Your students are watching you! Medical Student Self-Efficacy With Family Centered Care During Bedside Rounds. Young H et al. Academic Medicine 2012;87(6):767-775.
Reviewed by Julie Noffsinger
What was the Study Question?
This study explored to what extent observing role models, practicing, and receiving feedback influenced clerks' self-efficacy in family-centered care (FCC).
How was the study done?
Third year pediatric clerkship students were surveyed in Madison, Wisonsin over three years. The surveys assessed 1) the students' self-efficacy with FCC during rounds and with particular FCC tasks (relationship building, information exchange, and decision making) and 2) the supportive experiences (observing role models, practicing for mastery, and receiving feedback) that students encountered. They looked at self-efficacy under everyday stressors (tired, stressed, etc) and situational stressors (difficult families, no time for lunch, feeling nervous, etc). They used some very fancy statistics to determine which supportive experiences had a significant direct effect on students' self-efficacy during rounds under different stressors.
What were the results?
They found that observing role models and practicing for mastery supported self-efficacy with FCC during rounds (p<0.01), whereas receiving feedback did not. These results were consistent whether the students were experiencing everyday or situational stressors.
What are the implications of these findings?
In this study, feedback did not contribute to the students' self-efficacy during rounds. The authors propose a few explanations for this: receiving feedback may decrease a student's self-efficacy since it highlights areas for improvement, feedback may be delivered during rounds and this may weaken a student's self-efficacy, or the expectations of students are not clearly defined and this, too, leads to a decrease in self-efficacy.
Most educators provide feedback not to increase their students' self-efficacy but, rather, to increase their students' awareness of areas of strength and areas for growth. Recognizing this, perhaps the findings in this study are not that surprising.
As the authors point out, there were no objective observations of the students in this study. As a result, we do not really know how the students were actually performing - we only know how they feel they were performing. While self-efficacy (a person's self declared ability to (now) do something "Having taken ATLS, I now feel able to run a trauma code") is not as poor an indicator of performance as is self-assessment (a person's ability to judge the quality of one's own performance "I can handle trauma codes well"), it is still not great. As Dr. Kevin Eva likes to say to a room full of people when talking about the perils of self-assessment, "Put up your hand if you are a below-average driver." Not surprising, nowhere near half of the room raises their hands. (SLB)