Trainee Identification of the Self-efficacy Domains Needed to Succeed in Undergraduate and Graduate Medical Education.

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Learn more: PMC Disclaimer | PMC Copyright Notice Med Sci Educ . 2025 Mar 20;35(3):1587–1595. doi: 10.1007/s40670-025-02361-4 Trainee Identification of the Self-efficacy Domains Needed to Succeed in Undergraduate and Graduate Medical Education Brian Yuen 1 , Abdo Asmar 2 , Jonathan Kibble 3, ✉ Author information Article notes Copyright and License information 1 College of Medicine, University of Central Florida, Orlando, FL USA 2 Department of Internal Medicine, University of Central Florida, Orlando, FL USA 3 Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL 32827 USA ✉ Corresponding author. Accepted 2025 Mar 8; Collection date 2025 Jun. © The Author(s) under exclusive licence to International Association of Medical Science Educators 2025. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. PMC Copyright notice PMCID: PMC12228871  PMID: 40626001 Abstract Self-efficacy is defined as a person’s belief in their ability to perform context-specific tasks in a defined domain to accomplish a goal. There is a substantial body of evidence showing that the level of academic self-efficacy predicts achievement in a range of educational contexts, including medical training. The goals of this study were to identify (1) what domains of self-efficacy are most important for success from the perspective of learners at different stages of training and (2) what experiences during training most promote self-efficacy. The nominal group technique was applied to generate top 5 rank-ordered lists for each research question. One group of trainees was sampled from each year of the 4 years of medical school and from each year of the 3 years of post-graduate residency training in internal medicine. The most prevalent domains of self-efficacy identified were skills needed for patient interactions, multitasking while balancing personal wellness, independent studying, professional communication, and interprofessional work. Activities that most promoted self-efficacy related to experiences of mastery in the above domains, especially successful patient care encounters, multitasking, and self-care. Formative feedback and faculty mentorship were also important. We discuss possible interventions in the formal training programs that could better align with these trainee needs for self-efficacy. Keywords: Self-efficacy, Medical students, Graduate medical education, Internal medicine residency Introduction Self-efficacy is a belief in one’s own capabilities to successfully complete tasks in specific situations [ 1 ]. First formulated by Albert Bandura in 1977, this psychological construct has been directly linked to one’s resiliency in the face of setbacks, willingness to pursue increasingly difficult goals, and it strengthens confidence that a person’s own effort can produce their desired outcomes [ 2 – 4 ]. As one might expect, having a high degree of self-efficacy can prepare individuals for success in many situations. However, the level of self-efficacy a person has changes depending on the context surrounding the task at hand and, as a result, the most accurate tools to measure self-efficacy should be contextualized to the field and domains being investigated [ 1 ]. Currently, in the setting of preclinical education for medical students, there is a substantial body of evidence showing that academic self-efficacy can predict levels of achievement e.g., [ 5 – 10 ]. The most widely used measuring tool in traditional academics, cited over 6000 times, is the Motivated Strategies for Learning Questionnaire [ 11 ], which includes a sub-scale for academic self-efficacy. However, medical training goes beyond traditional academics, requiring core competencies such as interpersonal and communication skills, and professionalism, but also medical ethics, systems-based practice, practice-based learning, and more [ 12 ]. Furthermore, medical training in America is also typically split into three phases: a preclinical phase–focused medical knowledge acquisition, clinical clerkships and electives phase that traditionally occurs during the third and fourth year of medical school, and residency training post-graduation that takes between 3 and 7 years depending on the specialty, as medical graduates earn the right to practice independently as board-certified physicians. With this added complexity, finding what contexts require the most self-efficacy for medical trainees and how these evolve during training becomes increasingly important. Reflecting the interest in self-efficacy as a driver for success, there are many ongoing attempts to develop instruments to measure the myriad of possible self-efficacy domains in clinical medicine. For example, there are tools to measure self-efficacy for communication skills [ 13 ] and the ability to do research [ 14 ], to perform resuscitation [ 15 ], to exhibit patient-centered behaviors [ 16 ], to appropriately use medications [ 17 ], and more. These instruments have all been developed from the faculty expert perspective, and there is a gap in the literature that examines which self-efficacy domains are most critical for success from the perspective of medical trainees. Moreover, self-efficacy is a constantly modifiable trait influenced by positive and negative experiences over time [ 1 ], again arguing that insights covering the evolution of self-efficacy throughout the arc of medical training