임상실습에서 학생의 피드백탐색 행동 명확화(Med Educ, 2013)

임상실습에서 학생의 피드백탐색 행동 명확화(Med Educ, 2013)

Clarifying students’ feedback-seeking behaviour in clinical clerkships

Harold G J Bok,1 Pim W Teunissen,2,3 Annemarie Spruijt,1 Joanne P I Fokkema,4 Peter van Beukelen,1

Debbie A D C Jaarsma5 & Cees P M van der Vleuten2

도입

INTRODUCTION

Archer에 따르면 피드백은 인지, 기술 및 전문적 개발을 지원하는 데 핵심적인 역할을 합니다.10 그러나 임상 상황은 예측할 수 없고, 그때마다 다른 교수 방법이 사용되기 때문에 임상 작업장의 피드백은 감독자와 FR 모두에게 어려운 경우가 많다. 이러한 어려움에도 불구하고 임상 성과에 대한 피드백은 '효과적인 임상 훈련의 핵심'으로 설명되어 있다.9 직장 학습에 대한 연구는 피드백 제공에 대한 귀중한 통찰력을 제공하지만, 피드백을 받거나 적극적으로 추구하는 사람들의 역할은 여전히 설명되지 않았다.

According to Archer, feedback plays a central role in supporting cognitive, technical and professional development.10 However, feedback in the clinical workplace is often difficult for both supervisors and recipients because the clinical setting is unpredictable and different teaching methods are used within it.11 Despite these challenges, feedback on clinical performance is described as the ‘cornerstone of effective clinical training’.9 Research into workplace learning has yielded valuable insights into the provision of feedback, but the role of those receiving or actively seeking feedback has remained under-explored.12,13

조직 심리학에서, '피드백 탐색 행동'이라는 용어는 Ashford와 Cummings에 의해 만들어진 것으로 피드백을 유치하는 과정에 관련된 과정을 지칭하는 것이다.14,15 이러한 저자들에 의해 구성된 이론적 모델은 피드백을 추구하는 세 가지 주요 동기를 제안한다.

• 유용한 정보에 대한 욕구(도구적 동기) 

• 자존심을 옹호하거나 강화하려는 욕구(에고-기반 동기)

• 나에 대한 다른 사람의 인상을 보호하거나 강화하려는 욕구(이미지-기반 동기)14

In organisational psychology, the term ‘feedback-seeking behaviour’ was coined by Ashford and Cummings to refer to processes involved in inviting feedback.14,15 The theoretical model constructed by these authors proposes three primary motivators of feedback-seeking behaviour: 

• the desire for useful information (instrumental motive), 

• the desire to defend or enhance one’s ego (ego-based motive), and 

• the desire to protect or enhance the impressions that others hold of one (image-based motive).14

이 모델에서 중요한 개념은 피드백을 구하는 사람들의 목표가 그들의 성과에 대한 정보를 얻는 방법을 결정한다는 것이다.19–23 개인적 특성에 대한 자기 이론에 기초하여 학습 목표 지향은 성과 목표 지향과 구분할 수 있다,20 

Dweck에 의해 각각, 

• 학습지향: '새로운 기술을 배우고, 새로운 일을 마스터하고, 새로운 것을 이해하고 싶은 욕구' 

• 성과지향: '자신의 역량에 대한 긍정적인 판단을 획득하고 부정적인 판단을 피하려는 욕구 24

An important notion in this model is that the goals of those seeking feedback determine how they obtain information about their performance.19–23 Based on self-theories about personal attributes, a learning goal orientation can be distinguished from a performance goal orientation,20 described by Dweck as, respectively, ‘a desire to learn new skills, master new tasks, or understand new things’ and ‘winning positive judgements of your competence and avoiding negative ones’.24

목표 지향과 피드백 추구 행동 사이의 관계는 동기 부여에 의해 조정된다. 다른 말로 하면, 지배적인 동기를 바탕으로, 특정한 목표가 형성되고, 이것은 피드백을 찾는 행동을 인도한다.21 또한 어떤 목표를 지향하느냐에 따라 피드백 추구에 따르는 비용 및 편익에 대한 인식이 달라진다.17,25

