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Self‐Regulated Learning in Medical Education
Abstract
This chapter assures medical educator that self-regulated learning (SRL) can be taught and that educators play a pivotal role in helping learners to develop the relevant skills. It provides theoretical and practical information about a broader and more complex cycle of SRL, and proposes a model for its integration into medical curricula. The model, adapted from research in educational psychology, reflects four steps that comprise the cycle of SRL (planning, learning, feedback/assessment and adjustment), and the underlying elements within each. Adoption of a consistent, evidence-based model within and across the continuum of medical education and across programmes (i.e. around the country or around the world) will help us explore the effectiveness of this approach in helping learners set personal goals, consider how what they bring to their learning as unique individuals influences their learning, monitor their learning and make adjustments to assure that they meet their goals.
... The MAL model was developed to represent the daily problem-solving work of students and physicians and includes the need to regularly engage in and apply new learning, and to encompass the relationship between routine and adaptive expertise [3]. Incorporated in the MAL model are four stages of self-regulated learning (SRL) [6,7]: planning, learning, assessment, and adjustment [8]. The MAL model extends this SRL model to describe specific behaviors within each of the four phases as well as cognitive skills and internal characteristics that support SRL [9]. ...
Background
The master adaptive learner (MAL) uses self-regulated learning skills to develop adaptive, efficient, and accurate skills in practice. Given rapid changes in healthcare, it is essential that medical students develop into MALs. There is a need for an instrument that can capture MAL behaviors and characteristics. The objective of this study was to develop an instrument for measuring the MAL process in medical students and evaluate its psychometric properties.Methods
As part of curriculum evaluation, 818 students completed previously developed instruments with validity evidence including the Self-Regulated Learning Perception Scale, Brief Resilience Scale, Goal Orientation Scale, and Jefferson Scale of Physician Lifelong Learning. The authors performed exploratory factor analysis to examine underlying relationships between items. Items with high factor loadings were retained. Cronbach’s alpha was computed. In parallel, the multi-institutional research team rated the same items to provide content validity evidence of the items to MAL model.ResultsThe original 67 items were reduced to 28 items loading onto four factors: Planning, Learning, Resilience, and Motivation. Each subscale included the following number of items and Cronbach’s alpha: Planning (10 items, alpha = 0.88), Learning (6 items, alpha = 0.81), Resilience (6 items, alpha = 0.89), and Motivation (6 items, alpha = 0.81). The findings from the factor analyses aligned with the research team ratings of linkage to the components of MAL.Conclusion
These findings serve as a starting point for future work measuring master adaptive learning to identify and support learners. To fully measure the MAL construct, additional items may need to be developed.
... The PSY-CLAP tool was designed such that Likert-scale based scores need to be evidenced by the trainee and reflected on, as this can help establish future learning goals and foster self-regulated learning (Eva & Regehr, 2005;White, Gruppen, & Fatone, 2014). This will also encourage trainees' to reflect on significant events, as well as bringing such issues to supervision, where feedback from self-assessment could be provided (Kilminster, Cottrell, Grant, & Jolly, 2007). ...
... The study of self-regulation within domains requires consideration of the task that is performed by a learner as well as the strategic processing demands that are inherent to the domain [6]. In the medical field, self-regulation has been studied in numerous ways but from different lenses, such as: self-assessment in the context of professional development [7]; examining the interaction between personal attributes and environmental affordances [8]; and examining the developmental phases that occur through clinical practice [9]. For the purposes of this chapter, we outline a model that synthesizes existing accounts of self-regulation in problem-solving and situates the underlying activities in diagnosing patient cases in the medical domain101112 . ...
Medical diagnostic reasoning is ill-defined and complex, requiring novice physicians to monitor and control their problem-solving efforts. Self-regulation is critical for effective medical problem-solving, helping individuals progress towards a correct diagnosis through a series of actions that informs subsequent ones. Bio World is a computer-based learning environment designed to support novices in developing medical diagnostic reasoning as they receive feedback in the context of solving virtual cases. The system provides tools that scaffold learners in their requisite cognitive and metacognitive activities. Novices attain higher levels of competence as the system dynamically assesses their performance against expert solution paths. Dynamic assessment in this system relies on a novice-expert overlay and it is used to develop feedback when novices request help. When help-seeking occurs, help is provided by the tutoring module which applies a set of pre-defined rules based on the context of the learner’s activity. The system also provides cumulative feedback by comparing the novice solution with an expert solution following completion of the case. This chapter covers the essential design guidelines of this scaffolding approach to metacognitive activities in problem-solving within the domain of medical education. Specifically, we review recent advances in modeling metacognition through online measures, including concurrent think-aloud protocols, video-screen captures, and log-file entries. Educational data mining techniques are outlined with the goals of capturing metacognitive activities as they unfold throughout problem solving, and guiding the design of scaffolding tools in order to promote higher levels of competence in novices.