are needed. Among the few validated surveys attempting to capture the domains of self-efficacy in medical school was one developed from the faculty perspective by Artino et al. [ 18 ], who used the Accreditation Council for Graduate Medical Education’s competency framework as a starting point for faculty experts to develop survey items. Their initial survey of 19 items was reduced through factor analysis to 14 items that grouped into three domains of self-efficacy, which they termed as follows: Patient care self-efficacy, Interpersonal skills self-efficacy, and Evidence-based medicine self-efficacy. Questions related to patient care included asking about confidence in ability to apply basic science and epidemiology knowledge, developing differential diagnoses and treatment plans, managing uncertainty, and applying a systematic approach to improving one’s clinical practice. The interpersonal skills domain included items on effective listening skills, ability to demonstrate caring, and about cultural sensitivity. The evidence-based medicine domain spanned confidence in evaluating scientific evidence, ability to stay abreast of advances by reading literature, and practicing cost-effective healthcare [ 18 ]. With Artino’s domains and sub-domains as a frame of reference, the primary goal of the current study was to discover what contexts of medical training require the most self-efficacy in the eyes of trainees, and how their importance changes throughout the training process. The second goal of the current study was to identify what curricular experiences trainees have encountered that they perceive may have promoted self-efficacy. This secondary research question was framed by Bandura’s foundational work that identified four fundamental sources of self-efficacy: (1) enactive mastery experiences (successful performance), (2) vicarious learning from peers, (3) receiving feedback, and (4) affective/physiological reactions to situations [ 1 ]. Material and Methods Educational Settings The University of Central Florida (UCF), College of Medicine M.D. degree is a 4-year program that enrolls 120 students in each year. Students learn the normal body processes in their first year and transition to a systems-based pathophysiology in their second. Students must pass the United States Medical Licensing Examination (USMLE) Step 1 at the end of year 2 before moving into clerkships planned for years 3 and 4. They will then take USMLE Step 2 during the fall of their third year. Students apply to residency programs in fall of their senior year and learn about their disposition to residency programs in the spring. Our students graduate with their M.D. in May and begin residency training in July. Our Internal Medicine Residency Program is university-affiliated and approved by the Accreditation Council for Graduate Medical Education (ACGME) for 75 residents over a 3-year training period. There are two major clinical participating sites: a level II trauma community regional medical center and a Veterans Affairs (VA) hospital. This dual-site arrangement exposes residents to a diverse patient population and a rich pathology mixture, providing a comprehensive training experience. However, managing two distinct healthcare systems necessitates residents to adeptly navigate varied operational structures. The program adopts a scheduling model where residents rotate through diverse clinical duties followed by a dedicated period for continuity clinic every fifth week. Throughout their training, residents partake in a wide array of clinical experiences, including rotations in inpatient settings (such as the intensive care unit (ICU)), specialized medicine electives, and ambulatory services. Upon successfully completing the 36-month training program, qualified residents achieve eligibility for autonomous practice. Additionally, they gain the opportunity to undertake the American Board of Internal Medicine Exam (ABIM). Study Design This was an observational, descriptive study with a cross-sectional design. We set out to recruit a focus group of medical trainees at the M1–M4 level (medical school students) and PGY1–PGY3 internal medicine residents. The trainees were placed in cohorts based on year. The size of the medical school groups (M1–M4) was 6, 4, 3, and 4, respectively, each drawn from a class of 120 students. The size of PGY1–PGY3 groups was 5, 5, and 3 participants, respectively, each drawn from a class of 25 residents. Each focus group was first given the same introduction to define self-efficacy, using an everyday example of successfully shooting a basketball under pressure to illustrate the concept. They were then asked two questions: “What domains (situations/contexts) of your medical education thus far do you believe self-efficacy is most important for?”, then “What aspects of your medical training thus far did you feel most improved your self-efficacy?” To record their responses, we used the nominal group technique, a structured focus group method designed to effectively brainstorm ideas or problems on a given topic by giving each person equal opportunity to share their thoughts, then to reach consensus about the relative merit or importance of each idea or solution [ 19 ]. Our NGT protocol applied the following sequence, with separate rounds of NGT for each research question: After the brief introductory presentation to define self-efficacy, the research question was presented. Each team member silently thought of solutions on their own and wrote down at least five ideas Without