The relationship between goal orientation and feedback-seeking behaviour is mediated by motivation; in other words, based on a predominant motive, a specific goal is formulated, which then guides the feedback-seeking behaviour.21 Goal orientation also determines how the perceived costs and benefits of feedback are weighed in decisions about feedback seeking.17,25

사회 및 조직 심리학 문헌에서 설명한 바와 같이, 피드백 추구는 복잡한 현상이다. Teunissen et al.는 레지던트들의 목표 지향성이 예상되는 부정적인 효과와 피드백을 요청하는 잠재적 이익에 대한 그들의 인식에 영향을 미친다는 것을 보여주었다. 더욱이, 주치의의 감독 방식은 레지던트의 피드백 탐색 행동에 부분적으로 영향을 미치는 것 같았다.

As described in the social and organisational psychology literature, feedback-seeking behaviour is a complex phenomenon. Teunissen et al. showed that residents’ goal orientations influenced their perceptions of the expected negative effects and potential benefits of asking for feedback. Furthermore, the attending physician supervisory style seemed to partially influence the residents’ feedback-seeking behaviour.

일반적으로 임상 사무직은 다소 비정형적인 학습 환경으로 구성되는 것으로 간주되며, 그 환경 내에서 학생들의 학습에 영향을 미치는 다양한 요소들이 제시되어 왔다.27–29

Clinical clerkships are generally considered to comprise a rather unstructured learning environment and different factors have been shown to influence students’ learning within that environment.27–29

METHODS

Setting

The study was conducted among students in the clinical phase (Years 5 and 6) of the 6-year undergraduate curriculum of the Faculty of Veterinary Medicine, Utrecht University (FVMU), Utrecht, the Netherlands.

Study design

As relatively little is known about students’ feedback seeking behaviour in the veterinary medicine clinical setting, we designed an explorative qualitative study using an interpretive approach.30,31 Our aim was to contribute to understanding of the feedback-seeking behaviour of students in a clinical learning environment by describing our perceptions of that behaviour as they resulted from the analysis of interviews with students. 

The interviews were structured based on theoretical concepts of feedback-seeking behaviour.19–23 We combined inductive and deductive approaches to gain insight into feedback-seeking behaviour. This topic has received rather limited attention in medical education research and therefore we also considered previous work in fields outside medical education.32 We used semi-structured, face-to-face interviews to gain in-depth information and encourage students to openly share their views.33

Participants and procedure

Between April and June 2011, the principal researcher (GJB) interviewed students who had been sampled by maximum variation sampling to ensure that the sample included students following a variety of animal species tracks and in various phases of training. The logic and power of maximum variation sampling lie in selecting information-rich cases for in-depth study.33

Within 1 week of the interview, each participant was asked to comment on a one-page summary of his or her interview in order to support a member-checking protocol.34 The summary was written by the principal researcher and reflected participants’ answers to the main questions in the interview. Eight participants responded to this request, but made no suggestions for change. To facilitate the identification of new issues in subsequent interviews, data collection and analysis were performed iteratively. Interviewing continued until theoretical saturation was reached.

Interview development

• The interviews were structured using questions about students’ goals and motives in seeking feedback, characteristics of their feedback-seeking behaviour and factors influencing this behaviour. 

• The questions were based on the research questions and a theoretical framework derived from social and organisational psychology (Fig. 1).19–23 

• Two pilot interviews resulted in minor changes to the wording but not the content of the questions. The main questions were:

1 Why do you seek information about your performance of a clinical task?

2 Which factors influence the way you seek feedback?

3 How do you obtain information about your performance?

Analysis

• We used a template analysis method35 involving an iterative process of reducing and displaying the data, culminating in a template consisting of codes representing categories and factors, and the relationships among them. 

• Based on the theoretical framework, we designed an initial template, which was modified in the subsequent iterative process of data collection and analysis. 