... Self-directed learning (or self-regulated learning) is critical in the health care professions and involves goal setting, metacognition about one's own learning, the ability to accurately self-assess and be receptive to external feedback, and the ability to adjust one's own performance after reflection; these skills are seen as essential for effective lifelong learning. 1 Various educational tools have been implemented to encourage students in the health sciences to be more self-directed, including logbooks and portfolios. Logbooks typically constitute logs or records of individual skills being performed; the nature of logbooks in clinical education varies from blank notebooks to structured checklists. 2 Portfolios range in size from a simple checklist-style logbook to a broader collection of evidence, accompanied by a reflective narrative in which learners bring together evidence from different sources to document their learning journey. ...
A structured logbook, consisting of a competency log and a learning contract, was designed and implemented as part of a two-week structured work placement for final-year veterinary students, to help them become more self-directed in the workplace. The competency log encompassed 48 core skills and, along with the learning contract, was reviewed at the start and end of the placement. To assess their perceptions of the logbook in promoting self-directed learning, students and supervisors were asked to complete a questionnaire pre- and post-placement and to participate in focus groups (students) and interviews (supervisors) after the placement. The study found significant increases pre- to post-placement in students' perceived levels of competence in all 48 skills and their confidence in being self-directed. However, student attitudes toward the logbook significantly decreased in terms of it encouraging supervisors to take a clearly designed role in structuring learning and facilitating alignment of employer and student expectations. Although supervisors were generally positive about the logbook, some had not been able to review it with their students, which affected students' perceptions of the logbook's usefulness. Some supervisors felt they had not received enough training, and most, erroneously, believed the logbook to be an external research initiative rather than having been designed by the head of their own organization. This study demonstrated that a structured logbook may be useful in helping students become more self-directed; however, supervisor support for the logbook is critical. To facilitate this, supervisors require training and support from senior management.
... 64 Thirty years of education research has identified that explicit training in SRL techniques is effective 65,66 in terms of improving learning outcomes for students. We suggest that this framework could make important contributions to traditional medical training assessment frameworks that have been used to identify and remediate strugglers (see also [67][68][69]. The provision of 'learning to learn' courses for Year 1 medical students may provide an effective approach to helping students at an early stage of their medical careers to identify their SRL approach and make changes that might reduce their chances of future underperformance. ...
Objectives Remediation is usually offered to medical students and doctors in training who underperform on written or clinical examinations. However, there is uncertainty and conflicting evidence about the effectiveness of remediation. The aim of this systematic review was to synthesise the available evidence to clarify how and why remediation interventions may have worked in order to progress knowledge on this topic.
Methods The MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources Information Centre), Web of Science and Scopus databases were searched for papers published from 1984 to April 2012, using the search terms ‘remedial teaching’, ‘education’, ‘medical’, ‘undergraduate’/or ‘clinical clerkship’/or ‘internship and residency’, ‘at risk’ and ‘struggling’. Only studies that included an intervention, then provided retest data, and reported at least one outcome measure of satisfaction, knowledge, skills or effects on patients were eligible for inclusion. Studies of practising doctors were excluded. Data were abstracted independently in duplicate for all items. Coding differences were resolved through discussion.
Results Thirty-one of 2113 studies met the review criteria. Most studies were published after 2000 (n = 24, of which 12 were published from 2009 onwards), targeted medical students (n = 22) and were designed to improve performance on an immediately subsequent examination (n = 22). Control or comparison groups, conceptual frameworks, adequate sample sizes and long-term follow-up measures were rare. In studies that included long-term follow-up, improvements were not sustained. Intervention designs tended to be highly complex, but their design or reporting did not enable the identification of the active components of the remedial process.
Conclusions Most remediation interventions in medical education focus on improving performance to pass a re-sit of an examination or assessment and provide no insight into what types of extra support work, or how much extra teaching is critical, in terms of developing learning. More recent studies are generally of better quality. Rigorous approaches to developing and evaluating remediation interventions are required.
