Grit, resilience and a growth-mindset influence students' ability to positively adapt to the challenges of health professional training. However, it is unclear if interventions can improve these traits. This systematic review aimed to explore if interventions can improve these traits in health professional students (primary) and their impact on academic and/or wellbeing outcomes (secondary).
A comprehensive search of CINAHL, MEDLINE, Eric and Embase was conducted from inception until 15 March 2023. Randomised or non-randomised controlled trials and single-group intervention studies that aimed to improve health professional students' resilience, grit and/or growth-mindset were eligible for inclusion. Two reviewers independently screened studies for inclusion and evaluated quality using the Mixed Methods Appraisal Tool. Post-intervention data from randomised and non-randomised control trials were pooled using a random-effects model to calculate standardised mean differences (SMD) and 95% confidence intervals (CIs).
Resilience interventions improved resilience by a moderate amount in 13 studies with 990 participants (pooled SMD 0.74, 95%CI 0.03 to 1.46) and a large amount when interventions were greater than one session duration in 10 trials with 740 participants (pooled SMD 0.97, 95%CI 0.08 to 1.85). Grit and growth-mindset interventions improved grit (pooled SMD 0.48, 95%CI −0.05 to 1.00, n = 2) and growth-mindset (pooled SMD 0.25, 95%CI −0.18 to 0.68, n = 2) by a small amount. Resilience interventions decreased perceived stress by a small amount (pooled SMD −0.38, 95%CI −0.62 to −0.14, n = 5).
Resilience interventions improve resilience and decrease perceived stress in health professional students. Preliminary evidence suggests grit and growth-mindset interventions may also benefit health professional students. Interventions may be most effective when they are longer than one session and targeted to students with low baseline levels of resilience and grit.
As clinical educators working in the Canadian postgraduate medical education landscape, we are often asked ‘why competency-based medical education (CBME)’? CBME promises clearer training outcomes with a more explicit assessment of these outcomes.1 Ideally, this system allows for individualised attention to residents where areas to work on are readily identified. Summative decisions are made by groups (e.g. clinical competence committees [CCCs]) that decide on the entrustment and promotion of individual residents based on assessments of their performance in professional activities (e.g. entrustable professional activities [EPAs] or milestones).1
In CBME, programs are attempting to implement prospective entrustment decisions while moving away from the systems of presumptive trust that were a hallmark of pre-CBME, time-based training models.1 Operationalising this in a meaningful way has been fraught with difficulty. While there were problems with an over-reliance on presumptive trust and an under-reliance on objective assessment of competence, we are concerned that the current CBME implementation has swung too far towards heavily relying on assessment tools and processes that lack validity evidence to support the entrustment and promotion decisions that CCCs are trying to make.
In North America, the implementation of CBME has meant that almost every professional activity (or milestone) deemed important has been tightly tied to the completion of directly observed workplace-based assessments (WBAs) of that activity. So tightly have EPAs been bound to these WBAs that residents and educators alike use the terms interchangeably (i.e. ‘Send me an EPA’ means ‘let us complete a WBA’2). Unfortunately, this overloads supervisors and residents with assessment quotas and overwhelms CCCs with assessment data, some meaningful, some not.3
Furthermore, there has been an over-emphasis on one very narrow conceptualisation of WBA as an entrustment-based tool meant to assess single encounters without considering if it is the right tool for the job. Several assessment tools exist that can be applied in the workplace (longitudinal WBA, indirect observation, multi-source feedback, etc.). For some activities, assessment outside the workplace (simulation, objective structured clinical examination [OSCE], etc.) might provide more useful information to CCCs.
Over-reliance on entrustment-based WBA, or over-reliance on WBA itself, is based on the dangerous assumption that an assessment tool with supportive validity evidence in one context is transferrable to other contexts. In this issue, Ryan et al. show how unreliable WBA can be when a single WBA tool is deployed across different contexts.4
To combat the over-reliance on WBA, we argue for locally developed programmatic assessment.5
The authors have no conflicts of interest.
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