• We used the theoretical framework and the conceptual model only in designing the interview structure; we used an inductive approach to analyse the interviews. 

• The analysis resulted in an extensive list of codes, which were categorised. 

• The principal researcher (GJB) coded all transcripts and constructed themes. 

• Using the list of codes, another researcher (PWT) re-coded the eighth interview. 

• The two researchers reached agreement on the discrepancies between their analyses through discussion. 

• After 12 transcripts had been coded, theoretical saturation was reached and the final template was constructed. 

• GJB, two medical education experts (PWT, CPMvdV) and two experts in veterinary medical education (ADCJ, PvB) agreed on the final template after discussion. 

• The coding of the two remaining interviews confirmed the final template.

Confidentiality and ethical considerations

결과

RESULTS

The main categories to result from the analysis are interrelated, which shows that students dynamically adjust their feedback-seeking behaviour to fit a particular context. Fig. 2.

왜 학생들은 피드백을 탐색하는가?

Why do students seek feedback?

개인적 요인: 피드백 탐색자의 의도

Personal factors: intentions of the feedback seeker

어떤 목표들은 학생들에게 피드백 추구 동기와 피드백 회피 동기를 부여할 수 있다는 것을 나타냈다. 

• 피드백 추구(예: 임상 능력을 입증하고, 임상 능력을 개발하고, 지식과 기술을 향상시킴으로써 전문가로서 성장함으로써 긍정적인 판단을 받는 것) 

• 피드백 회피(예: 부정적인 판단을 피하고, 동료들에 비해 낮은 임상 능력을 보여주어야 하는 것을 피함) 

게다가, 학생들은 환자와 고객에 대한 책임감으로 피드백을 구하고자 동기부여를 받았고, 이것은 학생들은 임상 능력 향상 목적의 피드백 탐색을 자극했다.

The analysis indicated that distinctive goals can motivate students in seeking feedback (e.g. receiving positive judgements by demonstrating clinical competence, developing clinical competence and growing as a professional by improving knowledge and skills) and in avoiding feedback (e.g. avoiding negative judgements and avoiding having to demonstrate inferior clinical competence compared with one’s peers). Furthermore, students were motivated to seek feedback out of a sense of responsibility towards patients and clients, which stimulated them to seek feedback to improve their clinical competence.

개인적 요인: 피드백 탐색자의 특성

Personal factors: characteristics of the feedback seeker

피드백을 추구하는 행동은 또한 학생들의 신체적, 정신적 행복과 같은 개인적인 특성에 의해 영향을 받았다.

Feedback-seeking behaviour was also influenced by a student’s personal characteristics, such as his or her physical and mental well-being:

감독관 중 한 명이 나도 한 팀으로 대했다. 마치 내가 수의사 대학원생인 것처럼. 이것은 제가 매일의 임상 사례에 적극적으로 참여하게 된 매우 강력한 동기 부여였습니다. 그 결과 저는 더 자주 피드백을 요청했습니다.' (P5)

‘One of my supervisors treated me as one of the guys. As if I was a graduate veterinarian. This was a very strong motivator for me to participate actively in daily clinical practice and as a result I asked more frequently for feedback.’ (P5)

개인적 요인: 피드백 제공자의 특성

Personal factors: characteristics of the feedback provider

학생들은 피드백 제공자의 특성이 피드백을 탐색하도록 장려했다고 지적했다. 그들은 또한 [학생들이 질문을 할 시간이 있고 감독자들이 대답할 의향이 있는] 안전한 학습 환경에서 피드백을 더 요요청할 수 있었다. 감독자들은 학생들에게 신뢰를 얻어야 했고, 이러한 신뢰는 피드백을 주기 전에 학생들의 task 수행을 관찰함으로써 강화되었다. 학생들은 특정 직무에서 숙련되고 경험이 있다고 생각하는 상급자에게 피드백을 요청하는 것을 선호했다.