discussion, each member stated ideas in round-robin format, continuing until no more unique ideas could be thought of. Ideas formulated after people began discussing were also shared and recorded. The group had the opportunity to discuss each item with the goal of clarifying understanding and asking questions. The teams often used this time to group similar situations into broader categories. Multi-voting was used to reach a final consensus on the top items; each individual created their own top 5 rank order list, votes were tallied, there was brief discussion around differences, and the voting was repeated until a consensus top 5 was reached. Fourteen consensus lists were generated, one for each research question across each of the seven cohorts. Figure 1 provides an example of how ideas from individual participants were winnowed down to produce a final top 5 listing of ideas. The example in Fig. 1 is taken from the first research question about domains in which, as M1 students, they most needed to feel self-efficacious. Fig. 1. Open in a new tab Example from the M1 focus group showing the nominal group technique use to derive a consensus rank order The study was exempted by the UCF institutional review board (protocol # IRB00001138). All participants were recruited voluntarily with informed consent. Focus groups took place during the second half the academic year for each cohort. Medical students were recruited by e-mail and through posts on each year’s Facebook page. Internal medicine residents were messaged via email from the internal medicine program chief residents who also facilitated organization of the sessions around clinical schedules. Results Identifying the Domains of Self-efficacy One of the most common actions that each cohort took during the discussion phase was the grouping of similar answers into broader categories. Table 1 summarizes the top 5 final categories ranked by each cohort. In the sections below, we summarize the commonalities and major themes across cohorts. Table 1. Top 5 ranks of the most important self-efficacy domains for each learner cohort Rank M1 M2 M3 M4 PGY1 PGY2 PGY3 1 Patient Interactions Patient Interactions Multitasking Attending Interactions Multitasking Multitasking and Balancing Mental Health Balancing Mental Health 2 Working in a Team Independent Studying and Exam Taking Independent Studying and Exam Taking Building Rapport Balancing Mental Health Patient Interactions Clinical Competence 3 Independent Studying and Exam Taking Willingness to be Wrong + Communication and Presentation Ability Interprofessional Work Learning Clinical Procedures and Independent Studying Medical Management Interprofessional Work Pursuit of Career Goals 4 Communication and Presentation Ability Multitasking and Balancing Mental Health Patient Interactions Self-Advocacy for your Learning Interprofessional Work Professionalism Building (Non-Professional) Relationships 5 Taking Leadership Roles Self-Reflection Attending Interactions Willingness to be Wrong Building Rapport Medical Management Professionalism Open in a new tab Patient Interactions Almost all students across the cohorts believed that activities like seeing patients in clinics, practicing physical exams, and working with simulated patients required a similarly high degree of self-efficacy. Since these activities were also similar in nature, the students in each cohort agreed that a student with a high degree of self-efficacy in one situation would also definitely be confident in their ability to carry out the other situations. As such, many cohorts, specifically the M1, M2, M3, and PGY2 groups, believed these activities could reasonably be merged into a single domain of self-efficacy called “Patient Interactions.” A variant of this term includes “Building Rapport” from the M4s and PG1s, which emphasized the parts of patient care that involved building trust and proper bedside manner. Once students began working as residents, the act of formulating an assessment and plan at varying levels of detail and control was agreed as requiring a high degree of self-efficacy. The PGY1s and PGY2s termed this “Medical Management” and brought up how situations like figuring out which tests to order, treatments, and tuning medication dosages require a similar degree and type of self-efficacy. The PGY3s coined another related variant of this domain as “Clinical Competence,” which combined medical management plus activities that other classes described as patient interactions. Multitasking The next most ranked domain of self-efficacy was termed “Multitasking,” which spoke to the demands on trainees to develop organizational ability and high workload capacity across different activities. Most groups described multitasking in the context of the ability to balance between the different aspects of career work with personal care (mental health, family, friends). For medical students, career work meant scoring well on examinations, class activities, and clerkship performance. The residents felt that managing multiple patients and working in the hospital required a high degree of self-efficacy. All cohorts who ranked “ Multitasking ” believed that properly allocating time to these activities on top of other extracurriculars such as volunteering and research and personal health requires a high degree of self-efficacy. Mental health and well-being were an added dimension to the discussions around multitasking. For some groups, the strains of successfully multitasking made mental health considerations