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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
- 4. HOW?? What experiences? Self efficacy↑ LITTLE KNOWN IN MEDICAL EDUCATION WHAT??
- 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
- 8. PARTICIPANTS No 4 PGY-3 58min No 2 PGY-2 68min No 3 PGY-2 51min No 1 PGY-2 51min No 5 PGY-4 33min
- 9. Successful Clinical experience Autonomy Responsibility Role modeling Thankfulness from patients Attending physicians’ approval How do residents develop self-efficacy RESULTS
- 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.
- 13. DISCUSSION AND CONCLUSIONS Successful Clinical experience Autonomy Responsibility Role modeling mastery experience vicarious experience
- 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 Rural internist in Japan. #Assistant professor #Department of General Medicine #Okayama University Hospital #Generalist #Rural Medicine #Medical Education #Personal Development #Community development #FUO/Undiagnosed disease
Editor's Notes
- 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.