Students indicated that the characteristics of the feedback provider, encouraged them to seek feedback. They also remarked that asking for feedback was promoted by a safe learning climate, in which students had time to ask questions and supervisors were willing to answer them: Supervisors had to seem credible to students and this credibility was enhanced when supervisors observed task performance before giving feedback. Students preferred to ask for feedback from supervisors whom, they perceived as skilled and experienced in the task in question.

대인관계 요인: 피드백 탐색자와 제공자의 관계

Interpersonal factors: the relationship between the feedback seeker and provider

학생-감독자 관계는 다양한 방식으로 피드백 추구에 영향을 미쳤다. 관계를 지속하는 시간이 증가함에 따라, 학생들은 피드백을 요구할 가능성이 더 많아졌다. 학생-감독자 관계의 위계적 특성과 슈퍼바이저가 피드백 제공자와 평가자의 역할을 겸하고 있다는 것도 중요하다.

The student–supervisor relationship influenced feedback-seeking behaviour in different ways. As the duration of a relationship increased, the student became more likely to ask for feedback. The hierarchical nature of the student–supervisor relationship and the combining by supervisors of the roles of feedback provider and assessor were also important:

무엇이 학생의 피드백 탐색 행동에 영향을 미치는가?

What influences students’ feedback-seeking behaviour?

학생들이 팀의 일원이라고 느끼는 정도, 환자 진료에 참여하는 것, 그리고 스스로 인지하는 의사소통 기술은 모두 학생들이 피드백을 요구하도록 자극했습니다.

The extent to which students felt they were part of a team, their involvement in patient care and their self-perceived communication skills all stimulated students to ask for feedback:

에고

Ego

피드백을 요청하기 전에 학생들은 에고ego에 대한 비용(즉, 부정적인 피드백으로 인한 부정적 감정)과 이점(예: 긍정적인 피드백에서 발생하는 높은 자존감)을 비교했다. 이 분석의 결과는 개인 및 대인 관계에 따라 다릅니다. 

• 특정 임상 과제를 숙달하고 싶은 학생들은 피드백(신뢰할 수 있는 피드백 제공자)으로부터 예상 비용(부정적 피드백으로 인한 신뢰 손실)을 능가하는 혜택을 기대할 수 있었다. 

• 자존감을 높이고 인정을 받기 위해 피드백을 요청한 학생들은 (부정적인 피드백이나 상사의 행동에 의해 강요된 무능력에 의해) 자아가 손상될 위험을 고려했다. 

Before asking for feedback, students weighed the perceived ego costs (i.e. negative emotions resulting from negative feedback) and benefits (i.e. enhanced self-esteem arising from positive feedback). The outcome of this analysis depended on personal and interpersonal factors. Students who were eager to master a specific clinical task were likely to let expected benefits from feedback (credible feedback provider) prevail over expected costs (a loss of confidence as a result of negative feedback). Students who asked for feedback to increase their self-esteem and gain recognition took account of the risk for damage to their ego by feelings of incompetence imposed by negative feedback or the behaviour of the supervisor. This process is illustrated by this student:

이미지

Image

인식된 이미지perceived image에 대한 비용과 이점은 또 다른 영향 요소를 나타냅니다. 학생들은 임상 작업장에서 동료, 환자 및 감독자들이 자신에 대한 특정 사전 인식(이미지)을 갖고 있다고 느꼈다. 이것은 학생들에게 그들의 이미지를 개선시키기 위해 피드백을 구하고, 또는 이미지 손상을 방지하기 위해 피드백을 찾지 않게 만든다. 개인과 대인 관계 요소의 상호작용을 바탕으로, 학생들은 잠재적인 위험과 편익을 평가하고 상황에 맞는 피드백을 찾는 행동을 시작하는 것으로 보였다. 예를 들어, 한 학생은 자신의 피드백을 볼 수 있는 그룹의 구성(예: 그 상황을 목격하는 동료의 숫자)에 따라 자신의 피드백을 찾는 행동을 조정했다고 언급했다. 

