#10 Holding a Growth Mindset in Medical Education

February 15, 2022 | By Era Kryzhanovskaya

With Dr Nora Osman

Summary

Listen as our esteemed guest Dr Nora Osman discusses how a growth mindset is valuable to teachers and learners in medical education.  If we hold a fixed mindset, feedback and failures  don’t hold the nutritive potential they can as when we conceptualize them with a growth mindset.  We have to think deeply about how we can change the culture and structure of medical education to foster a growth mindset–one-off trainings are not the answer.

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Credits

• Producers, Hosts, Writers: Era Kryzhanovskaya MD / Molly Heublein MD
• Infographic/Cover art: Era Kryzhanovskaya MD 
• Editor:  Clair Morgan of nodderly (audio)
• Guest: Nora Yusuf Osman, MD

CME Partner: VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

Show Segments

• Intro, disclaimer, guest bio
• Guest one-liner/ Best piece of advice
• Picks of the Week
• Case from Kashlak- addressing failures
• Definitions
• How growth mindset impacts feedback
• Socio-Ecologic Model
• Changing the system to support growth mindset in med-ed
• Assessment of growth mindset
• Take home points
• Outro

Growth Mindset Pearls

1. Approaching setbacks or failures with a growth mindset leads these challenges to be  nutritive, energizing, a place to learn.  Conceptualizing failures from the place of a fixed mindset can invalidate the sense of self and discourage progress.
2. Holding a fixed mindset around medical education can impair honest feedback because it can be identity threatening; one’s observations may take an ego protective approach.  If you approach feedback from a growth mindset, redirecting comments and overall assessments can be productive and necessary for improvement.
3. We can’t embrace a growth mindset without taking a serious look at the way we are teaching medical knowledge and content.  We have taught that acquisition of knowledge is the place of success.  Instead, we could teach the goal of curiosity, failure as a process.  
4. We can use the socio-ecological model to consider how a growth mindset impacts multiple layers of medical training.

Growth Mindset

Definitions

Carol Dweck’s “self theories” or mindsets describe unconscious beliefs that can impact our ability to learn and grow (Theard 2021).  

Fixed mindset: a belief that talent, ability, skills are immutable, innate.  They cannot be improved, practice doesn’t help.  “I can’t draw”, “I’m a terrible athlete”.  Tends to be more performance oriented- looking for more external validation.  Less likely to seek out challenges or opportunities that may dispute that identity as failing can invalidate the sense of self.

Growth mindset: Talents, abilities are able to improved upon.  Challenge and failure are nutritive, energizing, it can help growth and development.  Has been linked with improved outcomes in many educational settings.

People may hold a fixed mindset in some aspects of their life but a growth mindset in others.  Not uncommon that someone may have a fixed mindset over education for example, “If I failed that test, maybe I shouldn’t be a doctor”, but that same learner might have a growth mindset around cooking, “I’ll learn new skills and recipes by making mistakes.”

Approaching situations of failure

When you’re dealing with a personal failure while trying to help learners, do a self check.  Be aware of your own perspective when approaching a conversation about a learner’s failure. Look internally.   Are you reading feedback as self-injurious, something that will be hard to overcome (a fixed mindset) or an opportunity for growth, something to move forward from (a growth mindset)?

When meeting with a learner or mentee for an on the fly conversation when someone catches her with her door open, Dr Osman says, “I can give you five minutes now, or I can give you more time later”.   This allows you to set expectations for the conversation and be present for the learners needs.

Approach the conversation with curiosity, consider the learner’s emotional place and perspectives, and normalize failure.  

Importance of growth mindset in medicine: Focus on Feedback

Holding a growth mindset versus a fixed mindset can impact giving and receiving feedback–the feedback conversation.  If you hold a fixed mindset around progress in medical education, you may be hesitant to give honest feedback because it can be identity threatening, and the feedback might hold on to an ego protective approach (e.g. injurious to self).  If you approach feedback from a growth mindset, it can be productive criticism (redirecting comments) and necessary for improvement (Carlson 2021).   

Dr Osman suggests giving feedback by focusing on specific truths of witnessed behaviors, with the goal of helping learners improve. Grounding the feedback in why you are sharing it!  “I’m telling you this because it’s important for patient care…”, “I’m sharing this with you because I want to help you grow…”  Focus on building trust and relationships is invaluable in feedback conversations.  

Using techniques from motivational interviewing can be helpful.  “Would it be helpful if I shared xyz with you?”   Sometimes sharing personal failures and the evolution of her attitude over time is a way Dr Osman helps learners relate and progress.

If feedback seems to elicit an emotional response, suggesting more of a fixed mindset, name that, “this seems to be landing hard.”  Dr. Osman also suggests asking the learner to write down what they heard from the conversation and email it back to understand how they are conceptualizing something.  

