develop competence. These findings are consistent with those in other studies, where a fixed theory of intelligence was associated with a “helpless” behaviour pattern, characterized by low persistence, and challenge avoidance. We were able to show that one’s implicit theories extend beyond the self and can influence how an individual manages the education of another. This work sheds light on some of the factors that man influence remediation decision-making and adds to the conversation surrounding professionalism as competency versus an attribute.

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