1. Locus of Control & Self-Efficacy Measures as Predictors of Resident’s Academic Performance Shailendra Prasad, MD, MPH, & Joseph Brocato, PhD, Department of Family Medicine and Community Health

2. Presentation Objectives –Describe Current resident assessment methods Describe key concepts of LOC & self-efficacy and their potential relationship to academic performance Describe the research design planned for the study –Identify the elements of two instruments to measure LOC & Self-Efficacy –State some of the implications of this study

3. Background Issues FM education is not uniform No standard experiential component to determine clinical exposure Breadth of training in Family Medicine is expansive and expanding

4. Global Challenges Residents from diverse background and different learning styles Patients don’t check board scores !!! Current academic measures may not be indicative of future performance Ill-defined, inconsistently applied, non- existent residency selection criteria

5. Current Methods of Resident Selection Limited mutual exposure/surface level assessment of candidates Traditional application materials (transcripts, boards, personal statement, letters of recommendation) Brief interview with PD, Residents, Faculty Program Extracurriculars (team fit): dinners, didactics Direct Observation : observerships, clinical rotations, other forms (rare)

6. Measures of resident’s academic performance In training examination (ITE) Board Scores Rotation based evaluations of medical knowledge Other evaluations –Structured & Unstructured

7. Newer Measures?

8. Key Concept: Locus of Control Originally described by Rotter in 1950s Individual’s perception of underlying causes of events in life Conceptualized as a unidimensional continuum from an internal to an external

9. Internal LOC “Actions are within ones control” General acceptance that internal LOC is desirable Studies in the 1980s - fewer people with internal LOC going into primary care

10. External LOC “Actions guided by outside factors” May be better for teamwork ? Could be learned and culturally determined Is this bad?

11. What do we know about LOC and physicians LOC may influence communication skills training- Belgian study- Libert et al Self-confidence and physical exam- Wu et al

12. Key Concept: Self Efficacy (i.e., Self-Assessment) Bandura (1997), Social Cognitive Theory –“Self-efficacy is concerned with people’s beliefs in their capabilities to produce given attainments” (perceived capability). –Note distinguishing principles: can do (capability) versus will do (intention). –People with high self-efficacy - that is, those who believe they can perform well - are more likely to view difficult tasks as something to be mastered rather than something to be avoided.

13. Research Questions from our Study What is the LOC & self-efficacy of FM residents (in terms of core knowledge and skill areas in FM)? Does this LOC & self-efficacy change over time? Are there differences in LOC & self-efficacy based on demographic differences? Are LOC & self-efficacy predictors of traditional academic performance during residency?

14. Research Design: Longitudinal Cohorts Five years in study length (allows for n=150) Year 1Year 2Year 3Year 4Year 5 Cohort 1 (G-1) Cohort 1 (G-2) Cohort 1 (G-3) Cohort 2 (G-1) Cohort 2 (G-2) Cohort 2 (G-3) Cohort 3 (G-1) Cohort 3 (G-2) Cohort 3 (G-3)

15. Research Design: Longitudinal Cohorts Off-cycle residents - tracked individually on their progression to PGY year Non-matriculating residents will be dropped from the study Transferring residents (both in/out) will not be included in the study (allows for n=150)

16. Research Design: Overview & Timeline Self Assessment of Knowledge and Skills & Locus of Control Assessment –PGY 1: During first month & during last month of internship/PGY 1 –PGY 2: During last month of PGY 2 –PGY 3: During last month of PGY 3 Resident Academic Performance –PGY 1: Board Scores, ITE Exams –PGY 2-3: Board Scores, ITE Exams –Post-residency?: Board Certification Exams?

17. Research Design: Respondents Univ of Minnesota FP Residents from the University (8 FP Programs) Domestic and IMG Includes DO and MD graduates Current system-wide ratio is: 41% IMG, 38% Allopathic/US, 21% Osteopathic/US

18. Research Design: Instrumentation Survey Monkey Longitudinal Resident Self- Assessments –Resident Self-Assessment of Knowledge and Skills –Duttweiler Internal Locus of Control Index

19. Resident Self Assessment of Knowledge and Skills Demographics &Tracking information (confidential, not anonymous) Knowledge areas based on FM program requirement subject matter Scale for knowledge base based upon Bloom’s Taxonomy (recall, comprehension, application, analytical, synthesis, evaluation) Skills: Core departmental inpatient and outpatient procedures Skills Scale: Dreyfus Model of Skill Acquisition Overall self-assessment: ACGME general competencies

20. Duttweiler Locus of Control Index (1984) Previously validated instrument of LOC 28 question survey instrument Complete questions using scaled responses

21. Next Steps Now-July 1, 2009: –Reduce survey length (select core procedures subset) –Continue to refine scaling to simplify –Validate all instrumentation (pilot) –IRB Review July 1, 2009: Assessment of incoming class of approximately 50 residents begins

22. Questions?/ Feedback

23. Theoretical References Bandura, Albert. (1997). Self-efficacy: the Exercise of Control. New York: Freeman Publishers. Bloom B. S. (1956). Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain. New York: David McKay Co Inc. Dreyfus, Stuart E. and Dreyfus, Hubert L. (1980). A Five Stage Model of the Mental Activities Involved in Directed Skill Acquisition. Unpublished Report. University of California-Berkeley/US Air Force. Duttweiler, Patricia C. (1984). The Internal Control Index: a Newly Developed Measure of Locus of Control. Educational and Psychological Measurement. 44(2), p. 209-221.