From residency to practice: Mindsets of early-career family physicians

Context: A mastery mindset is important for physicians’ engagement in lifelong learning. In primary care, early-career physicians face unique challenges in establishing independent clinical practice following residency training. This study aims to shed light on whether family physicians graduating from a competency-based education (CBME) residency program continue to exhibit mastery-oriented mindsets and motivations that could have an impact on lifelong learning and patient care outcomes.

Objective: To examine the mindsets of early-career family physicians following graduation from a CBME residency program.

Design: Longitudinal, cohort, survey study of family medicine (FM) residents.

Setting: One graduating FM resident cohort (2015-2017) at a large Canadian university was surveyed at three time points: 1) end of residency training, 2) one year into clinical practice, and 3) three years into clinical practice.

Population Studied: Of 70 eligible FM residents, 52 (74%), 43 (61%), and 29 (41%) completed the questionnaire at each of the three data collection points respectively.

Instrument: Baranik et al.’s instrument was used to measure the three types of mindsets (mastery, performance approach, performance avoidance). Each mindset was measured by 4 statements. Participants indicated their level of agreement with each statement (1=not at all agree; 10=completely agree).

Main Outcome Measures: Three types of mindsets: Mastery - self-directed, intrinsic motivation towards learning; performance approach - motivation towards impression management; and performance avoidance - motivation towards ego-protection. Descriptive and multivariate analysis of variance were performed.

Results: Irrespective of the time in practice, mean scores were the highest on the mastery mindset and the lowest on the performance avoidance mindset measures (P < 0.001). With time, the mastery mindset scores decreased among the cohort (P = 0.04).

Conclusions: Family physicians trained in a CBME residency program continued to be mastery-oriented in the first three years of clinical practice despite a downward trend. Residency programs need to ensure graduating physicians are equipped with knowledge and tools to maintain mastery mindset throughout their professional careers.