It can be helpful to have the feedback conversation with other trusted colleagues watching to help give you feedback on your feedback.

Socio-Ecological Model–apply growth mindset to the levels

Urie Bronfenbrenner‘s Socio-ecological model is a conceptual model that describes how relationships can be impacted by individual, interpersonal, organizational, cultural, and societal factors.  This is a model used frequently in the public health sphere.  

We can use this socio-ecological lens in cultivating a growth mindset (Osman 2020, Richardson 2021).

On the individual level– how do I personally perceptualize feedback, if I perceive it as injurious, I can’t be as honest.

Interpersonal level: In dyads: how can mentoring relationships embrace and foster the growth mindset.  Can I as the mentee embrace failure as nutritive and important for growth. Can the mentor be honest about failure?  

Institutional level: we’re good at this for patient safety- thinking about structures and systems that can contribute to medical errors for example.  In medical education, we could improve this significantly: when we hold the idea that we’re the best institutions, we get the best students, the best residents, it prevents us from actually doing the hard work of remediating and training (Dhaliwal 2021).  

Teaching about growth mindset

Growth mindset has been linked with success and is evaluated in a variety of other education and business, but less so in medicine; it’s a growing area of research (Wolcott 2021).  

We discuss that there are limitations to the success possible for an individual based on societal and other factors. Dr. Osman points out that a growth mindset alone is not enough to make someone the chair of their department.

Dr. Osman is hesitant to encourage growth mindset teaching and assessment without looking at the bigger structures in which we teach.   This is a paradigm shift: moving away from performance-oriented to mastery-oriented teaching and assessment.  Trying to teach growth mindset without broadly thinking about the way we teach across medical education and the structures within which we teach, is unlikely to be successful (Richardson 2021).    Cultivating a growth mindset needs a shift in medical education.  Dr Osman suggests a few options to foster this:  longitudinal experiences rather than block clerkships allow for a more developed relationships with preceptors, competency based, time variable education may be an approach, and normalizing feedback with “feedback friday” (or even normalizing a daily debrief after rounds) is important.  

Assessing growth mindset

It’s hard to change the way we look at assessment when we are not changing the way we are teaching.   We can’t embrace or foster a growth mindset without taking a serious look at the way we are teaching medical knowledge and content.  We have taught this acquisition of knowledge as the place of success.  Instead, we could teach the goal of curiosity, failure as a process.   Adding growth mindset “trainings” can’t really foster change.

Take home points:

We are all learning, and that’s important.  No one has all the answers.  Dr Osman is curious and would love to continue the conversation forward.  Be open to the idea that we can do better.

Links

1. Dr Osman suggests reading fiction in general.
2. Jennifer Egan, A Visit from the Goon Squad and “shame memories” 
3. Era’s pick of the week: Beautiful Country: A Memoir, by Qian Julie Wang
4. Molly’s pick of the week: The Nocturnists Podcast
5. Solomon SR, Atalay AJ, Osman NY.  Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education. Acad Med. 2021 Nov 1;96(11):1513-1517. doi: 10.1097/ACM.0000000000004251. PMID: 34292192.  Contact Dr Osman with any feedback: NOSMAN@BWH.HARVARD.EDU
6. Dhaliwal G, Hauer KE. Excellence in medical training: developing talent-not sorting it. Perspect Med Educ. 2021 Dec;10(6):356-361. doi: 10.1007/s40037-021-00678-5. Epub 2021 Aug 20. PMID: 34415554; PMCID: PMC8377327.
7. Onumah CM, Lai CJ, Levine D, Ismail N, Pincavage AT, Osman NY. Aiming for Equity in Clerkship Grading: Recommendations for Reducing the Effects of Structural and Individual Bias. Am J Med. 2021 Sep;134(9):1175-1183.e4. doi: 10.1016/j.amjmed.2021.06.001. Epub 2021 Jun 16. PMID: 34144012.

Goals

Listeners will become familiar with the role of growth mindset as it relates to medical education and the pipeline of future providers. 

Learning objectives

After listening to this episode, listeners will be able to…

1. Distinguish between fixed and growth mindsets in regards to personal traits and skills acquisition 
2. Describe the ways a growth mindset applies on a system-level, interpersonally, and individually in medical education
3. List steps educators can take to promote a growth mindset in their learning environments

Disclosures

Dr Osman reports no relevant financial disclosures. The Curbsiders Teach team report no relevant financial disclosures. 

Citation

Osman D, Heublein M, Kryzhanovskaya E. “#10 Holding a Growth Mindset in Medical Education. The Curbsiders Teach Podcast. http://thecurbsiders.com/teach.  February 15, 2022.