The effect of a brief social intervention on the examination results of UK medical students: a cluster randomised controlled trial

Effectiveness of Self-Affirmation Interventions in Educational Settings: A Meta-Analysis

School and university can be stressful contexts that can become an important source of identity threats when social prejudices or stereotypes come into play. Self-affirmation interventions are key strategies for mitigating the negative consequences of identity threat. This meta-analysis aims to provide an overview of the effectiveness of self-affirmation interventions in educational settings. A peer-reviewed article search was conducted in January 2023. A total of 144 experimental studies that tested the effect of self-affirmation interventions in educational contexts among high school and university students from different social and cultural backgrounds were considered. The average effect of self-affirmation interventions was of low magnitude (dIG+ = 0.41, z = 16.01, p < 0.00), with a 95% confidence interval whose values tended to lie between 0.36 and 0.45 (SE = 0.0253). In addition, moderators such as identity threat, participants' age, and intervention procedure were found. Through a meta-analysis of the impact of self-affirmation interventions in educational contexts, this study suggests that interventions are effective, resulting in a small mean effect size. Thus, self-affirmation interventions can be considered useful, brief, and inexpensive strategies to improve general well-being and performance in educational settings.

The effects of adolescent physical activity participation on cell phone dependence: The mediating role of self-control

BACKGROUND: The rapid development of science and technology and the swift improvement of people’s material living standards enabled smartphones to be indispensable of people’s daily lives. OBJECTIVE: The purpose of this paper was to examine the influence of self-control in adolescents’ participation in physical activity on cell phone dependence. METHODS: The Physical Activity Rating Scale (PARS-3), the Self-Control Scale, and the Cell Phone Dependence Scale were used to measure the influence of self-control in adolescents’ participation in physical activity on cell phone dependence among 649 adolescents. RESULTS: The results show: (1) There were significant differences (p < 0.01) in the physical activity levels of adolescents under different gender, birthplace, and education background. (2) Each dimensional variable of physical activity was negatively correlated with the cell phone dependence variable, and positively correlated with each variable of self-control, and the self-control variables were negatively correlated with cell phone dependence. (3) Self-control was partially mediating the effects of physical activity on cell phone dependence, with the mediating effect accounting for 39.68%. CONCLUSIONS: Adolescents’ participation in physical exercise activities will improve self-control and ultimately reduce cell phone dependence. Curbing the negative and malignant events of cell phone addiction among adolescents, timely investigation of mobile phone and Internet addiction, pathological formation mechanisms and intervention measures are important measures to reshape the healthy lifestyle of adolescents and have great practical significance for the prosperity and development of families, society, nation and country.

The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools

INTRODUCTION

Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research.

METHODS

Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows.

RESULTS

We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices).

CONCLUSIONS

Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.

Testing a Self-Affirmation Intervention for Improving the Psychosocial Health of Black and White Medical Students in the US

Self-affirmation interventions have been shown to mitigate the negative psychological effects of stereotype threat on Black students in secondary and undergraduate education. However, there is currently limited research testing whether Black students in medical schools may also experience the negative influences of stereotype threat. Until now, it has been unclear whether Black (vs. White) students experience a lower sense of belonging in medical school and whether they can benefit from self-affirmation interventions during medical training. With a longitudinal field experiment, we tested (a) whether Black (vs. White) medical students in the US experience decrements in psychological well-being (i.e., fatigue, depression, anxiety), sense of belonging, perceived residency competitiveness, and residency goal stability; and (b) the extent to which a self-affirmation intervention would ameliorate any observed disparities in these outcomes for Black students. With a sample of 234 Black and 182 White medical students across 50 schools in the US, we found that Black students tended to report more fatigue and less belonging than White students; however, the self-affirmation intervention did not significantly influence students' fatigue, depression, anxiety, or belonging. Unexpectedly, Black students in the self-affirmation (vs. control) condition reported lower perceived competitiveness for residency. White students' perceived competitiveness for residency was unaffected by the intervention. Exploratory analyses revealed that Black (vs. White) students were less likely to indicate stable residency goals over time, which may be an indication of threat; however, this racial gap was eliminated with the intervention. We discuss the plausible reasons for these findings and provide recommendations for future work in this area.

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise

BACKGROUND

Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors.

METHOD

Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail.

RESULTS

Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs.

CONCLUSIONS

Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.

Reconceptualizing Self-Affirmation With the Trigger and Channel Framework: Lessons From the Health Domain

Self-affirmation—a theory-based technique to affirm the adaptive adequacy of the self—can promote positive behavior change and adaptive outcomes, although effects are variable. We extend a novel framework (Trigger and Channel), proposing three conditions that facilitate self-affirmation-induced behavior change: (a) presence of psychological threat, (b) presence of resources to foster change, and (c) timeliness of the self-affirmation with respect to threat and resources. Using health behavior as a focus, we present meta-analytic evidence demonstrating that when these conditions are met, self-affirmation acts as a psychological trigger into a positive channel of resources that facilitate behavior change. The presence of a timely threat and the availability of timely resources independently predicted larger self-affirmation effects on behavior change, and the two interacted synergistically to predict still larger effects. The results illustrate the conditionality of self-affirmation effects and offer guidelines for when, where, and for whom self-affirmation will be most effective.