inseparable from the discussion of multitasking. The PGY1s described multitasking in terms of simultaneously juggling the care of multiple patients and, rather than combining categories, they believed that the maintenance of personal affairs was distinct enough for its own domain, which they termed “Balancing Mental Health.” In contrast to the other five cohorts, the M1s and M4s did not include multitasking in their ranking. Independent Studying and Exam Taking The third most ranked domain overall was “Independent Studying and Exam Taking.” This answer includes mainly preparing for exams (including faculty-prepared exams, the National Board of Medical Examiners (NBME) Subject Exams, and the USMLE Steps 1 and 2) and engaging in the self-learning needed to excel in clerkships. While this was heavily emphasized in the medical school cohorts (M1–M4), it was not ranked by any of the resident cohorts, despite their requirement to complete the USMLE Step 3 at this stage of training. Research and Professional Interactions Engaging in research and professional interactions are two sets of situations that some students felt were unique enough to warrant their own separate categories, but that other students felt were also similar enough to be placed under one umbrella term. The strong theme that created the overlap between these two topics was the need for extensive interaction with faculty during the research process. To clarify, engaging in research refers specifically to the act of writing papers, presenting at conferences, and reading academic literature. Professional interactions encompass any situation where medical students talk to other medical professionals. Examples of the separate treatment of these two domains included when the M2s and M4s described that asking questions to teachers without knowing the answers, purely for the sake of learning, deserved its own category, which they termed “Willingness to be Wrong.” The M3s and M4s also believe direct student-to-attending physician interactions was its own domain of self-efficacy, aptly titled “Attending Interactions.” In other discussions where engaging in research and interacting with professionals are grouped under a single domain, the names “Communication and Presentation Ability” (M1 and M2 cohorts) and “Interprofessional work” (M3, PGY1, PGY2 cohorts) were used. Students who came up with these categories believed that research and professional communication were similar since presenting at a conference involves talking to more than just physicians and working in the clinic involves speaking to many healthcare professionals from differing backgrounds. Additional Self-efficacy Domains Several unique domains also emerged. The M1s believed that “Taking Leadership Roles” in things like team-based exercises, research projects, and simulations required a high degree of self-efficacy. They felt the same way with being a strong team player. “Self-Reflection” is one devised by the M2s to describe actively trying to improve by thinking back on performance day to day. The M4s came up with “Self-Advocacy for Learning,” which shares similarities with “Willingness to be Wrong” but includes not only being unafraid to ask questions but also how actively seeking opportunities to learn in clinic instead of relying on constant guidance by preceptors. “Building Personal, (Non-professional) Relationships” was brought up by a single member of the PGY3 cohort, but quickly became a hot topic of discussion and as such was ranked by that group. The PGY2s and PGY3s also ranked a domain they called “Professionalism,” which describes how holding oneself accountable in clinical work, whether it be completing tasks in a timely manner or behaving courteously at all times, requires a consistent high degree of self-efficacy. Activities Promoting Self-efficacy After asking each cohort what they believed required the most self-efficacy at that stage of their medical training, we then queried what aspects of medical training had most improved their self-efficacy. Table 2 summarizes the top 5 activities ranked by each cohort. In the sections below, we summarize the commonalities and major themes across cohorts. Table 2. Top 5 ranks of the most important activities that promote self-efficacy for each learner cohort Rank M1 M2 M3 M4 PGY1 PGY2 PGY3 1 Patient Interactions Clinical Exposure Clinical Exposure Formative Feedback Successfully Multitasking Clinical Exposure Successfully Managing Patients 2 Team-based Exercises Positive Self-Recognition Mentorship Clinical Exposure Self-Care Increased General Medical Knowledge Self-Care 3 Administrative Support Programs Confronting Uncertainty Peer Support Summative Feedback Increased General Medical Knowledge Personal Experience Successful Self-regulation 4 Peer Support Mentorship Use of Third-Party Study Tools Mentorship Formative Feedback All Feedback Increased General Medical Knowledge 5 Third-party Study Tools Successfully Multitasking Personal Experience Personal Experience Personal Experience Successful Self-regulation Formative Feedback Open in a new tab Enactive Mastery Personal experiences are what increased self-efficacy the most for students. Nearly every cohort believed that actually doing clinical work was the best way to gain self-efficacy. The M1s used the term “Patient Interactions,” which included activities similar to the examples given for the first research question. The M2s, M3s, M4s, and the PGY2s used the term “Clinical Exposure” to describe any activity that involves students