Perceived image costs and benefits represented another influencing factor. Students felt that in the clinical workplace, peers, clients and supervisors had certain preconceptions (images) about them. This presented students with a choice between seeking feedback in the hope that it would improve their image, or refraining from seeking feedback in order to prevent any potential damage to their image. Based on the interaction between personal and interpersonal factors, students appeared to make an assessment of the potential risks and benefits and to embark on context-specific feedback-seeking behaviour. For example, a student mentioned that she adapted her feedback-seeking behaviour depending on the composition of the group that might witness the feedback (e.g. the number of peers present):

피드백을 받는 것을 거부하는 학생은, 긍정적인 이미지를 유지하는 동시에 자신의 행동을 평가하기 위해 다른 학생들의 행동을 모니터링할 것이다.

If a student decided against inviting feedback, he or she would monitor the behaviour of others in order to evaluate his or her own behaviour while maintaining a positive image.

피드백 이득에 대한 인식

Perceived feedback benefit

또한, 피드백의 관련성, 양, 질 또한 학생들의 피드백 추구에 영향을 끼쳤다. 예를 들어, 학생들은 자신이 과제를 수행하는 상황을 관찰하지 않았던 감독자로부터 받은 피드백을 평가절하했다. 또한, 받은 피드백의 가치는 자신의 목표와 연관지어 판단했다.

In addition , the perceived relevance, quantity and quality of feedback also impacted students’ feedback-seeking behaviour. For example, students placed less value on feedback received from a supervisor who had not observed the subject performing the task in question. Furthermore, the value of received feedback was judged in relation to a student’s goal:

학생들은 어떻게 피드백을 탐색하는가?

How do students seek feedback?

피드백 출처와 주제

Feedback source and topic orientation

임상 작업 공간에서 학생들은 자신의 퍼포먼스에 대한 정보를 다른 학생, 감독자(예: 전문의, 레지던트), 고객, 간호 직원 또는 이들의 조합으로부터 얻었다. 학생은 잠재적 위험과 편익에 대해 상황을 판단하여, 이에 따라 특정 피드백 source에 접근한다.

In the clinical workplace, students obtained information about their performance on a specific clinical task from other students, supervisors (e.g. specialists, residents), clients, nursing staff or a combination of these. Depending on their context-dependent assessment of potential risks and benefits, students would approach a specific feedback source:

임상 작업 공간에서 학생들은 수행해야 했던 작업과 관련된 특정 수의학 지식, 특정 수의학 기술 및 심층적 지식에 대해서 피드백을 구했다. 시간이 지남에 따라, 그리고 작업이 달라짐에 따라, 이러한 FSB는 달라질 수 있습니다.

In the clinical workplace, students sought feedback on specific veterinary knowledge, specific veterinary skills and in-depth knowledge relating to a task they were required or had been required to perform. Over time and depending on the task, this behaviour might change:

피드백 탐색 행동의 타이밍

Timing of feedback-seeking behaviour

잠재적 위험과 편익에 대한 상황별 평가를 바탕으로 학생들은 피드백을 구할 적절한 타이밍(예: 특정 임상 과제를 수행하는 동안, 직후, 나중)을 결정했다. 학생들은 특히 이미지나 자아에 대한 비용cost를 걱정할 때 피드백 추구를 미룰 가능성이 높았다.

Based on their context-dependent assessment of potential risks and benefits, students determined the appropriate moment for seeking feedback (e.g. during or immediately after performing a specific clinical task or at a later, more appropriate time). Students were particularly likely to postpone the seeking of feedback when they were worried about costs to their image or ego:

피드백 탐색 행동의 빈도

Frequency of feedback-seeking behaviour

학생들이 피드백을 원하는 빈도는 잠재적 위험과 편익을 상황별로 평가한 결과에 따라 달라지며, 따라서 다양한 임상 작업에 따라 달라진다. 예를 들어, 

• 학생이 학습지향적이고, 자신의 상사에 의해서 피드백을 구하도록 동기부여되어있고, 특정 임상 과제에 해당하는 주제에 관심을 가질 때, 피드백을 요청하는 빈도가 높아질 것이다. 