... The concept has been found to engage students , educators as well as policy makers [6]. Inspired by incentives for lifelong learning, and student centred education , the large interest for self-regulated learning in higher education has also reached medical education [7,8]. The theoretical constructs of regulation strategies are commonly measured by questionnaire scales for quantification of results. ...
Background
The degree of learners’ self-regulated learning and dependence on external regulation influence learning processes in higher education. These regulation strategies are commonly measured by questionnaires developed in other settings than in which they are being used, thereby requiring renewed validation. The aim of this study was to psychometrically evaluate the learning regulation strategy scales from the Inventory of Learning Styles with Swedish medical students (N = 206).
Methods
The regulation scales were evaluated regarding their reliability, scale dimensionality and interrelations. The primary evaluation focused on dimensionality and was performed with Mokken scale analysis. To assist future scale refinement, additional item analysis, such as item-to-scale correlations, was performed.
Results
Scale scores in the Swedish sample displayed good reliability in relation to published results: Cronbach’s alpha: 0.82, 0.72, and 0.65 for self-regulation, external regulation and lack of regulation scales respectively. The dimensionalities in scales were adequate for self-regulation and its subscales, whereas external regulation and lack of regulation displayed less unidimensionality. The established theoretical scales were largely replicated in the exploratory analysis. The item analysis identified two items that contributed little to their respective scales.
Discussion
The results indicate that these scales have an adequate capacity for detecting the three theoretically proposed learning regulation strategies in the medical education sample. Further construct validity should be sought by interpreting scale scores in relation to specific learning activities. Using established scales for measuring students’ regulation strategies enables a broad empirical base for increasing knowledge on regulation strategies in relation to different disciplinary settings and contributes to theoretical development.
Low stakes assessment without grading the performance of students in educational systems has received increasing attention in recent years. It is used in formative assessments to guide the learning process as well as in large-scales assessments to monitor educational programs. Yet, such assessments suffer from high variation in students’ test-taking effort. We aimed to identify institutional strategies related to serious test-taking behavior in low stakes assessment to provide medical schools with practical recommendations on how test-taking effort might be increased. First, we identified strategies that were already used by medical schools to increase the serious test-taking behavior on the low stakes Berlin Progress Test (BPT). Strategies which could be assigned to self-determination theory of Ryan and Deci were chosen for analysis. We conducted the study at nine medical schools in Germany and Austria with a total of 108,140 observations in an established low stakes assessment. A generalized linear-mixed effects model was used to assess the association between institutional strategies and the odds that students will take the BPT seriously. Overall, two institutional strategies were found to be positively related to more serious test-taking behavior: discussing low test performance with the mentor and consequences for not participating. Giving choice was negatively related to more serious test-taking behavior. At medical schools that presented the BPT as evaluation, this effect was larger in comparison to medical schools that presented the BPT as assessment.
Motivation is what moves us to do something. It involves energy and drive to learn, work effectively and achieve potential. Motivation also plays a large part in the interest and enjoyment of learning. Research suggests that salient motivations determine what activities people do or do not engage in (“attraction”), how long they engage in these activities (“retention”) and the depth to which they engage in these activities (“concentration”). Motivation is particularly relevant to learning because engaging in learning is an active process requiring conscious and deliberate activities. Therefore, motivation may determine what attracts individuals to learning. In an academic setting, motivation and learning are integrally related; this means that for learning to take place, motivation is important. Motivation in education is also important for deep learning and good academic performance as well as positive learner well-being and satisfaction. In the case of medical education, these are expected to contribute towards students becoming good doctors. This chapter will discuss the science of motivation and then will try to answer the important questions: To what extent are medical students intrinsically or extrinsically motivated? Why do we need to know? Which type of motivation is useful in medical education? It will then discuss the science and art of motivation, followed by discussion of motivation and self-regulation. The chapter will discuss also motivation in medical education, teaching, clinical as well as problem-based learning. It will expand to discuss motivation of medical school and medical profession applicants, and then it will conclude with motivation and e-learning.
Because change is ubiquitous in healthcare, clinicians must constantly make adaptations to their practice to provide the highest quality care to patients. In a previous article, Cutrer et al. described a metacognitive approach to learning based on self-regulation, which facilitates the development of the Master Adaptive Learner (MAL). The MAL process helps individuals to cultivate and demonstrate adaptive expertise, allowing them to investigate new concepts (learn) and create new solutions (innovate). An individual’s ability to learn in this manner is driven by several internal characteristics and is also impacted by numerous aspects of their context. In this article, the authors examine the important internal and contextual factors that can impede or foster Master Adaptive Learning.
