Emotion regulation tendencies, achievement emotions, and physiological arousal in a medical diagnostic reasoning simulation

Abstract

Despite the importance of emotion regulation in education there is a paucity of research examining it in authentic educational contexts. Moreover, emotion measurement continues to be dominated by self-report measures. We address these gaps in the literature by measuring emotion regulation and activation in 37 medical students’ who were solving medical cases using BioWorld, a computer based learning environment. Specifically, we examined students’ habitual use of emotion regulation strategies as well as electrodermal activation (emotional arousal) from skin conductance level (SCL) or skin conductance response (SCR), as well as appraisals of control and value and self-reported emotional responses during a diagnostic reasoning task in Bioworld. Our results revealed that medical students reported significantly higher habitual levels of reappraisal than suppression ER strategies. Higher habitual levels of reappraisal significantly and positively predicted learners’ self-reported pride. On the other hand, higher habitual levels of suppression significantly and positively predicted learners’ self-reported anxiety, shame, and hopelessness. Results also revealed that medical students experienced relatively low SCLs and few SCRs while interacting with Bioworld. Habitual suppression strategies significantly and positively predicted medical students’ SCLs, while SCRs significantly and positively predicted their diagnostic efficiency. Findings also revealed a significant, positive predictive relationship between SCL and shame and anxiety and the inverse relationship between SCL and task value. Implications and future directions are discussed.

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Fig. 1
Fig. 2

Notes

  1. 1.

    Participants were not asked if they interacted with similar environments to this one, but given the novelty and specificity of BioWorld it is very unlikely.

  2. 2.

    Students from first year onward in medical school stood to benefit from interacting with BioWorld which provides diagnostic reasoning training, therefore we did not exclude participants based on year of medical studies.

  3. 3.

    Instructors did not have a role in the experiment. Research assistants that were part of the lab that conducted this study managed the experimental protocol.

  4. 4.

    No comparisons with participants who wore an SCR bracelet were made because these participants were never directly compared (see Table 1; all usable SCR data came from participants who interacted with Case 1 or 2: n = 14).

  5. 5.

    “Type I error is and should be localized by H0 because Type I error refers to the error of falsely rejecting a given null hypothesis when it should not be rejected (e.g., Curran-Everett 2000). In other words, identification of the scope of a given H0 leads to the proper localization of Type I error, which, in turn, dictates how the respective alpha level should be adjusted.” (Matsunaga 2007, p. 251).

  6. 6.

    While p = .050 might be considered marginally significant rather than significant, it is squarely on the fence of p < .05. Moreover, this result was significant prior to outlier cleaning. Given that no single approach to outlier cleaning can deal perfectly with outliers and their influence on the distribution, the prior significance of this finding to a single outlier being removed, and the difference in reporting versus not reporting being a value of .001, we opted to refer to this variable as significant rather than marginally significant, as we do not typically report marginally significant results.

  7. 7.

    The academic achievement emotion questionnaire data was not collected for participants who wore the Biopac bracelet. See limitations for more details.

  8. 8.

    According to the CVT, pride can be elicited when students appraise an outcome with positive value (e.g., success) and believes that they are responsible for this outcome (Pekrun 2006). Pride during a performance task, such as a test, can be attributed to their level of knowledge and performance (Pekrun 2006; Pekrun et al. 2002). Likewise, during the diagnostic reasoning task, students can feel pride in relation to their knowledge of different diseases, symptoms, and presentations, and their perceived performance as they move through solving the case. For example, a student could feel proud that they were able to correctly select the laboratory test that enabled them to identify an abnormal test result indicative of a particular disease. Given that students can feel pride during diagnostic reasoning, it is possible that individual differences in emotion regulation could be associated with this emotion. Previous research in the context of test-taking and learning have also tested this possibility and found that wishful thinking and self-blame are negatively related to feelings of test pride (Decuir-Gunby et al. 2009) and habitual reappraisal is positively related to feelings of learning-related pride (Buric et al. 2016). Therefore, it is possible and reasonable to suggest that habitual reappraisal could be related to pride in the context of diagnostic reasoning.

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Acknowledgements

This research was supported by funding from the Social Sciences and Humanities Research Council of Canada (grant number: 895-2011-1006).

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Harley, J.M., Jarrell, A. & Lajoie, S.P. Emotion regulation tendencies, achievement emotions, and physiological arousal in a medical diagnostic reasoning simulation. Instr Sci 47, 151–180 (2019). https://doi.org/10.1007/s11251-018-09480-z

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Keywords

  • Emotion
  • Affect
  • Emotion regulation
  • Physiological
  • Arousal
  • Activation
  • Skin conductance