의과대학 2학년 학생의 동기부여신념, 정서, 성취(Med Educ, 2010)

의과대학 2학년 학생의 동기부여신념, 정서, 성취(Med Educ, 2010)

Second-year medical students’ motivational beliefs, emotions, and achievement

Anthony R Artino,1 Jeffery S La Rochelle2 & Steven J Durning2

INTRODUCTION

안타깝게도, 개개인을 성공에 이르게 하는 요인은 잘 이해된 바 없다. 더 나아가 의학교육 문헌들은 인지적 요인에 우선적으로 초점을 맞추고 있다(과거 학업성취, 표준화 시험 점수). 이들은 small to moderate 정도의 분산만을 설명해줄 뿐이다.

Unfortunately, the factors that lead to individual success are not well understood. Moreover, the medical education liter- ature tends to focus primarily on cognitive factors (e.g. prior academic achievement and standardised test scores), which typically explain only small to moderate amounts of variance in academic out- comes.2,3

최근, 정서적 요인의 중요성(동기부여와 감정)이 관심을 받고 있다. 이들 교육연구자들은 인지적 요인 단독의 효과를 넘어서 어떻게 감정이 성취성과에 영향을 주는지를 연구하고 있다. 본질적으로, 이들 연구자들은 인간의 마음은 단순히 정보를 처리하고 인지라는 것은 정보를 조작하는 것이며, 학습은 정보를 습득하고 저장하는 것이라는 식으로 학습을 컴퓨터에 비교하는 지나치게 단순화된 비유에 반대하는 것이다. 대신, 교육심리학자들은 인간의 사고는 훨씬 더 알쏭달쏭하며, 신축성있고, 동기부여와 감정에 영향을 받는다고 본다. 이러한 복잡성을 감안하면, 현재의 학습과 수행에 관한 모델은 정서적 요인을 고려해야 한다.

Recently, the importance of affective factors (e.g. motivation and emotion) has received greater emphasis among educators in fields outside medi- cine.4,5 In particular, these educational researchers have begun to explore how affect might ultimately influence achievement outcomes, above and beyond the effects of cognitive factors alone.6,7 In essence, these educators have argued against the over-sim- plified computer metaphor of learning, whereby the human mind is simply a processor of informa- tion, cognition primarily involves the manipulation of that information, and learning is merely the acquisition and storage of information. Instead, contemporary educational psychologists have proposed that human thinking is much more ‘fuzzy’ and flexible, and is subject to motivations and emotions that may serve multiple purposes at any given time.8 Given this complexity, current models of learning and performance often include consideration for affective factors.

이론적 프레임워크

Theoretical framework

사회인지이론에서는 인간의 기능functioning이 다음의 세 가지 요인이 역동적이고 상호작용는 것이라고 본다.

Social cognitive theory assumes that human functioning results from the triadic, dynamic and reciprocal interaction of

• 개인적 요인(신념, 기대, 태도, 이전 지식)
  personal factors (e.g. beliefs, expectations, attitudes and prior knowledge),

• 행동(개별적 행동, 선택, 말)
  behav- iours (e.g. individual actions, choices and verbal statements), and

• 사회적, 물리적 환경(자원, 행동의 결과, 타인, 물리적 환경)
  the social and physical environment (e.g. resources, consequences of actions, other people and physical settings).9

 

따라서 그림 1의 모델은 학생이 자신의 능력과 학습활동의 가치에 대해서 갖는 동기부여적 신념에 영향을 주는 학습환경의 맥락적 특성들(과제 특성, 교육 자원, 사회-문화 요인)을 나타낸 것이다. 즉, 이들 신념은 감정에 영향을 미치는데 즐거움, 불안 등이 그것이다. 이 감정들은 다양한 학업성과와 연결되어 있다.

Thus, the model in Fig. 1 proposes that contextual features of the learn-ing environment (e.g. task characteristics, instruc- tional resources and other broader socio-cultural factors) affect students’ motivational beliefs about their capabilities and the value of learning activities. In turn, these beliefs influence discrete achievement emotions, such as enjoyment and anxiety,6 which then link to various academic outcomes, such as student achievement and satisfaction.

