Medicine is a highly competitive professional education program. In Canada, applicants are expected to meet stringent academic requirements, including high final grades and scores on the Medical College Admission Test (MCAT). Medical schools may also ask prospective students about their involvement in non-academic activities, including pursuit of dedicated or competitive activities such as sport. In a general student population, for example, physical activity/sport involvement has been found to correlate positively with stress tolerance, good time management, and adaptive coping strategies.^1,2 The ultimate goal of medical schools is to select applicants with the highest probability of successful medical training and subsequent career.³ Although the emphasis has traditionally been placed on prospective students’ academic achievement due to its well-established association with performance in medical school,⁴ the associations between applicants’ non-academic pursuits and learning outcomes in medical school have yet to be established.

Involvement in sport offers invaluable opportunities for an individual to develop self-discipline, resilience, and motivations that may subsequently influence their functioning in stressful, high-stakes environments such as medical school and eventual medical practice. Recreational pursuit of physical activity/sport provides numerous health benefits and can be an effective way of coping with stress.²

Competitive pursuit of sport focuses on further skill development in the context of training and frequent competitions where performance outcome is on display (e.g., winning a race, failing to improve on previous results).⁵ Similar parallels can be drawn in medical school, where the focus is on competency acquisition, with frequent assessments of students’ knowledge and skills.

Individuals applying to medical schools are academically high-performing and motivated to achieve, many of whom have pursued sport at one (or various) points in their lives. Once in medical school, students find themselves surrounded by other high-achieving peers and face many challenges such as mastering large amounts of material in short periods of time and frequent assessments. How do these high-performing students, who have also pursued sport at varying levels, fare in their achievement goals and well-being in medical school? Specifically, are students focused on their performance relative to their high-achieving peers or are they oriented toward personal mastery and learning? Are students able to respond adaptively to the demands of medical studies? To answer these questions, we draw on Achievement Goal Theory (AGT),^6-8 a well-established framework that has been applied in the study of motivation across a wide range of achievement settings (e. g., education, sport, work).

Dedicated to understanding the reasons behind the individual’s drive to achieve competence and performance, AGT proposes that individuals adopt certain subconscious orientations – achievement goals – that influence their experience, behaviour, and coping reactions. Elliot and McGregor’s  2×2 framework⁷ distinguishes four achievement goals: (1) performance approach – the desire to look good and demonstrate competence relative to others; (2) mastery approach – the desire to learn, improve skills, or gain competence for its own sake; (3) performance avoidance – the desire to avoid demonstrating incompetence relative to others; and (4) mastery avoidance – the desire to avoid incompetence (i. e., not doing worse than one has done in the past), often accompanied by feelings of not being able to master all the material and fear of making errors. Some individuals can manifest multiple goals at the same time and, depending on the environment they are exposed to, may change their goals as they progress through their education and career.⁹

Across achievement settings, the extensive literature on achievement goals supports the adaptive nature of mastery approach goals relative to the other three goals.¹⁰ Mastery approach goals have been linked with enjoyment, deeper learning, satisfaction, stress tolerance, and well-being,^10-12 which are desired outcomes in medical education. Performance approach goals are considered less adaptive – although these goals are consistently linked to high achievement, they appear also to relate to unfavourable behaviours (e. g., use of surface learning strategies, cheating).^10-13 Avoidance goals are considered maladaptive as they are associated with poor psychological well-being and inadequate coping and learning strategies (e. g., worry, anxiety, procrastination, continued use of ineffective learning strategies).^14,15

Previous research in achievement goals has focused on personal characteristics such as gender, age, and cultural/ethnic background when examining the goals of individuals in specific settings (e. g., education, sport, work).^15,16  We aim to contribute to the existing literature by specifically focusing on medical students who had pursued physical activity/sport at varying levels of involvement and competition. By doing so, we aim to provide evidence that will inform admission and curriculum committees on the relationships between students’ involvement in physical activity/sport, achievement motivation, and well-being in school. This latter aim is in response to recent calls in medical education for research that extends motivation theory to health professions education.^17,18 The importance of this cannot be overstated because it is directly linked to preparing internally motivated and resilient health professionals. As such, using the AGT framework, we examined medical students’ well-being (academic burnout) and motivations for learning (achievement goals), while considering the level of students’ past involvement in physical activity/sport.

Overall, 3% (n=7) of the students reported no involvement in physical activity/sport in the past or currently; 33% (n=89) reported recreational non-competitive involvement in physical activity/sport; 24% (n=63) competed in intramurals or in a recreational league; 10% (n=26) competed against athletes from their city/town/nearby communities; 21% (n=55) competed against athletes from around their own or other province/state/territory; and 10% (n=27) competed against athletes from a country other than their own or as a member of a national team. Results of chi-square tests showed no significant associations between the level of past physical activity/sport involvement and students’ gender (χ²=4.5, p=0.48), age (χ²=14.9, p=0.45), and year in medical school (χ²=18.7, p=0.23). Overall, students tended to be predominantly mastery approach-oriented [mean (SD)=22.4 (3.1)]. The levels of endorsement of the other three achievement goals were lower and around the midpoint of their respective scales: performance approach [mean (SD)=16.9(4.4)]; performance avoidance [mean (SD)=13.9(4.3)]; and mastery avoidance [mean (SD)=16.3 (3.3)]. The overall mean (SD) on academic burnout was 20.7 (3.3), suggesting a moderate level of burnout among the students in this study.