• 반면, 성과 지향적인 학생이 자신의 이미지를 위태롭게 하는 상황에 직면했을 때, 적극적인 피드백을 찾는 빈도는 아마도 줄어들 것이다.

The frequency with which students sought feedback appeared to depend on the outcome of the context-dependent assessment of potential risks and benefits, and therefore varied for different clinical tasks. For example, 

• when a student was learning goal-orientated, motivated by her supervisor to seek feedback, and interested in the topic behind the specific clinical task, she would increase the frequency of asking for feedback. 

• By contrast, when a performance goal-oriented student was confronted with a situation in which his self-image was at stake, his frequency of active feedback seeking would probably decline:

피드백 탐색 행동의 유형

Types of feedback-seeking behaviour

학생들은 피드백을 얻기 위해 두 가지 주요 전략을 사용했다. 

• 그들은 다른 학생, 감독자 등의 행동을 모니터했고, 

• 특정 source로부터 피드백을 요청했다. 

학생들이 후자의 전략이 자신을 무능하게 보이게 할 수 있다고 우려할 때(즉, 자아와 이미지 비용이 발생할 수 있음), 그들은 다른 사람들을 모니터하는 전략을 활용하는 대신, inquiry 전략을 사용하지 않는 경향을 보여주었다.

Students used two main strategies to obtain feedback: 

• they monitored the behaviour of other students, supervisors and others, and 

• they explicitly asked for feedback from a specific source. 

When students were concerned that the latter strategy might make them look incompetent (i.e. it might incur ego and image costs), they tended to monitor others and not to use the inquiry strategy:

고찰

DISCUSSION

학생들은 그들의 피드백 추구에 영향을 준 두 가지 광범위한 목표, 즉 학습 목표 지향과 성과 목표 지향을 설명했다. 후자에 대해서는 학생들을 두 가지 범주로 구별할 수 있었다. 

• 자신의 임상 능력을 보여주고 긍정적인 판단을 받고 싶어서 피드백을 받으려는 의욕을 가진 학생들과, 

• 피드백의 부정적인 영향(부정적 판단을 받거나 다른 사람의 임상 능력보다 열등함을 보여주는 위험)을 잠재적으로 피하고자 하는 동기를 가진 학생 

Students described two broad goals that influenced their feedback-seeking behaviour: a learning goal orientation, and a performance goal orientation. We were able to distinguish two categories of students subject to the latter orientation: 

• students who are motivated to seek feedback because they want to demonstrate their clinical competence and receive positive judgements, and 

• students who are motivated to avoid potentially negative effects of feedback, such as negative judgements and demonstrations of their clinical competence as inferior to that of others. 

학습 목표 지향성을 가진 학생들은 그들의 지식과 기술을 향상시키고, 그들의 임상 능력을 개발하고 프로페셔널로 성장하는 것을 목표로 불확실성을 줄이는 데 집중했다. 목표 지향에 대한 이러한 연구 결과는 조직 심리학 영역 내에서 피드백 행동에 대한 연구와 일치한다.19,20

Students with a learning goal orientation focused on improving their knowledge and skills and on reducing uncertainty with the aim of developing their clinical competence and growing as a professional. These findings about goal orientation are consistent with research on feedback-seeking behaviour within the domain of organisational psychology.19,20

우리는 목표 지향 외에 피드백 제공자의 특성, 피드백 탐색자의 특성, 피드백 탐색기와 제공자 간의 관계 등 두 가지 다른 개인적 요소와 대인 관계 요인을 제안한다.

In addition to goal orientation, we propose two other personal factors and one interpersonal factor: characteristics of the feedback provider, characteristics of the feedback seeker, and the relationship between the feedback seeker and provider.