이 연구에서는 의과대학생의 학업적 성취를 예측하기 위하여 동기부여적 신념motivational belief와 성취관련 감정achievement emotion을 사용하였다. 동기부여적 신념에 대해서는 두 가지 구인을 고려하였다. 하나는 과제의 가치task value이고, 다른 하나는 학업적 자기효능감이다.

In this study, motivational beliefs and achievement emotions were used to predict medical students’ academic achievement in an introductory clinical reasoning course. In terms of motivational beliefs, two constructs were considered.

• Task value: 어떤 과목이 얼마나 재밌고, 중요하고, 유용한지에 대한 학생의 판단. 비-의학 분야에서는 TV가 높을수록 다양한 주요 성과(미래 학습활동에 대한 선택, 학업 성취)가 높다.
  The first is task value, which can be defined as students’ judgements of how interesting, important and useful a course is to them.10 Research in non-medical contexts has typi- cally demonstrated that task value beliefs positively predict many important outcomes, such as choice of future learning activities10 and academic achievement.11

• 학업적 자기효능감Academic self-efficacy: 특정 학업 과제를 성공적으로 수행할 수 있다고 판단하는 정도. SE가 높을수록 다양한 학업성과에 영향을 준다.
  The second motivational belief examined was academic self-efficacy, which can be defined as stu- dents’ judgements of their capabilities to successfully perform specific academic tasks.9 Generally, research has shown that self-efficacy beliefs positively influence many academic outcomes, including, for example, choice of activities,12 level of effort13 and academic achievement.14

성취감정Achievement Emotion은 개인적 요인의 두 번째 부분이다. Pekrun은 AE의 통제-가치 이론을 제안하였다. 통제-가치 이론Control-value theory은 AE가 성취-관련 활동과 연관된 개별 감정들이라고 정의했으며, 여기에는 즐거움(새로운 것을 배울 때의), 불안(고부담 시험에 대한), 지루함(길고 재미없는 강의) 등이 있다. Pekrun에 따르면, AE는 개인의 Motivational belief(SE, TV)에 의해 결정된다.

Achievement emotions represent the second set of personal factors in the conceptual model. Pekrun6 has proposed a control-value theory of achievement emotions. Control-value theory defines achievement emotions as discrete emotions that are associated with achievement-related activities such as, for example, the enjoyment that often comes from learning some- thing new, the anxiety associated with taking a high- stakes examination or the boredom that may occur during a long, uninteresting lecture. According to Pekrun,6 achievement emotions are determined, in part, by individuals’ motivational beliefs, such as self- efficacy and task value beliefs. Limited educational research in secondary schools and post-secondary universities has indicated that achievement emotions predict students’ use of learning strategies, choice of future courses and academic achievement.15,16

개념 모델에서 묘사된 관계는 상호적이다.

Finally, consistent with social cognitive theory, the relationships depicted in the conceptual model are assumed to be reciprocal.

 

 

방법

METHODS

참여자

Participants

F Edward He´bert School of Medicine의 2학년 학생. 미국의 유일한 federal medical school.

The participants were second-year medical students enrolled in the F Edward He´bert School of Medicine, Uniformed Services University of the Health Sciences (USU). The USU is the only US federal medical school and matriculates approximately 170 medical students each year.

교육 맥락

Instructional context

2학년 시작시 임상추론입문ICR 과목

The instructional context was a second-year course called Introduction to Clinical Reasoning (ICR). This course was chosen for the present study because it represents students’ first exposure to clinical decision making

진행: 강의와 소그룹 세션

Generally speaking, each ICR session

• begins with an overview lecture on the topic,

• which is followed by mandatory small-group sessions on the topic.

 

강의의 목표: 용어/병태생리/실제 접근

In the overview lecture (30–50 minutes), the general goals are:

• to teach relevant terminology;

• to review and reinforce pertinent pathophysiology, and

• to illustrate a practical approach to the topic.

 

소그룹 세션의 목표(1)

In the small-group sessions, the general goals are two- fold:

• to illustrate major diagnostic entities encom- passed within the topic, and

• to teach typical ‘patterns’ of presentation for these diagnostic entities and key decision points to help students arrive at the diagnosis.

소그룹 세션의 목표(2)

This second general goal of the small-group session includes teaching students to

• identify key findings,

• recognise problems and construct problem lists,

• build clinical vocabulary,

• identify syndromes,

• compare and contrast similar diagnoses seen with a given topic, and

• formulate a differential diagnosis that the student can defend using the presenting data.