Figure 1 shows trends in achievement goals based on students’ physical activity/sport involvement. An upward trend in mastery approach and downward trends in the other three (maladaptive) achievement goals were observed across the levels of physical activity/sport involvement.

Correlational analyses revealed significant, although small, negative correlations (Table 1) between the level of physical activity/sport involvement and performance approach (r=-0.15, p=0.014), performance avoidance (r=-0.21, p=0.001), and mastery avoidance  (r=-0.24, p<0.001) goals, as well as with academic burnout (r=-0.15, p=0.014), suggesting that with increasing levels of physical activity/sport involvement students tended to endorse maladaptive goals to a lesser degree and experienced less academic burnout in the program. Finally, the correlation between the level of physical activity/sport involvement and mastery approach was positive but did not reach statistical significance (r=0.11, p=0.09).

To better understand the nature of the relationships between physical activity/sport involvement, on the one hand, and achievement goals and academic burnout, on the other, item-level correlations were also examined. As shown in Table 1, the largest significant negative correlations with the level of physical activity/sport involvement were observed for the following items on achievement goals: “I enjoy when others in my program are aware of how well I am doing” (performance approach; r=-0.20, p<0.001); ”I am concerned about taking on a task if my performance would reveal that I had low ability” (performance avoidance; r=-0.24, p<0.001); and “In my program, I focus on not doing worse than I have done in the past” (mastery avoidance; r=-0.30, p<0.001). The negative direction of these correlations suggests that as the level of students’ physical activity/sport involvement increased from none to recreational to competitive, students tended to focus less on how they were doing relative to others in the program. With respect to academic burnout, students with higher levels of past physical activity/sport involvement tended to tolerate the pressure of their classes well, manage the amount of school work well, and have enough energy for their leisure activities after school (Table 1).

Medical education and practice are known for being high-stress and high-stakes environments, which can potentially elicit burnout and poor coping strategies (e. g., alcohol use).^2,21,22 Compared to similar-age individuals in the general population, medical students have substantially higher levels of burnout, stress, and depression.²¹ Searching for solutions, medical school admission committees have started to consider students’ pursuits of dedicated non-academic activities (e. g., sport, music) for their potential beneficial effects on personal and learning outcomes, including motivation and well-being in school. For example, in our medical school, an applicant’s involvement in dedicated non-academic activities is currently weighted at maximum of 30%, depending on the level and duration of such pursuits. In this study, we examined motivations for learning (achievement goals) and well-being (academic burnout) in medical students with varying levels of prior involvement in physical activity/sport.

Using Elliot and McGregor’s 2×2 achievement goals framework,⁷ we observed that medical students in this study were predominantly mastery approach-oriented. Although there was a positive association between mastery approach scores and the level of physical activity/sport involvement, this association did not reach significance. The high level of mastery approach goals among medical students is promising, as these goals are linked to adaptive and beneficial cognitions, behaviours, and learning outcomes. In two recent studies conducted with medical students, mastery approach orientation had the strongest association with general self-efficacy,²³ frustration tolerance, and perceived psychosocial medical abilities (defined as the level of interest, confidence, clinical abilities, and sensitivity in addressing the psychosocial aspects of patient care).²⁴

Compared to mastery approach goals, the endorsement of the other three goals – performance approach, performance avoidance, and mastery avoidance – by medical students in this study was consistently at lower levels. Further, we observed significant negative correlations between the level of past physical activity/sport involvement and these achievement goals, suggesting that with increasing levels of past physical activity/sport involvement the goal orientations toward performance (approach and avoidance) and mastery avoidance in medical school tended to decrease. These results are reassuring in that these achievement goals are known for their maladaptive nature and impact on students’ well-being. Specifically, performance goals relate to undesirable outcomes such as poor study habits, anxiety, and self-handicapping.^25,26 Similarly, individuals with mastery avoidance goals are more likely to perceive help-seeking as threatening and experience worry and high stress.^7,27 In the present study, the largest negative correlations were observed between students’ level of physical activity/sport involvement and avoidance goals.

Overall, medical students reported a moderate level of academic burnout. However, as the level of past physical activity/sport involvement increased, students reported experiencing lower levels of academic burnout, in particular tolerating the pressures of the school, managing the amount of school work well, and having enough energy for their leisure activities after school. Although the design of the present study does not allow for causal inferences, the significant relationship suggests potential benefit of physical activity/sport involvement in this area and warrants further exploration.

Most notably, only 3% of the students in this study reported no involvement in physical activity/sports at any point in their lives, with the majority of the students having pursued physical activity/sport recreationally. Despite the well-recognized health benefits of physical activity, studies have shown that students’ involvement in such activities and their exercise habits tend to deteriorate upon entry into college.² In a study conducted with medical students in Australia, more than half of the students reported that they did more exercise before the commencement of medical training.²⁸ This raises an important question as to what curricular initiatives and learning environments are likely to be effective in helping students maintain their physical activity/sport involvement and in fostering beneficial motivations for learning in medical students. 

Medicine is a highly competitive education program and poses many demands for individuals who aspire to health careers. Our findings indicate that the pursuit of dedicated personal activities such as physical activity and sport appears to be associated with the desired quality of motivation and well-being of medical students. A school culture that fosters resilience of newly admitted students through extracurricular activities and raises students’ awareness of the consequences of maladaptive achievement goals is likely to be beneficial in addressing academic burnout and improving the mental health of medical students.