Locust of control

You could be forgiven for reading the title of this editorial twice but, no, it is not a spelling mistake or a copy-editing error. Read on to discover the point of the title.

Locus of control, a concept developed by renowned American psychologist, Professor Julian Rotter [1], concerns itself with how much an individual person believes that they can influence what happens in their own life.

Generally speaking, it is easy to see why having a degree of self-determination in one’s own path through life would, to most people, seem a good thing.

Certainly, within health professions education, students being active participants in their education as opposed to passive observers, offers benefits to them, their educators and the patients they encounter [2]. Moreover, being such active participants can further nurture and reinforce the very sense of self determination from which it arises. Educational and professional confidence increases and nervous novices quickly become the self-assured proto-professionals that those who have taught them are justly proud of when they graduate.

Unfortunately, the reverse situation can also all too often be brought into being. Let me explain what I mean. In recent years in some countries, modern health professions education has come under pressure to increase student numbers to try to reduce workforce shortages. Simultaneously, there has been an increasing pressure on educational institutions and governments to do more with less resource or, as someone said to me just last week, ‘do more with no resource at all’. In these circumstances, the quality of student experience, the educational environment and the educational climate are all put at risk because such pressure inevitably leads to more structure and regimentation, and reduced flexibility, in order to cope with the higher throughput. The underlying reason for this in most circumstances is that the more one ‘size’ of education fits all students, the cheaper it becomes to deliver.

From the students’ perspective, however, there is an erosion of student curricular influence and choice, and this can cause a decline in their sense of wellbeing through a reduction in their enjoyment of education, increased stress, and heightened anxiety from their loss of self-determination.

In the extreme, systems originally set up for learner benefit can become detached, unthinking and uncaring, using the large-scale principles of equity and fairness to all as an excuse for the imposition of randomness and dissociation of individual student effort, preferences or requests from their individual attainment and allocation to, for example, further training or some other coveted resource or outcome such as employment in a specific geographical location.

Therefore, my plea to educators in positions of influence is to think carefully as you structure educationally related systems in the face of increasing external pressures. Please don’t become the locust of control referred to in the title of this editorial, the locust who nibbles away at the ability of students to have influence over their destiny. Even small bites mount up if there are enough of them, and students can quickly lose any individual sense of influence over their education, their chosen professional path and their wider lives, resulting in unintended consequences far beyond the apparent magnitude of the original decisions which led to them.

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