title: Students' goal orientations, perceptions of early clinical experiences and learning outcomes.
abstract: BACKGROUND
  Workplace learning is optimised when learners engage in the activities of the workplace; learner engagement is influenced by workplace affordances and learner agency. Learner agency can be operationalised through achievement goal theory, which explains that students can have different goal orientations as they enter learning situations: mastery (learn and improve), performance approach (demonstrate competence) or performance-avoid (avoid demonstrating incompetence). Mastery-orientated, compared with performance-orientated, students approach curricular experiences as opportunities for developing rather than demonstrating competence. This study explored the relationships among students' achievement goal orientations, workplace affordances and learning outcomes in the context of early clinical experiences.
  
  
  METHODS
  Students who completed their preclerkship curricula at four medical schools answered a questionnaire about their personal goal orientation and the perceived goal structure and workplace affordances of their preceptorship experiences. All items used a 5-point scale (1 = strongly disagree/not at all true, 5 = strongly agree/very true). Students were evaluated by their preceptors and completed standardised-patient exams at the end of their pre-clerkship curricula. Analyses included descriptive statistics and mediation analysis.
  
  
  RESULTS
  Of 517 students, 296 (57.3%) responded and 253 (85.5%) had linked performance data. Student goal orientation means were: mastery, mean = 4.27 (SD = 0.65); performance-approach, 2.41 (0.76); performance-avoid, 2.84 (0.88). Student goal orientation and performance on preceptor evaluations (PEval) or standardised-patient exams (SPExam) were not significantly related. Perceptions of a mastery-structured curriculum and inviting workplace were associated with higher SPExam (β = 0.28, p = 0.02) and PEval (β = 0.51, p = 0.00) scores, respectively. Student mastery goal orientation was positively associated with perceptions of a mastery-structured curriculum (β = 0.59, p = 0.00) and positive workplace affordances (β = 0.25-0.29, p ≤ 0.01).
  
  
  CONCLUSIONS
  Students held a predominant mastery goal orientation towards their early clinical experiences. Mastery-orientated students perceived preceptorships as mastery-structured with positive workplace affordances, and those perceiving a mastery-structured or inviting preceptorship performed better. Clinical experiences should be structured to emphasise learning rather than demonstration of skills to promote learning outcomes.
authors.affiliation: Department of Pediatrics, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: H Carrie
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands.|Department of Medicine, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Olle
authors.initials: O
authors.lastname: ten Cate
authors.affiliation: Department of Medicine, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Sullivan
authors.affiliation: Department of Medicine, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Boscardin
authors.affiliation: Departments of Family and Community Medicine and Obstetrics and Gynecology, School of Medicine, University of California, Davis, California, USA.
authors.forename: W Suzanne
authors.initials: WS
authors.lastname: Eidson-Ton
authors.affiliation: Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Preetha
authors.initials: P
authors.lastname: Basaviah
authors.affiliation: Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Woehrle
authors.affiliation: Department of Medicine, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Arianne
authors.initials: A
authors.lastname: Teherani
mesh_terms: D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D006040:Goals; D006801:Humans; D007858:Learning; D011446:Prospective Studies; D013337:Students, Medical / Q000523:psychology*; D017132:Workplace / Q000523:psychology