A Values Affirmation Intervention to Improve Female Residents' Surgical Performance

BACKGROUND

Female residents in surgical training may face stereotype threat. The awareness of negative stereotypes about surgical ability based on gender may heighten stress and thus reduce performance.

OBJECTIVE

The main objective of this study was to assess the effectiveness of a brief stress-reducing writing exercise, known as a values affirmation, to mitigate the negative effects of stereotype threat on the performance of female surgical residents.

METHODS

This is a randomized, controlled trial in which 167 residents were invited to participate. A total of 45 resident volunteers, including 18 women, were randomized to the affirmation condition or the no-affirmation condition. We administered a values affirmation intervention and measured clinical evaluations data both prior to and 6 months after the intervention.

RESULTS

Women benefited from the affirmation. Women who had participated in the affirmation exercise earned higher clinical evaluation scores than those in the control condition (B = 0.34, P < .05). For men, performance did not differ by affirmation condition (B = -0.20, P = .35).

CONCLUSIONS

Our findings suggest a benefit of values affirmation for women in surgical training, as measured by performance on clinical evaluations. This suggests that a brief psychological intervention may improve on-the-job performance for women in surgery, an underrepresented group.

Bridging the gap: the roles of social capital and ethnicity in medical student achievement

OBJECTIVES

Within medical education, there is a discrepancy between the achievement level of White students and that of their ethnic minority peers. The processes underlying this disparity have not been adequately investigated or explained. This study utilises social network analysis to investigate the impact of relationships on medical student achievement by ethnicity, specifically by examining homophily (the tendency to interact with others in the same group) by ethnicity, age and role.

METHODS

Data from a cross-sectional social network study conducted in one UK medical school are presented and are analysed alongside examination records obtained from the medical school. Participants were sampled across the four hospital placement sites; a total of 158 medical students in their clinical phase (Years 3 and 4) completed the survey. The research was designed and analysed using social capital theory.

RESULTS

Although significant patterns of ethnic and religious homophily emerged, no link was found between these factors and achievement. Interacting with problem-based learning (PBL) group peers in study-related activities, and having seniors in a wider academic support network were directly linked to better achievement. Students in higher academic quartiles were more likely to be named by members of their PBL group in study activities and to name at least one tutor or clinician in their network. Students from lower-achieving groups were least likely to have the social capital enabling, and resulting from, interactions with members of more expert social groups.

CONCLUSIONS

Lower levels of the social capital that mediates interaction with peers, tutors and clinicians may be the cause of underperformance by ethnic minority students. Because of ethnic homophily, minority students may be cut off from potential and actual resources that facilitate learning and achievement.

The psychology of change: self-affirmation and social psychological intervention

People have a basic need to maintain the integrity of the self, a global sense of personal adequacy. Events that threaten self-integrity arouse stress and self-protective defenses that can hamper performance and growth. However, an intervention known as self-affirmation can curb these negative outcomes. Self-affirmation interventions typically have people write about core personal values. The interventions bring about a more expansive view of the self and its resources, weakening the implications of a threat for personal integrity. Timely affirmations have been shown to improve education, health, and relationship outcomes, with benefits that sometimes persist for months and years. Like other interventions and experiences, self-affirmations can have lasting benefits when they touch off a cycle of adaptive potential, a positive feedback loop between the self-system and the social system that propagates adaptive outcomes over time. The present review highlights both connections with other disciplines and lessons for a social psychological understanding of intervention and change.

Predicting who applies to study medicine: implication for diversity in UK medical schools

AIMS

Widening access to medical school is a priority in medical selection. If disadvantaged students do not apply, interventions cannot be effective. To date, no studies have examined factors that predict who chooses to apply to medicine and if socio-demographics influence the profile of those who apply to study medicine.

METHODS

A large database provided by the UK University and Colleges Admissions Service on all 1,225,156 applicants to UK universities over a 3-year period (2002-2004) was analysed. The relationship between demographics, preference to study medicine and academic performance prior to entry (A level score) were explored using logistic and linear regression and path modelling.

RESULTS

Those applying to study medicine were more likely to be female, non-white, of higher socio-economic status and from fee-paying schools. Applying to study medicine was associated with increased academic entrance performance over and above socio-demographic factors. Importantly, in those applying to study medicine socio-demographic inequalities in entrance exam performance was either reduced (for ethnicity and SES) or abolished (for sex and schooling).

CONCLUSIONS

It is argued that early interventions are needed to increase applications for certain groups to help to reduce socio-demographic inequalities in entrance exam performance and hence medical school admissions.

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis

OBJECTIVE

To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts.

STUDY SELECTION

The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n = 23,742) indicated candidates of "non-white" ethnicity underperformed compared with white candidates (Cohen's d = -0.42, 95% confidence interval -0.50 to -0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses.

CONCLUSION

Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.

Stereotype threat and health disparities: what medical educators and future physicians need to know

Patients' experience of stereotype threat in clinical settings and encounters may be one contributor to health care disparities. Stereotype threat occurs when cues in the environment make negative stereotypes associated with an individual's group status salient, triggering physiological and psychological processes that have detrimental consequences for behavior. By recognizing and understanding the factors that can trigger stereotype threat and understanding its consequences in medical settings, providers can prevent it from occurring or ameliorate its consequences for patient behavior and outcomes. In this paper, we discuss the implications of stereotype threat for medical education and trainee performance and offer practical suggestions for how future providers might reduce stereotype threat in their exam rooms and clinics.