New understandings of medical education and literate expertise

1. New understandings of medical education and literate expertise Professor Kirsti Lonka University of Helsinki, Finland, and Karolinska Institutet, Sweden Faculty of Behavioral Sciences

2. Research project on doctoral education • A large national research project on PhD Education • The research project is carried out in collaboration with • Finnish Universities of Helsinki, Tampere, and Oulu • Our international collaborators are: Karolinska Institutet, Stockholm, Sweden; Ramon Llull University, Barcelona, Spain. • Multiple data gathering methods (e.g. surveys, participant observations, mind-maps and interviews) are applied. • The data is collected in three levels of PhD education: • Students • Supervisors • Scholarly communities Käyttäytymis-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi

3. Thank you for my colleagues, Dr. Kirsi Pyhältö and Ms. Jenni Stubb who contributed to this study Käyttäytymis-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi

4. Klara Bolander Laksov (2007)LEARNING ACROSS PARADIGMSTowards an understanding of the development of medical teaching practice. (Doctoral Dissertation, Karolinska Institutet) - So, does knowledge exist, or is it just something that is constructed by humans, as our teachers suggest? - Of course it exists! Take the periodic table for instance, it surely exists without humans. Atoms are there whether we like it or not! - Yes, the atoms are there, but it was us, scientists, who named them atoms, and therefore our understanding of them is formed by our own constructions, aren’t they? - What do you mean constructions? This is just objective knowledge, THEY ARE THERE! But of course it took us some time to find ways of discovering them.

5. Paradigms (Kuhn, 1962) • Cognitive road maps for scholars – ideas taken for granted or dominant notions about scientific behavior. These vary across domains. • Paradigms consist of three components: 1. Epistemology: ”How do we know the world?” or ”What is the relationship between the inquirer and the known?” 2. Ontology: ”What is the nature of reality?” 3. Methodology: ”How do we gain knowledge about the world?”

6. Some research traditions in medical education

7. Academic discourses (Ken Hyland, 2007) • Genre = a way of grouping texts together, representing how writers typically use language to respond to recurring situations. • Differences in text purpose and style • Writing is a based on writer-reader expectations (about what is relevant communication) • Academic genres are embedded in disciplinary argument • Different voices, attitudes, disciplinary variations • How much the writer tries to persuade the reader – writing is like a dance where the two parties are trying to predict each others’ moves!

8. Traditions in writing Behavioral and social sciences lie in between Modified on the basis of : Hyland, K. (2007, June) Teaching and researching genre: Academic writing in the disciplines. A keynote address in 4th EATAW Conference, Bochum, Germany, June 30- July 2, 2007.

9. CONCEPTIONS OF ACADEMIC WRITING Our ideas of writing may affect our productivity?

10. Productivity • Optimism and self-efficacy beliefs in writing are essential in order for PhD students to become productive authors (Boice, 1990; 1993) • Seeing oneself as a productive and active agent in the scholarly community is an important part of this process • Already Bandura (1977) suggested that all psychological activities alter the level and strength of self-efficacy. In turn, self-efficacy determines how much effort will be expended in carrying out a certain task, and how long it will be sustained, even when facing obstacles and aversive experiences.

11. Käyttäytymis-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi

12. Knowledge transformation • Expert writers usually have learned to understand academic writing primarily as a process of knowledge transformation, rather than repetition (Bereiter & Scardamalia, 1987) • Seeing writing as a creative and collaborative act, not just writing down things that are already known. • Belief of knowledge transformation may help to establish a dialogue with others, write multiple drafts, be open for receiving feedback and revise one’s work on the basis of comments. • Expert writing calls taking into account the point of view of both the potential reader and the disciplinary genre, which often remain tacit (Olson, 1994).