절차

Procedures

척도

Measurements

설문

Surveys

1/3 종료 후 설문

End-of-trimester 1 survey

MB를 다음을 가지고 측정

Students’ motivational beliefs were measured using two subscales adapted from Artino and McCoach:18

• 1 a 6-item task value subscale assessed students’ judgements of how interesting, important and useful the clinical reasoning course was to them, and 

• 2 a 5-item self-efficacy subscale assessed students’ confidence in their ability to learn the material presented in the course.

약간의 워딩 변화

Several minor wording changes were made to the motivational beliefs subscales;

2/3 종료 후 설문

End-of-trimester 2 survey

AE를 다음을 가지고 측정

Students’ achievement emotions were measured using a shortened version of the class-related emo- tions section of the Achievement Emotions Ques- tionnaire (AEQ):19

• 1 a 4-item enjoyment subscale assessed students’ course-related enjoyment; 

• 2 a 6-item anxiety subscale assessed students’ course-related anxiety, and 

• 3 a 5-item boredom subscale assessed students’ 3 course-related boredom.

약간의 워딩 변화

Once again, changes were made to the original subscales to reflect the specific medical education context studied here.

학업성취

Achievement outcomes

Course examination grade

National board shelf examination score

분석

Analysis

Prior to analysis, the data were screened for accuracy and missing values, and each survey item was checked for normality. Following data screening, three sets of analyses were conducted.

• First, confir- matory factor analysis (CFA) techniques were used to validate the hypothesised survey structure and identify survey modifications that would result in a refined, more parsimonious measurement model.

• Factors identified in the CFA were then subjected to reliability analysis, and descriptive statistics and Pearson correlations were calculated.

• Finally, a causal model was estimated using structural equa- tion modelling (SEM). Built upon the multivariate techniques of factor and path analysis, SEM is a flexible and powerful statistical tool that allows researchers to test a priori hypotheses regarding the inter-relationships between both observed and latent variables (for a detailed explanation of SEM and its applicability in medical education research, see Violato and Hecker22).

In the present study, the aim of the SEM was to test the hypothesised linear relations between the latent beliefs and emotions variables and students’ academic achievement.

All CFA and SEM analyses were conducted using AMOS 7.023 and the remainder of the analyses were conducted using SPSS 16.0 (SPSS, Inc., Chicago, IL, USA).

 

결과

RESULTS

대부분의 종단연구에서 자료의 결측과 (연구대상자의) attrition은 흔한 문제이다.

In most longitudinal studies, missing data and attri- tion are frequent problems; this study was no excep- tion. Among the 174 students enrolled in the ICR course, 136 agreed to complete both surveys (giving a 78% response rate). The sample included 86 men (63%) and 50 women; their mean age was 24.9 years (SD = 1.5).

 

CFA

Confirmatory factor analysis

두 설문의 convergent와 discriminant validity를 검사하기 위하여 시행. MLE가 사용되었고, chi-square가 model fit을 평가하기 위해서 사용됨. 일반적으로 chi-square에서 유의하지 않은 결과가 good model fit을 의미한다. 그러나 chi-square 검사는 샘플 크기와 상관관계의 크기에 영향을 받기 때문에, 연구자들은 chi-square에만 의존하지 않는다. 여기에 몇 가지 추가적인 fit indices를 사용하는데, 여기에는 자유도 비율degrees of freedom ratio, CFI, RMSEA등이 있다.

A CFA was conducted to examine the convergent and discriminant validity of the two surveys. Maximum likelihood estimation was used to esti- mate the parameters and a chi-square test was conducted to assess model fit. Generally, a non- significant chi-square result indicates a good model fit.24 However, because the chi-square test is affected by the sample size and the size of the correlations in the model, researchers do not normally rely on the chi-square test as the sole measure of model fit. Therefore, several additional fit indices were considered together with the chi-square test. These indices included the chi-square : degrees of freedom ratio (also referred to as the normed chi-square statistic), the com- parative fit index (CFI), and the root-mean-square error of approximation (RMSEA).

26개의 문항을 다섯 개의 latent variable에 load함.