교수진과 학생들은 이러한 관계적 요소를 알고 있어야 하며, 이러한 요소들은 적극적인 피드백을 구하는 행동에 영향을 미치고, 결과적으로 학습을 강화할 수 있다. 임상실습에 관해서는 상황적 차이가 학습자와 감독자 사이의 역학 관계에 영향을 미친다는 것을 알아야 한다(예: 임상적 로테이션 대 레지던트 교육).

faculty staff and students should be aware of these relational factors, which influence active feedback seeking behaviour and as a consequence may enhance learning. People involved with clerkships should be aware that contextual differences (i.e. clinical rotation versus residency training) influence the dynamic between learner and supervisor.

우리가 제안하는 개인(대인)적인 요인들은 지속적으로 상호작용하였고, 학생들의 피드백을 찾는 행동은 [비용-편익 분석의 결과에 따라] 특정 상황에서 가장 중요하다고 인식하는 요인에 의해 영향을 받는다.

The (inter)personal factors we propose interact continuously and students’ feedback-seeking behaviour is influenced by the factors they perceive to be the most salient in a certain situation, depending on the outcome of a cost–benefit analysis

우리의 결과는 학생들의 비용-편익 분석의 결과가 

• 자아의 인식 비용 및 편익, 

• 이미지에 대한 인식 비용 및 편익, 

• 인식된 피드백 이익

...의 세 가지 요인에 의해 결정된다는 것을 시사한다. 

Our results suggest that the outcome of students’ cost–benefit analyses is determined by three categories of factor: 

• perceived costs and benefits to the ego; 

• perceived costs and benefits to image, and 

• perceived feedback profit. 

이러한 범주는 다른 연구에서 확인된 피드백을 찾는 세 가지 주요 동기와 일치하는 것으로 보인다.

• 도구적 동기(즉, 목표를 달성하기 위한 도구로서 피드백을 사용하는 것)

• 자아 기반 동기

• 이미지 기반 동기

These categories appear to be in line with three main motives for seeking feedback identified in other studies: 

• an instrumental motive (i.e. to use feedback as an instrument for achieving a goal); 

• an ego-based motive, and 

• an image-based motive.12,21,22,36

Goffman은 개개인은 피드백을 특정한 자기표현self-presentation을 유지하기 위한 귀중한 자원으로 인식하고 있다고 지적했다.37 피드백 탐색 행동은 잠재적으로 피드백을 찾는 학습자의 불확실성이나 무능함을 노출시킬 위험이 있다. 학생들은 임상실습 동안 긍정적인 자기표현을 유지할 필요성을 인식하였다. 학생들은 피드백을 구함으로써 잠재적으로 상당한 비용이 발생하고, 이것을 image-threatening 상황으로 인식하여 피드백을 원하는 빈도를 줄였다고 언급했다.

Goffman pointed out that individuals perceive feedback as a valuable resource with which to maintain a particular self-presentation.37 Feedback-seeking behaviour can potentially expose uncertainty or incompetence in the learner seeking feedback. The need to maintain a positive self-presentation was recognised by students seeking feedback during clinical clerkships, who mentioned that their perceptions of image-threatening situations as potentially incurring of significant costs decreased the frequency with which they sought feedback.

분석 결과를 토대로, 우리는 임상실습에서 학생들의 피드백 탐색 행동을 특징짓는 다섯 가지 요소를 제안합니다: 출처, 주제, 타이밍, 빈도 및 방법.

Based on our analysis, we propose five elements that characterise students’ feedback-seeking behaviour in clinical clerkships: 

• source, 

• topic, 

• timing, 

• frequency, and 

• method.

Strengths and limitations

Suggestions for future research

Implications for practice

이 연구의 결과는 학생들의 FSB는 연속적인 피드백 경험들에 맞게 행동을 조정하면서 발달한다는 것을 보여준다. 따라서 피드백은 학생들이 적극적으로 피드백을 구하도록 자극하는 구체적인 요건을 충족해야 한다. FSB는 학생이 자신이 임상 팀의 일원으로 인정받고 환자 치료에 대한 책임을 받는다고 느낄 때 증가한다.

