NUR 5223 Module 4 Motivation and Feedback Paper Example

Good Job Is Not Feedback: Rebuilding How Preceptors Talk to Perioperative Fellows After a Case, Using Self-Determination Theory, Hattie and Timperley's Feedback Model and R2C2

Student Name

American College of Education

NUR5223: Theoretical Foundations in Teaching and Learning

Module 4 Assignment

Instructor Name

May 30, 2028

What Fellows Hear Now

The environment analysis in Module 3 found that fellows in the perioperative fellowship often hesitate to ask questions and that the preceptors who help them most make their thinking visible. This paper looks at the other side of the conversation: what preceptors say after a case. Over two weeks, the author asked fellows to write down, at the end of each day, the feedback they had received. Of 71 entries, 38 were a general comment such as good job, nice work or you are getting there, 17 were a correction delivered during the case, usually brief and under time pressure, and only 16 described a conversation after a case in which the preceptor and fellow discussed a specific part of the fellow's performance and what to do next. Fellows said the general comments were pleasant but told them nothing, and several said that corrections during the case, without a later conversation, left them unsure whether they had made a serious error or a trivial one. Two fellows who were considering leaving the fellowship said that they did not know whether they were progressing.

Why It Matters: Self-Determination Theory

Ryan and Deci (2000) propose that people are most motivated, and learn and perform best, when three basic psychological needs are met: autonomy, the sense that one's actions are self-endorsed rather than controlled; competence, the sense of being effective; and relatedness, the sense of connection with others. Environments that support these needs foster intrinsic motivation and the internalization of values, while environments that thwart them lead to controlled motivation, reduced engagement and disengagement.

The fellows' experience maps onto all three. General praise does little for competence, because it gives no information about what was effective; fellows cannot feel competent at something they cannot identify. Brief corrections during a case, with no follow-up, threaten competence without restoring it. Taking over a task without explanation, as described in Module 3, undermines autonomy. And the absence of a conversation after the case leaves relatedness to chance. The fellows were not short of encouragement; they were short of the information that would let them feel competent for a reason. For experienced nurses who were confident in their previous roles, the threat to competence is especially sharp, which may explain why two were thinking of leaving.

What Useful Feedback Contains

Hattie and Timperley (2007), synthesizing research on feedback in education, describe effective feedback as answering three questions: where am I going, which concerns the goal; how am I going, which concerns progress toward it; and where to next, which concerns what to do to improve. They also distinguish four levels at which feedback can be directed: the task, such as whether a count was performed correctly; the process, such as the strategy used to track items during a long case; self-regulation, such as how the learner monitors their own performance; and the self, such as praise of the person. Their review found that feedback about the self, the level of most of what the fellows received, is the least effective, because it carries little information about the task and can distract attention from it. Feedback at the process and self-regulation levels is the most powerful for deep learning.

Applied to the fellowship, useful feedback after a case would name the goal the fellow was working on, such as leading the closing count, describe specifically what went well and what did not at the process level, and agree on one thing to do differently in the next case. Most of what the fellows received answered none of the three questions.

A Five-Minute Post-Case Routine

To make useful feedback routine, the fellowship will adopt a short structure based on the R2C2 model, developed and tested for performance feedback in medical education. Its four phases are building the relationship, exploring the learner's reactions to the feedback, exploring the content of the feedback so that the learner understands it, and coaching for change toward a specific plan (Sargeant et al., 2015). For the operating room, the routine is compressed to five minutes after the patient leaves the room, before the next case begins.

Relationship: the preceptor asks how the fellow thought the case went, which signals interest and gives the fellow a say. Reactions and content: the preceptor names one thing done well and one thing to work on, both at the task or process level, for example: your closing count was accurate, and when the sponge was missing you stopped the closure and called for a search right away, which was exactly right; the part to work on is anticipating the next instrument during the anastomosis, because the surgeon had to ask twice. The preceptor then asks how the fellow sees it. Coaching: together they agree on one specific thing to try next case, such as watching the surgeon's hands and the scrub's tray during critical steps and preparing the next item before it is requested. The fellow writes the goal on the participation card described in Module 3, and the next case's conversation begins by asking about it.

Preparing Preceptors and Protecting Safety

Preceptors will practice the routine in the workshop described in Module 3, using video examples and role play, with attention to two difficulties. The first is feedback on a serious error, where the preceptor must be clear about the risk without shaming the fellow; the routine keeps the focus on the task and the next step, and the preceptor can tell the fellow directly that raising the problem was the right thing to do. The second is time pressure; the routine is short by design, and when there is no time between cases, the conversation moves to the end of the day rather than disappearing. Because psychological safety depends on predictability, the routine will be the same every day, so fellows know that feedback is coming and that it is part of learning, not a sign of trouble.

Preceptors, too, need feedback on their feedback. During the first month, the author will observe one post-case conversation for each preceptor and use the same routine to discuss it: what the preceptor thought went well, one specific point to adjust and one thing to try next time. Modeling the routine on the preceptors themselves makes it familiar, shows that it applies to experienced staff as well as learners, and gives the author a direct view of whether the conversations are happening as intended rather than relying on logs alone.

Evaluation

The routine will be evaluated by repeating the two-week feedback log at weeks eight and sixteen, with the target that at least two thirds of entries describe a post-case conversation with a specific goal. Fellows will also complete a short measure of perceived competence and autonomy, based on self-determination theory, at the same points. The effect on retention in the fellowship, the outcome that matters most to the hospital, will be tracked for the cohort.

References

Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77(1), 81-112. https://doi.org/10.3102/003465430298487

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. https://doi.org/10.1037/0003-066X.55.1.68

Sargeant, J., Lockyer, J., Mann, K., Holmboe, E., Silver, I., Armson, H., Driessen, E., MacLeod, T., Yen, W., Ross, K., & Power, M. (2015). Facilitated reflective performance feedback: Developing an evidence- and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Academic Medicine, 90(12), 1698-1706. https://doi.org/10.1097/ACM.0000000000000809