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Residents in the medical field work to fulfil their clinical duties and study to pass exams at the same time. Thus, they need to continuously learn and acquire knowledge in a self-regulated manner that accommodates their busy work schedule. The importance of self-regulated learning (SRL) and its relation to motivation is widely recognized in educational literature, yet it is still not sufficiently explored in medical education literature. The relationship between self-regulated learning (SRL) and motivation has not been sufficiently explored among medical residents. A total of 160 residents from different medical departments at McGill University were asked to complete a questionnaire about their psychological needs satisfaction, motivation to learn, and use of SRL strategies. Our results showed that residents who are more intrinsically motivated reported more utilization of SRL strategies. Results are discussed in terms of their impact on medical education practice as well as their theoretical implications.
Objectives:
This study investigates the students' satisfaction and awareness of competency towards smartphone use and schema based learning in dental radiology practice.
Methods:
Third-year students undertaking a dental radiology practicum at a dental school were divided into two groups: one group received traditional clinical training, whereas the other group used smartphones in classes and received new training using schema assignments. At the end of the course, students' satisfaction with the training and self-awareness of their competency were surveyed, and their achievement was assessed.
Results:
Although students' satisfaction with smartphone-based training was generally high, it was less than that of students trained by traditional instruction. However, most students that received smartphone-based training had higher self-scored competency before than after training. The smartphone group scored higher on T/F or multiple-choice questions, whereas the traditional group scored higher on short answer questions.
Conclusions:
Smartphone education with schema based assignment proved to be attractive in dental radiology, but students showed less satisfaction, and need to meet the requirements of evidence-based practice. Although the full use of smartphone education with schema is not recommended in dental education, we think that it could be try to use as a supplementary approach with traditional didactic method to facilitate student's exploration and self-study to cope with rapid change in educational environment.
Background
Since the introduction of the e-learning electrocardiogram (ECG) course ‘ECG Online’ into the curriculum at the University of Ulm, a small but relatively constant number of students have decided not to participate in the online course but to attend the face-to-face course, although the content of both courses is identical. The present study examined why students prefer one format or the other.
Methods
In a qualitative research approach, ten medical students were questioned in a guided interview. At the time of the survey the interviewees were enrolled in the 7th to 10th semesters. Among the respondents, 2 had participated only in the face-to-face ECG course, 4 only in the online version and 4 in both the face-to-face and the online course.
Results
Interestingly, the very factors associated with e-learning – and always praised as advantages of it – are viewed critically by the students. Thus, although the 24-h access to learning content was consistently evaluated positively, the unlimited availability (lack of expiry date) was not seen as conducive to learning. The lack of fixed time constraints and the attendant lack of pressure were important reasons why some of the students had discontinued the online course prematurely. A similar distinction was seen in the flexibility of location for e-learning, because the very obligation to be physically present on a particular day at a fixed time led to a higher degree of commitment to courses and a willingness to actually attend the course until the end. In addition, if the content has a high degree of perceived professional relevance face-to-face courses are preferred because they offer the possibility of direct interaction.
Conclusions
Even though the small sample size limits the generalisability of the results, our findings indicate that when developing online courses students’ needs could be better met if measures were included to strengthen extrinsic and intrinsic motivation and formats were favoured that enable students to have a minimum level of personal interaction with the lecturer.
A smart university must utilize different technical solutions to offer its students varied and innovative learning environments optimizing the core learning activities. Contact with patients is at the core of medical and health care education, often taking place at a university hospital. However, students from one profession seldom get the chance to practice in a hospital setting with students from other professions, and they seldom see the whole patient trajectory during clinical practice. Establishing a smart virtual university hospital mirroring a real life hospital can prepare students for direct patient contact such as practice placement and clinical rotation, and thus optimize and sometimes also increase their time on task. Such a virtual arena will support student learning by providing adaptive and flexible solutions for practicing a variety of clinical situations at the students’ own pace. We present a framework for a smart virtual university hospital as well as our experiences when it comes to developing and testing solutions for training interprofessional team communication and collaboration. In the main part of the work reported here, medicine and nursing students worked in groups with the clinical scenarios in a virtual hospital using desktop PCs alone and with virtual reality goggles. In the evaluation, it was found that all the students agreed that they had learned about the value of clear communication, which was the main learning outcome. Using virtual reality goggles, almost all the students reported that they felt more engaged into the situation than using desktop PCs alone. At the same time, most also reported ‘cyber sickness’. We conclude that a smart virtual university hospital is a feasible alternative for collaborative interprofessional learning.