The results of this study indicate that students’ feedback-seeking behaviour develops as students adjust their behaviour to consecutive experiences of feedback. It is therefore essential that feedback should meet specific requirements that stimulate students to actively seek feedback. As feedback-seeking behaviour increased when the student felt him or herself to be recognised as a member of the clinical team and to be given responsibilities in patient care.

교사가 학생을 임상 팀의 일원으로 받아들이도록 하기 위한 전략을 개발해야 할 것 같다. 또한 임상 환경에서 관리자의 행동이 학생들의 피드백 탐색 행동에 영향을 미쳤기 때문에, 우리는 임상 작업장에서 학생들의 피드백 탐색 행동에 영향을 미치는 요소를 피드백에 대한 관리자 훈련과 학생 훈련에 통합할 것을 제안한다.

it seems advisable that teachers should develop strategies to make the student feel accepted as a member of the clinical team. Furthermore, as supervisors’ behaviour within the clinical setting influenced students’ feedback-seeking behaviour, we propose to incorporate factors that influence students’ feedback-seeking behaviour in the clinical workplace into feedback training for supervisors and students.

그 결과는 또한 학습 환경이 학생들의 피드백을 구하는 행동을 촉진하거나 방해한다는 것을 보여주었다.

The results showed that the learning climate also promotes or deters students’ feedback-seeking behaviour.

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Med Educ. 2013 Mar;47(3):282-91. doi: 10.1111/medu.12054.

Clarifying students' feedback-seeking behaviour in clinical clerkships.

Bok HG1, Teunissen PW, Spruijt A, Fokkema JP, van Beukelen P, Jaarsma DA, van der Vleuten CP.

Author information

1

Quality Improvement in Veterinary Education, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands. g.j.bok@uu.nl

Abstract

CONTEXT:

Why and how do students seek feedback on their performance in the clinical workplace and which factors influence this? These questions have remained largely unanswered in research into workplace learning during clinical clerkships. Research on feedback has focused mainly on feedback providers. Whether and how feedback recipients actively seek feedback are under-examined issues. Research in organisational psychology has proposed a mechanism whereby feedback seeking is influenced by motives and goal orientation mediated by the perceived costs and benefits of feedback. Building on a recently published model of resident doctors' feedback-seeking behaviour, we conducted a qualitative study to explore students' feedback-seeking behaviours in the clinical workplace.

METHODS:

Between April and June 2011, we conducted semi-structured face-to-face interviews with veterinary medicine students in Years 5 and 6 about their feedback-seeking behaviour during clinical clerkships. In the interviews, 14 students were asked about their goals and motives for seeking feedback, the characteristics of their feedback-seeking behaviour and factors influencing that behaviour. Using template analysis, we coded the interview transcripts and iteratively reduced and displayed the data until agreement on the final template was reached.

RESULTS:

The students described personal and interpersonal factors to explain their reasons for seeking feedback. The factors related to intentions and the characteristics of the feedback provider, and the relationship between the feedback seeker and provider. Motives relating to image and ego, particularly when students thought that feedback might have a positive effect on image and ego, influenced feedback-seeking behaviour and could induce specific behaviours related to students' orientation towards particular sources of feedback, their orientation towards particular topics for and timing of feedback, and the frequency and method of feedback-seeking behaviour.

CONCLUSIONS:

This study shows that during clinical clerkships, students actively seek feedback according to personal and interpersonal factors. Perceived costs and benefits influenced this active feedback-seeking behaviour. These results may contribute towards the optimising and developing of meaningful educational opportunities during clerkships.

© Blackwell Publishing Ltd 2013.

Comment in

• Got feedback? [Med Educ. 2013]
• How can medical education benefit from the evidence on learners seeking and using feedback? [Med Educ. 2013]
• Seeking a different angle on feedback in clinical education: the learner as seeker, judge and user of performance information. [Med Educ. 2013]
• The influence of cognitive biases on feedback seeking. [Med Educ. 2013]

PMID:

 

23398014

 

DOI:

 

10.1111/medu.12054

[Indexed for MEDLINE]