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Why receiving feedback collides with self determination

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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.

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  1. During many faculty development trainings of feedback I have observed that clinicians tend to convey feedback messages less honest and clear in role play than they intended just minutes before a feedback conversation, even in settings where their feedback skill is being observed.


  • Artino, A. R. (2012). Academic self-efficacy: From educational theory to instructional practice. Perspectives on Medical Education, 1(2), 76–85.

    Article  Google Scholar 

  • Cantillon, P., & Sargeant, J. (2008). Giving feedback in clinical settings. BMJ, 337, 1292–1294.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

  • Ende, J. (1983). Feedback in clinical medical education. JAMA, The Journal of the American Medical Association, 250(6), 777–781.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Gawande, A. (2011). Personal best. Top athletes and singers have coaches. Should you? The New Yorker (pp. 44–53). October 3.

  • Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77(1), 81–112.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Iedema, R. (2011). Creating safety by strengthening clinicians’ capacity for reflexivity. BMJ Quality and Safety, 20(Suppl 1), i83–i86.

    Google Scholar 

  • Kilminster, S. M., & Jolly, B. C. (2000). Effective supervision in clinical practice settings: A literature review. Medical Education, 34(10), 827–840.

    Article  Google Scholar 

  • Kolb, D. A. (1984). Experiential learning. Experience as the source of learning and development. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

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Correspondence to Olle Th. J. ten Cate.

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ten Cate, O.T.J. Why receiving feedback collides with self determination. Adv in Health Sci Educ 18, 845–849 (2013).

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