Background:
Students' self-regulated learning becomes essential with increased use of exploratory web-based activities such as virtual patients (VPs). The purpose was to investigate the interplay between students' self-regulated learning strategies and perceived benefit in VP learning activities.
Method:
A cross-sectional study (n = 150) comparing students' study strategies and perceived benefit of a virtual patient learning activity in a clinical clerkship preparatory course. Teacher regulation varied among three settings and was classified from shared to strong. These settings were compared regarding their respective relations between regulation strategies and perceived benefit of the virtual patient activity.
Results:
Self-regulation learning strategy was generally associated with perceived benefit of the VP activities (rho 0.27, p < 0.001), but was not true in all settings. The association was higher in the two strongly regulated settings. The external regulation strategy did generally associate weakly with perceived benefit (rho 0.17, p < 0.05) with large variations between settings.
Conclusions:
The flexible student-autonomous appeal of virtual patients should not lead to the dismissal of guidance and related course activities. External teacher and peer regulation seem to be productive for increasing learners' perceived benefit. Awareness of the interplay among teacher regulation (external) and various study strategies can increase the value of flexible web-based learning resources to students.
In courses with large enrollment, faculty members sometimes struggle with an understanding of how individual students are engaging in their courses. Information about the level of student engagement that instructors would likely find most useful can be linked to: (1) the learning strategies that students are using; (2) the barriers to learning that students are encountering; and (3) whether the course materials and activities are yielding the intended learning outcomes. This study drew upon self-regulated learning theory (SRL) to specify relevant information about learning engagement, and how the measures of particular scales might prove useful for student/faculty reflection. We tested the quality of such information as collected via the Motivated Strategies for Learning Questionnaire (MSLQ). MSLQ items were administered through a web-based survey to 150 students in a first-year medical gross anatomy course. The resulting 66 responses (44% response rate) were examined for information quality (internal reliability and predictive validity) and usefulness of the results to the course instructor. Students' final grades in the course were correlated with their MSLQ scale scores to assess the predictive validity of the measures. These results were consistent with the course design and expectations, showing that greater use of learning strategies such as elaboration and critical thinking was associated with higher levels of performance in the course. Motivation subscales for learning were also correlated with the higher levels of performance in the course. The extent to which these scales capture valid and reliable information in other institutional settings and courses needs further investigation. Anat Sci Educ. © 2014 American Association of Anatomists.
Even though peer process feedback is an often used tool to enhance the effectiveness of collaborative learning environments like PBL, the conditions under which it is best facilitated still need to be investigated. Therefore, this study investigated the effects of individual versus shared reflection and goal setting on students' individual contributions to the group and their academic achievement. In addition, the influence of prior knowledge on the effectiveness of peer feedback was studied. In this pretest-intervention-posttest study 242 first year students were divided into three conditions: condition 1 (individual reflection and goal setting), condition 2 (individual and shared reflection and goal setting), and condition 3 (control group). Results indicated that the quality of individual contributions to the tutorial group did not improve after receiving the peer feedback, nor did it differ between the three conditions. With regard to academic achievement, only males in conditions 1 and 2 showed better academic achievement compared with condition 3. However, there was no difference between both ways of reflection and goal setting with regard to achievement, indicating that both ways are equally effective. Nevertheless, it is still too early to conclude that peer feedback combined with reflection and goal setting is not effective in enhancing students' individual contributions. Students only had a limited number of opportunities to improve their contributions. Therefore, future research should investigate whether an increase in number of tutorial group meetings can enhance the effectiveness of peer feedback. In addition, the effect of quality of reflection and goal setting could be taken into consideration in future research.
Self-determination Theory (SDT), designed by Edward Deci and Richard Ryan, serves among the current major motivational theories in psychology. SDT research has been conducted in many areas, among which are education and health care, but its applications in medical education are rare. The potential of SDT to help understand processes in medical education justifies this Guide. SDT is explained in seven principles, one of which is the distinction of three innate psychological needs of human beings: for competence, for autonomy and for relatedness. Further, SDT elaborates how humans tend to internalise regulation of behaviour that initially has been external, in order to develop autonomous, self-determined behaviour. Implications of SDT for medical education are discussed with reference to preparation and selection, curriculum structure, classroom teaching, assessments and examinations, self-directed learning, clinical teaching, students as teachers and researchers, continuing professional development, faculty development and stress among trainees.
