Motivation for feedback-seeking among pediatric residents: a mixed methods study

Abstract

Background: For effective self-directed life-long learning physicians need to engage in feedback-seeking, which means fostering such behavior during training. Self-determination theory (SDT) posits that intrinsic motivation is fostered when the environment optimizes the individual's experience of autonomy, relatedness, and competence. Educational settings meeting these psychological needs may foster intrinsic motivation in trainees, enhance their desire for feedback, and promote feedback-seeking. We sought to examine residents' feedback-seeking behaviors through the lens of SDT and explore the association with intrinsic motivation and career choice.

Methods: We used a mixed-methods approach with an explanatory sequential design. Residents participated in simulation training, completed an inventory of intrinsic motivation (IMI) and responded to sequential opportunities for performance feedback requiring different levels of effort. We compared IMI scores and career choice between groups with different effort. We interviewed high-effort feedback-seekers and conducted thematic analysis of interview data.

Results: Thirty-four of 35 residents completed the survey (97%). Of those completing the study, 12 engaged in low-effort feedback-seeking only, 10 indicated intent for high-effort feedback-seeking and 10 actually engaged in higher effort to get feedback. Groups did not differ in mean IMI scores. Among high-effort feedback-seekers more residents were interested in critical care-related fields compared to the other groups. We identified 5 themes around autonomy, relatedness, and competence clarifying residents' reasons for feedback-seeking.

Conclusions: Our findings suggest that among residents, the relationship between motivation and feedback-seeking is complex and cannot be predicted by IMI score. Career plans and relationships with feedback providers impact feedback-seeking, which can inform educational interventions.

Keywords: Feedback; Feedback-seeking; Intrinsic motivation; Self determination theory.

Fig. 1

Study procedures. Residents participating as team leaders were recruited to the study immediately after the simulation session, and those who consented completed the IMI and indicated whether they were interested in written feedback. Those interested received feedback via e-mail, with a link to survey questions about career choice and the opportunity to request additional feedback in an in-person session. Those who indicated interest were prompted to e-mail the study investigator with potential dates and times for the session. These study procedures led to 3 study groups: Group A: low effort feedback-seeking; Group B: intended high effort feedback-seeking; Group C: actual high effort feedback-seeking