13. Blocks • The Writer’s Block basically means that people sometimes fail in written productivity, although there is nothing wrong with their literary skills or intellectual capacity (Rose, 1984/2009). • Even experienced and skilful writers may suffer from blocks in their writing process. • Boice's (1993) review addressed the most often mentioned reasons for writing blocks: internal censors, fears of failure, perfectionism, early negative experiences, procrastination, and poor mental health. He concluded that blocking seldom has a single cause, and that many different maladaptive thoughts may be related.

14. Procrastination • Procrastination means that sometimes people postpone or fail starting such tasks that would be important in terms of their success. Such behavior is often counterproductive, and it is extremely prevalent in academic work • Writing may be especially likely to lend itself to procrastination, since it seldom offers short term rewards (Boice, 1990) • Procrastination is described either as adaptive or maladaptive. The former means that procrastinators aim at improved time management and efficiency in addition to consciously inducing a state of flow by fighting to meet the deadline. The maladaptive version occurs e.g. when students fear failure, are anxious, or simply lazy.

15. Käyttäytymis-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi

16. Perfectionism • Perfectionism in academic writing means that one keeps reworking material until it seems absolutely perfect (Boice, 1990). Such behavior is often related to fear of failure, avoiding criticism or attempts to impress others. This makes it difficult to share drafts, receiving feedback, and often leads to writing problems. • There are two variants of perfectionism: 1) Self-oriented perfectionists set themselves mastery goals and work hard and procrastinate less. 2) Socially prescribed perfectionists rather avoid failure; either by making no effort at all (i.e. procrastinating) or working even harder to avoid failure at all costs (Neumeister, 2004).

17. Innate ability • Sawyer (2009) pointed out it may be misleading to think that writers mainly work alone and they have a special, innate gift to communicate their valuable message. • Writing itself appears to be a solitary activity, but it may be harmful to believe that it is simply a result of a predetermined readiness. • A strong epistemological belief in innate ability (Schommer, 1993) might be contradictory to seeing writing as a creative and collaborative act of knowledge transformation.

18. The Writing Process Questionnaire - Measuring PhD students’ ideas about academic writing

19. METHOD ”The PhD Experience” - Questionnaire • The PhD. student survey was conducted in 2006-2007 • The participants were 669 PhD students in medicine, arts, and behavioural sciences who filled in the PhD experience questionnaire • The survey consisted of both open ended questions and Likert-type statements. The themes of the survey were: • PhD. student's view of the thesis process and how they saw themselves as a part of the scientific community • The student – supervisor interaction • Stress, anxiety, lack of interest, and exhaustion • Perceptions of the learning environment • “The Writing Process” - Questionnaire

20. METHODThe Writing Process Questionnaire • This study aimed to measure PhD students’ ideas concerning writing and how they saw themselves as writers. • The purpose was to create an instrument in order to analyse what factors may either promote or prevent the process of academic writing. • The version developed for PhD Students was based on an instrument, created by Lonka (1996), which has been widely used in Finland and internationally • A six-factor solution was assumed: Blocks, Procrastination, Perfectionism, Knowledge transformation, (Writing as) Innate ability, and Productivity. These constructs were measured by 26 Likert-type statements on the scale 1-5.

21. The modified MED NORD questionnaire measured emotional problems (Lonka et al., 2008) with 10 items on scale 1-5

22. Examples of questions concerning writing Blocks: (α = .60) “ I sometimes get completely stuck if I have toproduce texts.” Procrastination (α = .81): “I find it difficult to start writing.” Perfectionism (α = .66): :“I find it difficult to hand over my texts, because they never seem complete.” Knowledge transforming (α = .63):“Writing often means creating new ideas and ways of expressing oneself” Innate ability (α = .74): “Writing is a skill, which cannot be taught” Productivity (α = .74): “I am a regular and productive writer”

23. THE MAIN RESULT A confirmatory factor analysis (LISREL) confirmed the above presented six-factor structure of the writing scale (RMSEA= 0.065, CFI=0.92, NNFI=0.91).

