Medical Students' Intention to Change After Receiving Formative Feedback: Employing Social Cognitive Theories of Behavior.

Abstract

We applied Azjen's theory of planned behavior (TPB) and Triandis' theory of interpersonal behavior (TIB) to understand medical students' intention to change behavior based on feedback received during an obstetrics and gynecology clerkship. Both models presume that behavioral intention is strongly related to actual behavior. We collected free-text responses from students during a year-long Feedback Focused initiative on the obstetrics and gynecology clerkship at Harvard Medical School. Students reported feedback daily and what they would change based on that feedback. We applied TPB and TIB to identify students' motivation to change. We analyzed data using directed content analysis. We reviewed 1,443 feedback entries from 122 students between July 2, 2018, and May 31, 2019. Self-efficacy was the most commonly represented component, related to a student expressing their own role, ability, or skill integrating the feedback (85%). Some entries (11%) focused on students' attitudes or beliefs about the outcome of the implemented feedback, usually patient focused but sometimes about the learner's outcome. Intentions motivated by social norms and expectations focused on the perceived or stated expectations of others, usually a superior or a team (11%). A small number of entries (1.7%) indicated that students had an emotional response to challenging or meaningful feedback. While self-efficacy is an important change motivator, faculty development geared toward improving the provision of meaningful feedback that bridges a desired behavior change to an outcome of interest, framed through the attitudes and beliefs or social norms lens, may improve trainee performance.