working in an actual clinic at any capacity, from volunteering to managing patients as a resident. The PGY3s focused on successfully managing patients as its own source of self-efficacy and ranked a domain with the same name. In a similar vein, the cohorts also believed that successfully progressing through the process of working as a medical student and resident built self-efficacy. Nearly every cohort used the term “Personal Experience” to describe this process. An example from the M1s was their experience of going through team-based learning exercises, one of the activities integrated into the UCF COM curriculum, they said helped with building self-efficacy. The M2s came up with the domain of “Confronting Uncertainty,” to reflect the view that the act of continuously tackling the unknown built self-efficacy. The M2s and PGY1s also created another term “Successfully Multitasking,” to describe how self-efficacy for domains could be built each time students successfully did something while balancing personal life and professional demands. Later, in the PGY2 and PGY3 levels, students would combine aspects of multitasking with continuing the already good habits they developed to be known as “Successful Self-Regulation” as a builder of self-efficacy. The unifying underlying theme was successful personal experiences that promoted self-efficacy to address the next challenge. Feedback and Mentorship The next major source of self-efficacy for students was feedback. Getting advice on where missteps are being made, how to improve, and how to act was a consistent builder of confidence in all cohorts. The M1s improved their self-efficacy in part from the COM’s in-house support team (scheduling advisors, academic advisors) as a source of feedback. The M1s and M3s also believed that advice from peers was also a strong builder of self-efficacy due to shared experiences and goals. Starting in M2 year, many believed that having a professional to connect with really helped them to feel more confident in their ability to perform well across various situations. They would eventually define the relationships that they built with individuals in the medical field for the express purpose of career guidance as “Mentorship.” As students transitioned into M3 and M4 years, “Mentorship” became synonymous with Feedback from Preceptors. From M4 years onwards, feedback from any source became an important driver of self-efficacy. Other Activities Promoting Self-efficacy Independently acquiring knowledge was also a common source of self-efficacy. The M1s and M3s highlighted specifically how integrating the lecture materials with third-party tools like Sketchy, AMBOSS, and UWorld to broaden their knowledge helped to build self-efficacy. The residents built their knowledge through actually managing patients, and termed it “Increased General Medical Knowledge.” Lastly, aside from all the experience, learning, and feedback, a few cohorts believed that stepping back from the work for a moment and taking time to celebrate accomplishments was another strong source of self-efficacy. The M2s termed this “Positive Self-Recognition,” while the PGY1s and PGY3s used the term “Self-Care” to also include the self-efficacy building (and therapeutic) effect of taking time for oneself. Discussion Our study is unusual in that it is one of the few that samples viewpoints across both undergraduate and graduate medical education. A limitation of our investigation is the small sample sizes in each cohort, drawn from a single medical school in the South Atlantic region of the USA. Therefore, our data does not claim generalizability or transferability to similar settings. Instead, it offers a snapshot of the experience at one institution, generating new ideas and providing a straightforward method for others to gather similar information in their local context. To help others gather similar data, we recommend emphasizing student and resident leadership within the research team. The first surprise in our data was that junior medical students did not focus on academic self-efficacy. We expected that the initial focus of students would reflect the abundance of medical knowledge that was evaluated in the M.D. curriculum and by USMLE licensing examinations. Yet, most M1–M3 students emphasized the importance of independent study and exam preparation over day-to-day curriculum activities. Reports indicate a growing trend among medical students to rely heavily on commercial third-party resources, leading to a decline in attendance at formal classroom settings [ 20 ]. Our data suggests that this shift may be partly due to the enhanced self-efficacy provided by these third-party resources. Two of our groups specifically mentioned these resources as self-efficacy boosters, rather than relying on those developed within the formal curriculum. Our study further indicates that trainees value the development of independent learning skills, which was emphasized in all medical student cohorts. This was also evidenced by both second- and third-year residents acknowledging that cultivating self-regulated habits enhances their self-efficacy. Development of independent learning skills help students become lifelong learners, a required feature of medical training as embodied in Standard 6.3 “Self-Directed and Life-Long Learning” of the Liaison Committee on Medical Education’s accreditation requirements [ 21 ]. In our M.D. curriculum, we are accelerating a shift towards a flipped classroom model in an effort to leverage the established