Optimising learner agency in feedback about performance: Influences on agentic feedback behaviour and an educational intervention to improve it

Abstract

Background

Feedback is central to learning, yet many medical learners are dissatisfied with feedback and its translation into learning is variable. Teacher-centred interventions to improve feedback have had limited success; targeting learner agency holds promise. Influences on agentic feedback behaviour are known but a theoretical framework is needed. Also required are evidence-based interventions to improve learner agency in feedback. This study explored influences on medical student feedback behaviour during clinical attachments and determined whether a feedback workshop could improve agentic feedback behaviour and satisfaction with feedback.

Methods

An exploratory study of influences on agentic student feedback behaviour was conducted, involving 7 focus groups with 46 medical students. The Triadic Reciprocal Causation model of Social Cognitive Theory was adopted during theoretical thematic analysis to conceptualise interactions between influences on feedback behaviour. Alongside analysis, a student-directed feedback workshop to be held during clinical attachments was designed, piloted with 10 students in one cohort then implemented for two subsequent cohorts (n=126). Evaluation surveys with closed and open items were held at the start and end of term. Pre-post quantitative data were compared with descriptive statistics; qualitative data was analysed with content analysis.

Results

Learner attributes and environmental factors (i.e., clinical learning context, teacher attributes/behaviours) were identified as key determinants of agentic student feedback behaviour, with bidirectional interplay between them. Teacher-student relationships interacted with each determinant. Workshop evaluation demonstrated increased agentic feedback behaviour for all outcomes except feedback utilisation.

Conclusions

Influences on medical students’ agentic feedback behaviour can be understood within an extended Triadic Reciprocal Causation model. Relationships are centrally situated and interact with behaviour, learner attributes and environmental factors. A feedback workshop improved agentic student feedback behaviour and satisfaction with feedback. Future interventions should address learner attributes, behaviour, environmental factors and student-teacher relationships, appreciating their co-dependency.