24. Correlations with emotional problems (* p < 0.05, ** p < 0.01)

25. Summary of the study • The Writing Process Questionnaire is a reliable and valid instrument for measuring PhD students’ ideas concerning writing • The experienced emotional problems correlated positively with blocks, procrastination and perfectionism, and in contrast, negatively with productivity • Ideas concerning writing do matter, and it is worthwile to monitor these ideas • The Writing Conceptions Questionnaire may be used as a tool for self-reflection about one’s own writing (Lonka, 2003).

26. How are PhD students in medicine different from other domains? Käyttäytymis-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi

27. Participants The participants were PhD students in medicine (n= 163) and in humanities, psychology, and education (n= 506) from a major Finnish University.

28. PhD students in medicine vs. behavioral sciences: components of dysfunctional orientation Käyttäytymis-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi

29. PhD students in medicine vs behavourial sciences: The writing process questionnaire Käyttäytymis-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi

30. Medicine vs. othersPerceptions of the learning environment Käyttäytymis-tieteellinen tiedekunta / Henkilön nimi / Esityksen nimi

31. Challenges in research on medical education • A Mixed-method, multi-paradigm domain • Negotiations of meaning among educationalists, psychologists, and medical educators • Educational psychology as a typical background framework: applying psychological methods and concepts in the educational settings • Balancing between different academic genres and traditions of writing

32. Discussion • Problems in writing were related to other emotional problems • PhD students in medicine experienced more stress, exhaustion and lack of interest • They more often experienced writer’s blocks, but they were less perfectionist than students in other fields • Our qualitative interview and videotape studies shed more light on these phenomena • Research in medical education may be demanding in various ways

33. Thank you for your attention! The city of Helsinki from the sea

34. BACKGROUND LITERATURE Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.Psychological Review. Vol 84(2), Mar 1977, 191-215. Bereiter, C. , & Scardamalia, M. (1987). The psychology of written composition. Hillsdale, NJ: Erlbaum. Boice, R. (1990) Professors as writers. A self-help guide to productive writing. Stillwater, Oklahoma: New Forums Press. Boice, R. (1993). Writing blocks and tacit knowledge. Journal of Higher Education, 64, 19-54. Byrne, B. M. (1998). Structural equation modeling with LISREL, PRELIS and SIMPLIS: Basic concepts, applications and programming. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. Lonka, K (2003) Helping Doctoral Students To Finish Their Theses. In: L. Björk, G. Bräuer, L. Rienecker, G. Ruhmann, & P. Stray Jørgensen, (eds.) Teaching Academic Writing Across Europe. Kluwer University Press. Lonka, K., Sharafi, P., Karlgren, K., Masiello I., Nieminen, J., Birgegård, G., & Josephson, A. (2008). Development of MED NORD - A tool for measuring medical students’ well-being and study orientations. Medical Teacher, 30, 72-79. Olson, D. (1994). The World on Paper. The conceptual and cognitive implications of writing and reading. Cambridge, MA: Cambridge University Press. Pyhältö, K., Stubb, J. & Lonka, K. (2009). Developing Scholarly Communities as Learning Environments for Doctoral Students. International Journal for Academic Development 14, no. 3: 221- 232.  Rose, M. (2009) Writer’s block: The cognitive dimension. The Conference on College Composition and Communication of the National Council of Teachers of English. Originally published 1984. Sawyer, K. (2009). Writing as a collaborative act. In S.B. Kaufman & J.C. Kaufman (Eds.), The psychology of creative writing (pp. 166-179). Cambridge: Cambridge University Press. Schommer, M. (1993) Comparisons of beliefs about the nature of knowledge and learning among postsecondary students. Research in Higher Education, 34, 3, 355-370. Tynjälä, P., Mason, L. & Lonka , K.(Eds., 2001) Writing as a Learning Tool: Integrating theory and practice. Studies in Writing, Vol. 7. Dordrecth, The Netherlands: Kluwer Academic Publishers.