The 26 survey items used in this study were hypoth- esised to load onto five distinct latent variables: task value, self-efficacy, enjoyment, anxiety and boredom. Based on the model fit guidelines outlined by Hu and Bentler,25 the resulting goodness-of-fit indices indicated that the model fit the data only marginally well. In particular, the chi-square result was statisti- cally significant (v2 [289, n = 136] = 565.89, p < 0.001), and although the normed chi-square statistic (1.96) was < 3.0, the CFI (0.80) was < 0.90 and the RMSEA (0.08) was > 0.06 (the latter two statistics indicated a marginal model fit).

model fit을 개선하기 위해서 최종 solution을 위한 trimming시행. SE척도에서 하나 배제, Anxiety에허 두 개 배제.

Next, in an attempt to improve model fit, standar- dised residuals and modification indices were exam- ined and five items were identified as having large standardised residuals and⁄ or large modification indices. Because one of the objectives of the CFA was to further refine the measurement model, these five items were trimmed from the final solution (see recommendations in Brown).26 The trimmed items included one item from the self-efficacy scale (‘I’m confident I can learn in the context of the small-group sessions’), two items from the anxiety scale (‘I feel uneasy during the small-group discussion sessions’ and ‘I feel nervous during the small-group discussion sessions’) and two items from the boredom scale (‘I feel this course is fairly dull’ and ‘I’m generally uninterested in the course material’).

두 번째 CFA가 시행되었고, 결과가 향상됨.

Following the trimming procedure, a second CFA was conducted; all fit indices improved as a result of these modifications. The chi-square result remained statistically significant (v2 [179, n = 136] = 259.92, p < 0.001); however, the normed chi-square result (1.45) went down to < 3.0, the CFI (0.92) went up to > 0.90 and the RMSEA (0.05) went down to < 0.06, all indicating that the revised model was an adequate fit to the data. The survey items retained in the final solution are provided in Table 1, along with their means and SDs.

Descriptive statistics and Pearson correlations

 

 

Evaluating the structural equation model

DISCUSSION

의학 외 다른 교육연구에서는 정서요인을 중요하게 인정하고 있음.

Recently, educational researchers in fields outside medicine have acknowledged the critical role per- sonal affective factors, like motivation and emotion, play in learning and performance.4–8,11

이번 연구의 결과는 가설로서 제기한 일부 관계를 지지해줌. 특히 TV는 Enjoyment, Boredom과 연관이 있었음. 이것은 통제-가치 이론의 연구결과와도 부합하는 것으로, 그 과목이 흥미롭고 유용하다고 생각하는 학생일수록 그것을 공부하는게 즐겁고, 덜 지루하다. 유사하게 학생의 SE는 Anxiety와 부적 상관관계에 있었다. 즉, 더 그 과목을 잘 할수 있다고 생각하는 학생일수록 불안을 덜 느낀다. 이 역시 통제-가치 이론과 부합하며, Bandura가 원래 개념화한 자기효능감, 그리고 그것이 학습의 정서적 요소에 미치는 영향과도 부합한다. 더 나아가서 이들 연구결과는 의학교육자들이 학생의 TV와 SE를 가지고 학생의 성취 감정향상을 볼 수 있음을 시사한다.

Findings from this study provide some support for the hypothesised relationships. Specifically, task value beliefs were positive predictors of students’ course- related enjoyment and negative predictors of their reported boredom. Thus, the direction and magni- tude of these effects, which are consistent with previous empirical work using control-value theory,6,15,16 suggest that students who believed the course was interesting, important and useful were also more likely to enjoy it and less likely to become bored. Similarly, students’ academic self-efficacy was a negative predictor of anxiety, indicating that those who were confident they could learn the course material were also less likely to experience course- related anxiety. The direction and size of this effect is also consistent with control-value theory6,15,16 and Bandura’s9 original conceptualisation of self-efficacy and its influence on affective components of learn- ing. Further, these results suggest that medical educators may observe improvements in students’ achievement emotions by first addressing students’ task value beliefs and self-efficacy perceptions (for specific instructional recommendations, see Schunk et al.11).

성취감정에 있어서, Enjoyment는 NBME점수와, Anxiety/Boredom은 과목 성적과 관련이 있었음. 즉, '즐거움enjoyment'는 의과대학에서 진행되는 이후 성취도에 영향을 주며, Anxiety/Boredome은 보다 즉각적, 과목-관련 학업성취에 영향을 준다.