benefits in terms of engagement, attitude, and metacognition in addition to mastering course content [ 22 ]. These models are permeating graduate medical education as well [ 23 ]. Our initial hypothesis that junior students would prioritize self-efficacy for patient care later in their training was incorrect because this theme turned out to be dominant throughout all stages of education. Trainee needs evolved in parallel with the curriculum regarding patient interactions. First-year students believed that basic skills like patient interviewing and conducting physical exams required a high degree of self-efficacy. During their clerkship years, students continued to emphasize the need for self-efficacy in patient interactions, shifting their focus towards clinical reasoning, developing differential diagnoses, and treatment plans. This emphasis on self-efficacy persisted into residency, where the focus evolved towards being responsible for patient care and building rapport to handle difficult conversations. Our data, in line with Artino et al.’s faculty-developed survey [ 18 ], reinforces that patient care and interpersonal skills are major domains requiring high self-efficacy from the student perspective. For instance, survey questions in the interpersonal skills domain by Artino et al. included listening skills, showing care when counseling a patient, and demonstrating cultural sensitivity, all of which overlapped with our trainees’ theme of “Building Rapport.” The takeaway from these parallels is that patient interactions should clearly be a major focus for curriculum developers to intentionally scaffold trainee development. In a sense, this seems obvious for medical trainees but in practice there are major resource implications of increasing patient exposure for all students across the early curriculum, as well as providing adequate individual mentoring and feedback across clinical contexts that is ongoing throughout medical training. In their recent review of the effectiveness of early clinical exposure in medical education, Tayade and Latti summarize evidence showing improvement in student motivation and confidence in clinical skills and communication [ 24 ]; they also provide examples from the classroom, community and hospital settings to promote early clinical exposure. An expected benefit of using focus groups was that trainees would generate some new ideas about key self-efficacy domains beyond previously published faculty perspectives. For example, the second major theme among trainees was balancing mental well-being while multitasking, a topic discussed by most cohorts. This theme emerged for students facing the USMLE Step 1 exam and was emphasized by residents throughout all 3 years of post-graduate training. Senior residents even shifted their focus to maintaining wellness and personal relationships, in addition to developing their future careers. It is well known that medical trainees are vulnerable to high incidences of mental health problems and burnout [ 25 – 27 ]. Although some programs have taken steps to combat these issues, the high workload and learning demands are an unavoidable reality in medical training and beyond. Trainee support for wellness is already an accreditation requirement in both medical school and residency, but this area clearly needs continued vigilance and creative solutions from program administrators. It was gratifying to note that medical students cited some of our formal programs, such as counseling and peer support systems, as enhancers of their self-efficacy in this domain. Similarly, references made by second- and third-year resident groups to the positive effects on self-efficacy due to the development of self-regulation strongly echoed the goals and language of our formal holistic wellness and professional development program, which was specifically designed for residents around self-determination theory [ 28 ]. In addition to well-being, another novel domain identified by trainees was the need for self-efficacy in interprofessional communication, a consistent topic across our cohorts. Our data suggested more work is needed to help students become comfortable interacting with faculty early in the program. In this regard, the trend towards low classroom attendance early in the curriculum is particularly concerning, as it limits the development of interpersonal and professionalism skills in trainees. This also reduces the feedback students receive, a crucial source of self-efficacy emphasized by both our data and existing literature [ 1 ]. Similarly, the need for self-efficacy in interprofessional skills was highlighted in the context of early trainees working within peer teams and later in clinical interprofessional work. Over the past 10–15 years, there has been an increasing focus on interprofessional education (IPE) in medical schools, with positive, albeit slow, progress [ 29 ]. Implementing formal IPE is logistically challenging, but our data suggests that renewed vigor in this area is warranted. Trainees describe a need for developing self-efficacy in interprofessional work, presumably as they recognize its critical role in the real-world functioning of a medical center. Our secondary research goal, exploring activities that promote self-efficacy, was intentionally broad, making data interpretation challenging. As noted previously, the four fundamental sources of self-efficacy described by Bandura [ 1 ] are (1) enactive mastery experiences (successful performance), (2) vicarious learning from peers, (3) receiving