Advances in Health Sciences Education

, Volume 18, Issue 4, pp 845–849 | Cite as

Why receiving feedback collides with self determination

  • Olle Th. J. ten CateEmail author


Providing feedback to trainees in clinical settings is considered important for development and acquisition of skill. Despite recommendations how to provide feedback that have appeared in the literature, research shows that its effectiveness is often disappointing. To understand why receiving feedback is more difficult than it appears, this paper views the feedback process through the lens of Self-Determination Theory (SDT). SDT claims that the development and maintenance of intrinsic motivation, associated with effective learning, requires feelings of competence, autonomy and relatedness. These three psychological needs are not likely to be satisfied in most feedback procedures. It explains why feedback is often less effective than one would expect. Suggestions to convey feedback in ways that may preserve the trainee’s autonomy are provided.


Feedback Self-Determination Theory Clinical context 


  1. Artino, A. R. (2012). Academic self-efficacy: From educational theory to instructional practice. Perspectives on Medical Education, 1(2), 76–85.CrossRefGoogle Scholar
  2. Cantillon, P., & Sargeant, J. (2008). Giving feedback in clinical settings. BMJ, 337, 1292–1294.CrossRefGoogle Scholar
  3. Cavalcanti, R. B., & Detsky, A. S. (2011). The education and training of future physicians—Why coaches can’t be judges. JAMA, The Journal of the American Medical Association, 306(9), 993–994.CrossRefGoogle Scholar
  4. Deci, E. L., & Ryan, R. M. (2002). Overview of self-determination theory: An organismic dialectical perspective. In L. Deci & R. M. Ryan (Eds.), Handbook of self-determination research (1st ed.). Rochester, NY: The University of Rochester Press.Google Scholar
  5. Ende, J. (1983). Feedback in clinical medical education. JAMA, The Journal of the American Medical Association, 250(6), 777–781.CrossRefGoogle Scholar
  6. Ericsson, K. A., Krampe, R. T., Tesch-romer, C., Ashworth, C., Carey, G., Grassia, J., et al. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363–406.CrossRefGoogle Scholar
  7. Eva, K. W., Cunnington, J. P. W., Reiter, H. I., Keane, D. R., & Norman, G. R. (2004). How can I know what I don’t know? Poor self assessment in a well-defined domain. Advances in Health Sciences Education : Theory and Practice, 9(3), 211–224.CrossRefGoogle Scholar
  8. Gawande, A. (2011). Personal best. Top athletes and singers have coaches. Should you? The New Yorker (pp. 44–53). October 3.Google Scholar
  9. Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77(1), 81–112.CrossRefGoogle Scholar
  10. Hwang, A., Ang, S., & Francesco, A. M. (2002). The silent Chinese: The influence of face and kiasuism on student feedback-seeking behaviors. Journal of Management Education, 26(1), 70–98.CrossRefGoogle Scholar
  11. Iedema, R. (2011). Creating safety by strengthening clinicians’ capacity for reflexivity. BMJ Quality and Safety, 20(Suppl 1), i83–i86.Google Scholar
  12. Kilminster, S. M., & Jolly, B. C. (2000). Effective supervision in clinical practice settings: A literature review. Medical Education, 34(10), 827–840.CrossRefGoogle Scholar
  13. Kolb, D. A. (1984). Experiential learning. Experience as the source of learning and development. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.Google Scholar
  14. Kusurkar, R. A., Croiset, G., & Ten Cate, T. J. (2011). Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory. Medical Teacher, 33(12), 978–982.CrossRefGoogle Scholar
  15. Liberman, A. S., Liberman, M., Steinert, Y., McLeod, P., & Meterissian, S. (2005). Surgery residents and attending surgeons have different perceptions of feedback. Medical Teacher, 27(5), 470–472.CrossRefGoogle Scholar
  16. Parkes, J., Abercrombie, S., & McCarty, T. (2012). Feedback sandwiches affect perceptions but not performance. Advances in health sciences education: Theory and practice, (Electronic prepublication). doi: 10.1007/s10459-012-9377-9.
  17. Pendleton, D., Scofield, T., Tate, P., & Havelock, P. (1984). The consultation: An approach to learning and teaching (1st ed.). Oxford: Oxford University Press.Google Scholar
  18. Reeve, J. (2002). Self-determination theory applied to educational settings. In E. L. Deci & R. M. Ryan (Eds.), Handbook of self-determination research (1st ed., pp. 183–204). Rochester, NY: The University of Rochester Press.Google Scholar
  19. Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78.CrossRefGoogle Scholar
  20. Sutkin, G., Wagner, E., Harris, I., & Schiffer, R. (2008). What makes a good clinical teacher in medicine? A review of the literature. Academic Medicine: Journal of the Association of American Medical Colleges, 83(5), 452–466.CrossRefGoogle Scholar
  21. Ten Cate, T. J., Kusurkar, R. A., & Williams, G. C. (2011). How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59. Medical Teacher, 33(12), 961–973.CrossRefGoogle Scholar
  22. Teunissen, P. W., Stapel, D. A., van der Vleuten, C., Scherpbier, A., Boor, K., & Scheele, F. (2009). Who wants feedback? An investigation of the variables influencing residents’ feedback-seeking behavior in relation to night shifts. Academic Medicine, 84(7), 910–917.CrossRefGoogle Scholar
  23. Van de Ridder, J. M. M., Stokking, K. M., McGaghie, W. C., & Ten Cate, O. T. J. (2008). What is feedback in clinical education? Medical Education, 42(2), 189–197.CrossRefGoogle Scholar
  24. Van Rensen, E. L. J., De Vries, B., Leistikow, I. P., Thieme Groen, E. S., Numan, S., Tates, K., Kalkman, C. J., et al. (2010). Using video for engaging professionals in reflexive practice improvement. International Forum on Quality and Safety in Health Care. Nice, France, 20–23 April. Poster.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Center for Research and Development of EducationUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.UtrechtThe Netherlands

Personalised recommendations