[E poster]how do residents develop self efficacy through clinical training a qualitative study
1. HOW DO RESIDENTS DEVELOP
SELF-EFFICACY THROUGH
CLINICAL TRAINING? A
QUALITATIVE STUDY
KAZUKI TOKUMASU
DEPARTMENT OF GENERAL MEDICINE
OKAYAMA UNIVERSITY HOSPITAL
General Medicine
Okinawa Chubu Hospital
2. INTRODUCTION
Self efficacy↑
Performance↑
Self-efficacy is the “belief in one’s
capabilities to organize and execute the
courses of action required to produce
given attainments” (Bandura, 1997).
(Chaput & Dunn, 2001; Johnston et al.,
2004; Kell, 2006)
3. WHAT IS ALREADY KNOWN ON SELF-EFFICACY
Self efficacy↑ Performance↑
Category Subjects Self-efficacy influences Authors
Medical
Education
Medical students Academic performance↑
・Chaput & Dunn, 2001
・Johnston et al., 2004
・Kell, 2006
Nursing
Education
Nursing Students
Narrow the theory–practice gap
・Kuiper & Pesut, 2004
・Kuiper, Pesut, & Kautz,
2009
Established a link
exists between self-efficacy and
acquisition of clinical skills
・Bambini 2009
・Golden-berg 2005
・Kuiper 2010
・Wagner 2009
Student’s academic achievement↑
・Black 2007
General
Education
Students Academic performance↑
・Choi 2005
5. KNOWN AND UNKNOWN ON SELF-EFFICACY
Category Subjects
What kind of experience
increase Self-efficacy?
How they develop
Self-efficacy?
Authors
Medical
Education
Medical
students
Deep learning
approach
Papinczak,
2008
Doctors ??? ???
Nursing
Education
Students
・Realistic situation
(Successful behavior)
・Observing individuals
similar to oneself succeed in
goal attainment
・Student engagement
Walker
and
Avant,
2005
General
Education
・Mastery experiences
・Observing individuals
similar to oneself succeed
・Social persuasion.
Cognitive processes
Motivational
processes
Affective processes
Selection processes
Bandura,
1994
College
students
Making decisions in complex
environments
High goals setting
Cognitive process
Motivational process
Affective process
Martin M,
2001
6. RESEARCH QUESTION
The purpose of this study is to explore
What kind of experience
increase self-efficacy
and
How residents develop self-
efficacy in clinical training
qualitatively.
7. • Qualitative study using semi-structured interviews based on
the interview guide.
• Participants: Five Japanese post graduate year(PGY)2-4
residents at Okinawa Chubu Hospital and Okayama
University Hospital.
• Definition: “Self-efficacy” is the belief in one’s capabilities
to organize and execute the courses of action required to
produce given attainments (Bandura, 1997).
• Data analysis: All interviews were recorded, transcribed and
anonymized. The transcripts were analyzed based on Steps
for Coding and Theorization (Otani, 2008), which is a
sequential and thematic qualitative data analysis technique.
METHODS
10. “…The case was a patient who said that a foreign body had entered his
ear. I was very pleased to have removed the foreign matter. So the patient
confirmed my name. …The patient said “Your name is… I will remember." I
was very grateful. At that time, I was very happy and my motivation
improved. ..The number of days in between was more comfortable than
usual. It's not always fun, but I was able to work with higher motivation.”
Case 1
SUCCESSFUL CLINICAL EXPERIENCE WITH
AUTONOMY AND RESPONSIBILITY
Successful treatment with patient’s gratefulness.
11. SUCCESSFUL CLINICAL EXPERIENCE WITH
AUTONOMY AND RESPONSIBILITY
“…when I got a positive feed back I often get motivated. This is especially
true when I received positive feedback from an attending physician and a
word of gratitude from the patients. And also when I noticed some
problems with the patients and I was able to report it to my attending
physician…”
Case 2
Appropriate assessment with attending physician’s
positive feedback.
12. “…Even if the doctor is PGY-3, for example If you come to a surgical case,
it is necessary to manage the patient semi-independently. When I look at
these things directly, I consider having to learn from now. …. When I look
at my wife, she is already working hard as a neurosurgeon. I think about
that the first time I got help from my senior teacher ... and of course I get
help, but I realized that I have to be independent….. I was looking at my
wife and I really thought that I would not be troubled when it came to
that situation. It's very motivational.….It is necessary to answer the
details, for instance, the amount of injection…”
ROLE MODELING
Case
Looking at a close member as a role model
strengthens self-efficacy.
14. TAKE HOME MESSAGE
Realization of the processes involved in developing self-
efficacy among physicians-in-training can make their
development more effective.
4 Tips for Clinical Teachers
1. Support your residents to have successful experiences.
2. Their experiences should involve autonomy and
responsibility.
3. Make resident's clinical management be semi-
independent.
4. Facilitate resident finding near peer role model.
15. CO-AUTHORS
Mikako Obika1
Haruo Obara2
Makoto Kikukawa3
Fumio Otsuka1
*1 Department of General Medicine, Okayama University Hospital, Japan,
*2 Department of General Internal Medicine, Okinawa Chubu Hospital, Okinawa, Japan
*3 Department of Medical Education, Kyusyu University, Fukuoka, Japan
16. IF YOU HAVE ANY QUESTION, PLEASE CONTACT ME.
Kazuki Tokumasu
tokumasu@okayama-u.ac.jp
Editor's Notes
Survey: What kind of experience increase self-efficacy and How residents develop self-efficacy?
Multon, K. D., Brown, S. D., & Lent, R. W. (1991). Relation of self-
efficacy beliefs to academic outcomes: A meta-analytic investigation.
Journal of Counseling Psychology, 38, 30-38.
(Chaput & Dunn, 2001; Johnston et al., 2004; Kell, 2006)
This is a previous research about how to
social persuation is a powerful means of increasing self-efficacy. Kate R 2003
Two main experiences were identified to develop residents’ self-efficacy:
First, “Successful clinical experience with autonomy and responsibility” was the most effective factor in enhancing residents’ self-efficacy. Additionally, thankfulness from patients and attending physicians’ approval reinforced the efficacy. Autonomy is the attitude of having one's own choice in managing patients. Responsibility was a force that obliges residents to take charge of their patients.
Second, “Role model of a close member” influenced self-efficacy positively.
Spending time with well-trained senior doctor, inspired the resident doctors to attain the same performance level and improve their sense of self-efficacy.
# Autonomy being defined as the attitude of having one's own choice in managing patients.
# Responsibility was a force that obliged residents to take charge of their patients.
Successful clinical experience is strongly related to mastery experience, which is the most effective way of creating a strong sense of efficacy. Additionally, in postgraduate clinical settings, autonomy and responsibility, that are crucial qualities for clinicians, are powerful factors that strengthen the mastery experience. As young doctors, residents felt a huge gap between own goals to contribute to patients’ management and actual abilities. Thus, these mastery experiences have a great power to develop self-efficacy.
Role modeling is a vicarious experience in which seeing similar people succeed strengthens self-efficacy. The closer the relationship, the deeper is its influence on self-efficacy.