feedback, and (4) affective/physiological reactions to situations. Reviewing the data in Table 2 , our participants strongly reinforced these sources, particularly the dominant role of enactive mastery experiences. For example, learners consistently ranked clinical exposure, patient interactions, successful clinical encounters, and multitasking (i.e., enactive mastery) as the most important factors. In alignment with Bandura’s second category of vicarious learning, the medical student groups ranked Peer Support and there was also a mention of “secondhand experience.” The third category of receiving feedback was strongly reflected in the discussion of several groups as they ranked categories such as Mentorship, Formative Feedback, and All Feedback. These insights are valuable for program development, highlighting again the need for programs to maximize patient exposure to provide students with the opportunity to develop self-efficacy through enactive mastery experiences. However, a note of caution is needed because such clinical exposure must be carefully scaffolded with appropriately escalating difficulty levels. It is equally true that too many failed encounters at too great a difficulty level could harm self-efficacy and hinder trainee progress. Perhaps the bridge that allows appropriate escalation of difficulty for a given learner is the feedback and coaching they receive from teachers and mentors. Most educators would probably agree that providing excellent feedback is a key area for faculty intervention. However, providing excellent feedback that is individualized, timely, and actionable is easier said than done. The literature on effective feedback shows it to be a complex challenge, involving considerations of type, timing, frequency, and focus [ 30 ]. Finally, it should be acknowledged that determining the correct level granularity of a self-efficacy domain is a vexing question. Bandura’s work clearly demonstrated that self-efficacy is not a “domain general” entity [ 1 ] and surely has operational sub-domains. Similarly, it must change across practice contexts as well as the complexity of the situation. Statistical techniques such as factor analysis can “lump” items into a domain such as “Patient Care” and our approach using the NGT method likely has the same effect of “lumping” because participants intentionally spend time gathering individual ideas into categories before voting on ranks. Nevertheless, as a starting point, we have identified domains of self-efficacy that deserve consideration for interventions that may promote them. While we and many others have presented associations between the level of self-efficacy and performance e.g., [ 7 , 31 ], it would not necessarily follow that an intervention to increase self-efficacy would automatically increase performance. There are examples in the literature, including in health education e.g., [ 32 , 33 ], in which teaching interventions have increased both self-efficacy and performance. However, different approaches to mathematical modeling produce differing views on whether self-efficacy is a mediator of better performance, or just a correlate [ 8 , 34 ]. Our future studies will begin the work of designing programmatic interventions aimed at increasing self-efficacy, one domain and context at a time, while simultaneously attempting to determine changes in performance outcomes. Given the highest priority assigned by trainees to the development of self-efficacy in patient interactions, we would propose starting with the early communication skills curriculum. For example, curriculum evolution at our institution will shortly include the new deployment of faculty coaches for clinical skills. We aim to study how development of a coaching relationship can positively impact student self-efficacy in the patient interaction domain. Data Availability The dataset analyzed in the present study is available from the corresponding author on reasonable request. Declarations Competing Interests The authors declare no competing interests. Footnotes Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman and Company; 1997. [ Google Scholar ] 2. Schunk DH. Self-efficacy and academic motivation. Educ Psychol. 1991;26:207–31. [ Google Scholar ] 3. Benight CC, Bandura A. Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy. Behav Res Ther. 2004;42:1129–48. [ DOI ] [ PubMed ] [ Google Scholar ] 4. Artino AR Jr. Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ. 2012;1:76–85. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 5. Artino AR, La Rochelle JS, Durning SJ. Second-year medical students’ motivational beliefs, emotions, and achievement. Med Educ. 2010;44:1203–12. [ DOI ] [ PubMed ] [ Google Scholar ] 6. Artino AR, Hemmer P, Durning SJ. Using self-regulated learning theory to understand the beliefs, emotions, and behaviors of struggling medical students. Acad Med. 2011;86:S35–8. [ DOI ] [ PubMed ] [ Google Scholar ] 7. Kauffman CA, Derazin M, Asmar A, Kibble JD. Relationship between classroom attendance and examination performance in a second-year medical pathophysiology class. Adv Physiol Educ. 2018;42:593–8. [ DOI ] [ PubMed ] [ Google Scholar ] 8. Stegers-Jager KM, Cohen-Schotanus J, Themmen APN. Motivation, learning strategies, participation and medical school performance. Med Educ. 2012;46:678–88. [ DOI ] [ PubMed ] [ Google Scholar ] 9. Burgoon JM, Meece JL, Granger NA. Self-efficacy’s influence on student academic achievement in the medical anatomy curriculum. Anat Sci Educ. 2012;5:249–55. [ DOI ] [ PubMed ] [ Google Scholar ] 10. Bandura A: Guide for constructing self-efficacy scales. In: Pajares F, Urdan F. Greenwich, CT, editors. Adolescence and education, vol. 4: self-efficacy beliefs of adolescents. Information Age Publishing; 2006 pp. 307–337. 