Motivation in learning behaviour and education is well-researched in general education, but less in medical education.
To answer two research questions, 'How has the literature studied motivation as either an independent or dependent variable? How is motivation useful in predicting and understanding processes and outcomes in medical education?' in the light of the Self-determination Theory (SDT) of motivation.
A literature search performed using the PubMed, PsycINFO and ERIC databases resulted in 460 articles. The inclusion criteria were empirical research, specific measurement of motivation and qualitative research studies which had well-designed methodology. Only studies related to medical students/school were included.
Findings of 56 articles were included in the review. Motivation as an independent variable appears to affect learning and study behaviour, academic performance, choice of medicine and specialty within medicine and intention to continue medical study. Motivation as a dependent variable appears to be affected by age, gender, ethnicity, socioeconomic status, personality, year of medical curriculum and teacher and peer support, all of which cannot be manipulated by medical educators. Motivation is also affected by factors that can be influenced, among which are, autonomy, competence and relatedness, which have been described as the basic psychological needs important for intrinsic motivation according to SDT.
Motivation is an independent variable in medical education influencing important outcomes and is also a dependent variable influenced by autonomy, competence and relatedness. This review finds some evidence in support of the validity of SDT in medical education.
Maximizing the potential of feedback requires being receptive to suggestions for change, adapting feedback according to different learning styles, and making the most of new developments. This article provides a foundation in the theory of modern medical education for those receiving or giving feedback at any level.
Traditionally, medical schools have tended to make assumptions that students will "automatically" engage in self-education effectively after graduation and subsequent training in residency and fellowships. In reality, the majority of medical graduates out in practice feel unprepared for learning on their own. Many medical schools are now adopting strategies and pedagogies to help students become self-regulating learners. Along with these changes in practices and pedagogy, many schools are eliminating a cornerstone of extrinsic motivation: discriminating grades. To study the effects of the switch from discriminating to pass-fail grading in the second year of medical school, we compared internal and external assessments and evaluations for a second-year class with a discriminating grading scale (Honors, High Pass, Pass, Fail) and for a second-year class with a pass-fail grading scale. Of the measures we compared (MCATs, GPAs, means on second-year examinations, USMLE Step 1 scores, residency placement, in which there were no statistically significant changes), the only statistically significant decreases (lower performance with pass fail) were found in two of the second-year courses. Performance in one other course also improved significantly. Pass-fail grading can meet several important intended outcomes, including "leveling the playing field" for incoming students with different academic backgrounds, reducing competition and fostering collaboration among members of a class, more time for extracurricular interests and personal activities. Pass-fail grading also reduces competition and supports collaboration, and fosters intrinsic motivation, which is key to self-regulated, lifelong learning.
Giving performance feedback to students in psychiatry requires particular delicacy and skill since a critique of the subjective artistry of the psychiatric interview may be felt more personally than a critique of an objective skill, such as eliciting a reflex or applying a stethoscope to the chest. Thus, one would expect that psychiatrists 1) are adept at giving feedback and 2) have written about the nuances of feedback delivery in psychiatric education. After a curricular needs assessment in our program revealed that feedback delivery was being neglected at all levels of training, a review of the medical education literature was conducted to find explanations for preceptor difficulty with performance feedback delivery in undergraduate psychiatric education.
A qualitative content-analysis review of the PubMed and OVID literature on feedback delivery and medical education was conducted.
Several articles were available on feedback delivery in medical education, but only one of the studies was specific to undergraduate psychiatric education. Several articles offered practical tips to address deficiencies in the feedback process, but there was little to no explanation for the reasons behind the deficiencies.
Reasons for the challenges faced by medical students and teachers during feedback conversations have not been fully explored in the literature. In contrast to other areas of medicine, little has been written specifically about feedback to students in undergraduate psychiatric education. Although there are many resources to assist medical educators with feedback delivery skills, an understanding as to why physicians and students struggle with feedback conversations is needed. Reasons for the apparent disconnect between what should be happening and what is actually happening during feedback conversations with undergraduate psychiatry students need to be understood. The authors hypothesize causes for the problems with feedback delivery in undergraduate psychiatric education.