In terms of achievement emotions, course-related enjoyment was positively related to students’ NBME shelf examination scores, whereas both anxiety and boredom were negatively related to students’ course examination grades. These results suggest that enjoyment, a positive emotion, may have important direct effects on subsequent achievement outcomes in medical school. By contrast, anxiety and boredom, both negative emotions, may have direct effects on more immediate, course-related achievement outcomes.

 

이 정도의 medium effect size는 limited empirical evidence와 부합.

Finally, the overall effects for the model were R2 = 0.20 and 0.14 for the course examination grade and national board shelf examination score, respec- tively. These medium effect sizes are consistent with the limited empirical evidence linking achievement emotions to scholastic achievement.6,15,16

의학교육에 대한 함의

Implications for medical education

의대생들은 high-functioning하고 successful하며, 본질적으로 강력한 동기부여신념이 있고, 부정적 감정을 잘 조절할 수있는 대응기전을 갖추었다는 은연중의 가정이 있다. 비록 본 연구결과는 강력한 동기부여신념을 지지해줄지는 모르나, 부정적인 성취감정의 영향에 면역이 되어있지는 않다는 것을 보여준다.

There is an implicit assumption that medical students are predominantly high-functioning and successful, and possess inherently strong motiva- tional beliefs and advanced coping mechanisms with which they can assuage negative achievement emotions. Although the results presented here do confirm the presence of strong motivational beliefs, the findings suggest that medical students are not immune to the effects of negative achievement emotions.

교육자들은 과목의 구조/내용/교육법/점수체계 등을 고려하고, 이것들이 MB와 AE에 어떻게 영향을 주는지 고려해야 함.

In addition, these findings suggest that educators should consider course structure, content, teaching method and grading scheme – and how these factors might impact both motivational beliefs and achievement emotions over time – as these personal factors could potentially affect other important performance outcomes.

6 Pekrun R. The control-value theory of achievement emotions: assumptions, corollaries, and implications for educational research and practice. Educ Psychol Rev 2006;18:315–41.

22 Violato C, Hecker KG. How to use structural equation modelling in medical education research: a brief guide. Teach Learn Med 2007;19:362–71.

 

 

 

 

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Med Educ. 2010 Dec;44(12):1203-12. doi: 10.1111/j.1365-2923.2010.03712.x.

Second-year medical students' motivational beliefs, emotions, and achievement.

Artino AR1, La Rochelle JS, Durning SJ.

Author information

• 1Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712, USA. anthony.artino@usuhs.mil

Abstract

CONTEXT:

A challenge for medical educators is to better understand the personal factors that lead to individual success in medical school and beyond. Recently, educational researchers in fields outside medicine have acknowledged the importance of motivation and emotion in students' learning and performance. These affective factors have received less emphasis in the medical education literature.

OBJECTIVES:

This longitudinal study examined the relations between medical students' motivational beliefs (task value and self-efficacy),achievement emotions (enjoyment, anxiety and boredom) and academic achievement.

METHODS:

Second-year medical students (n=136) completed motivational beliefs and achievement emotions surveys following their first and second trimesters, respectively. Academic achievement was operationalised as students' average course examination grades and national board shelf examination scores.

RESULTS:

The results largely confirmed the hypothesised relations between beliefs, emotions and achievement. Structural equation modelling revealed that task value beliefs were positively associated with course-related enjoyment (standardised regression coefficient [β] = 0.59) and were negatively related to boredom (β= -0.25), whereas self-efficacy beliefs were negatively associated with course-related anxiety only (β = -0.47). Furthermore, student enjoyment was positively associated with national board shelf examination score (β = 0.31), whereas anxiety and boredom were both negatively related to course examination grade (β= -0.36 and -0.27, respectively). The overall structural model accounted for considerable variance in each of the achievement outcomes: R(2) = 0.20 and 0.14 for the course examination grade and national board shelf examination score, respectively.

CONCLUSIONS:

This study suggests that medical students' motivational beliefs and achievement emotions are important contributors to their academic achievement. These results have implications for medical educators striving to understand the personal factors that influence learning and performance in medical training.

© Blackwell Publishing Ltd 2010.

PMID:

 

21091760

 

[PubMed - indexed for MEDLINE]