11. Pintrich PR, Smith DAF, Garcia T, McKeachie W. A Manual for the use of the Motivated Strategies for Learning Questionnaire (MSLQ). Ann Arbor, MI: University of Michigan, National Center for Research to Improve Postsecondary Teaching and Learning; 1991. 12. Kibble J, Plochocki J. Comparing machine learning models and human raters when ranking medical student performance evaluations. J Grad Med Educ. 2023;15:488–93. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Axboe MK, Christensen KS, Kofoed PE, Ammentorp J. Development and validation of a self-efficacy questionnaire (SE-12) measuring the clinical communication skills of health care professionals. BMC Med Educ. 2016;16:272. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Mullikin EA, Bakken LL, Betz NE. Assessing research self-efficacy in physician-scientists: the clinical research appraisal inventory. J Career Assess. 2007;15:367–87. [ Google Scholar ] 15. Turner NM, Van De Leemput AJ, Draaisma JM, Oosterveld P, Ten Cate OT. Validity of the visual analogue scale as an instrument to measure self-efficacy in resuscitation skills. Med Educ. 2008;42:503–11. [ DOI ] [ PubMed ] [ Google Scholar ] 16. Zachariae R, O’Connor M, Lassesen B, Olesen M, Kjær LB, Thygesen M, Mørcke AM. The self-efficacy in patient-centeredness questionnaire–a new measure of medical student and physician confidence in exhibiting patient-centered behaviors. BMC Med Educ. 2015;15:1–3. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Lamarche L, Tejpal A, Mangin D. Self-efficacy for medication management: a systematic review of instruments. Patient Prefer Adherence. 2018; pp. 1279–87. [ DOI ] [ PMC free article ] [ PubMed ] 18. Artino AR Jr, Dong T, DeZee KJ, Gilliland WR, Waechter DM, Cruess DF, Durning SJ. Development and initial validation of a survey to assess students’ self-efficacy in medical school. Mil Med. 2012;177:31–7. [ DOI ] [ PubMed ] [ Google Scholar ] 19. Delbecq AL, Van de Ven AH. A group process model for problem identification and program planning. J Appl Behav Sci. 1971;7:466–92. [ Google Scholar ] 20. Kauffman CA, Derazin M, Asmar A, Kibble JD. Patterns of medical student engagement in a second-year pathophysiology course: relationship to USMLE Step 1 performance. Adv Physiol Educ. 2019;43:512–8. [ DOI ] [ PubMed ] [ Google Scholar ] 21. Liaison Committee on Medical Education Standards. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the MD degree (online). https://lcme.org/publications/ [accessed 11/25/2024]. 22. Al-Samarraie H, Shamsuddin A, Alzahrani AI. A flipped classroom model in higher education: a review of the evidence across disciplines. Educ Technol Res Dev. 2020;68:1017–51. [ Google Scholar ] 23. French H, Arias-Shah A, Gisondo C, Gray MM. Perspectives: the flipped classroom in graduate medical education. NeoReviews. 2020;21:e150–6. [ DOI ] [ PubMed ] [ Google Scholar ] 24. Tayade MC, Latti RG. Effectiveness of early clinical exposure in medical education: settings and scientific theories – review. J Educ and Health Promot. 2021;10:117. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 25. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, Durning S, Moutier C, Szydlo DW, Novotny PJ, Sloan JA, Shanafelt TD. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334–41. [ DOI ] [ PubMed ] [ Google Scholar ] 26. Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;289:3161–6. [ DOI ] [ PubMed ] [ Google Scholar ] 27. Ye GY, Davidson JE, Kim K, Zisook S. Physician death by suicide in the United States: 2012–2016. J Psych Res. 2021;134:158–65. [ DOI ] [ PubMed ] [ Google Scholar ] 28. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55:68. [ DOI ] [ PubMed ] [ Google Scholar ] 29. Saragih ID, Tarihoran DE, Sharma S, Chou FH. A systematic review and meta-analysis of outcomes of interprofessional education for healthcare students from seven countries. Nurse Educ Prac. 2023;29:103683. [ DOI ] [ PubMed ] [ Google Scholar ] 30. Shute VJ. Focus on formative feedback. Rev Educ Res. 2008;78:153–89. [ Google Scholar ] 31. Ruiz J, Kaminnik P, Kibble J, Kauffman C. Relationships between medical student wellness, self-efficacy, and academic performance during the “post-COVID” period. Adv Physiol Educ. 2024;48:137–46. [ DOI ] [ PubMed ] [ Google Scholar ] 32. Chang CY, Hwang GJ, Gau ML. Promoting students’ learning achievement and self-efficacy: a mobile chatbot approach for nursing training. Br J Educ Technol. 2022;53:171–88. [ Google Scholar ] 33. Binkhorst M, Draaisma JM, Benthem Y, van de Pol EM, Hogeveen M, Tan EC. Peer-led pediatric resuscitation training: effects on self-efficacy and skill performance. BMC Med Educ. 2020;20:1–8. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. Wu H, Li S, Zheng J, Guo J. Medical students’ motivation and academic performance: the mediating roles of self-efficacy and learning engagement. Med Educ Online. 2020;25:1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement The dataset analyzed in the present study is available from the corresponding author on reasonable request. Articles from Medical Science Educator are provided here courtesy of Springer ACTIONS View on publisher site PDF (753.8 KB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

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