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1. Introducción

1.3. El proceso de estadificación y la linfadenectomía

1.3.2. Estadificación preterapéutica

1.3.2.1. Técnicas de imagen

This chapter has already explored the concept of worth and the perceived worthiness of receiving feedback. It will now consider in more detail Dawn’s perception of herself as a learner. My objective opinion of Dawn is of an able student who achieves very good

summative assessment marks overall, though she can be quiet and somewhat shy. Despite academic achievement evidence to support her ability, Dawn appears to have a differing opinion of herself. The initial quote at the outset of this chapter from my interview Dawn is:

Me: Why might you not have [asked the educator for feedback]? I know he is busy, but he is helping you and he is helping everybody else as well.

Dawn: But my patient’s gone [home], whereas there’s people [other students] there with patients who he’s focusing on. I don’t know, I just… I should do that more. Me: Right (pause), would you have asked him later on?

Dawn: That’s something [I] should do more, ask what have I done right today and what do I need to improve. Because then that helps me – yes, I’ve learned

something. That [feedback conversation with me] was useful, that. (Dawn)

Within this quote, Dawn seems to portray herself as a student healthcare professional who does not view herself or her performance as worthy of educator investment (i.e. feedback) and one of a student who has been reluctant or unable to take responsibility for her own

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learning – evidenced by her use of “should” twice suggesting either reluctance and/or inability. Dawn also seems reluctant to take ownership of her learning as she was not keen to practically seek support and feedback, even when encouraged to do so. It is unclear whether this reluctance is due to a lack of confidence, her quiet and shy demeanour, or her lack of ability. What is also interesting is the differentiation that Dawn makes between her lifeworld “self” and her performance. In the final sentence of the excerpt she distinguishes between performance or “skill” and her person as “self”. There is a sense that Dawn finds it difficult to separate the two, potentially making constructive feedback personally critical. Personally critical feedback might be perceived as a threat to the “self”.

The view that Dawn believes her learning need is of less importance than the need of another student raises legitimate questions about Dawn’s perception of herself. It is clear from Dawn’s dialogue that she recognises the benefit of actively seeking feedback from educators though, despite this recognition, is usually reluctant to source it. This poses the question of why Dawn is reluctant to seek feedback and gives rise to the examination of how feedback might be a threat.

5.2.2.1 Feedback as a threat to “self”

By considering “self” from a lifeworld position (A. Ashworth & Ashworth, 2003; P. Ashworth, 2003) and using the other lifeworld dimensions to illuminate the perception of “self” in more depth, it is interesting to consider feedback as a threat (or otherwise) in an attempt to explore Dawn’s reluctance to seek feedback. Kluger and Van Dijk (2010) suggest that learners who view feedback as a threat to the “self” might exhibit a reduction in their performance (performance in the broadest sense) as a direct result of the said feedback. Their work utilises the theory of self-regulation as posited by Higgins (1998). This theory draws on people being motivated either by prevention tasks, in which the main purpose is to avoid pain or punishment, or promotion tasks which have the main aim of success or achievement. Kluger and Van Dijk (2010) describe the “dangers” of feedback and the “damage” that it can effect on motivation and performance if not managed well.

Consideration of the theory of self-regulation through the lens of the lifeworld concept of “self” is particularly interesting as it adds further exploratory depth to the quote offered by Dawn. Despite Dawn’s academic ability as evidenced by high summative assessment grades, she appears to lack confidence in and conviction of her worth with regards to feedback. Using the self-regulation foci model, Dawn could be reluctant to access feedback as she is protective of her vulnerable learner “self”, prioritising her security over potential gain:

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The difference between the prevention and promotion foci reflects the basic conflict between the drive to preserve the status quo and the drive to initiate change, or between the need for security and the need for self-actualisation. (Kluger & Van Dijk, 2010, p. 1167)

This hypothesis offers one explanation for Dawn’s reluctance. Together with her uncertainty as to which community of practice (or multiples of) she belongs to in the learning

environment her attempts to protect herself and limited self-efficacy may explain her hesitant learning behaviour in the university-based clinical learning environment. One suggestion by Kluger and Van Dijk (2010) is that the feedback process should be replaced by a feed-forward interview process that creates “a reflection process that firstly serves the interviewee and his or her needs” (p. 1172), can intentionally draw out the positive aspects of a learning situation and supports the learner in their internal inspection and positive activation of “self”.

Whilst this evidence offers only one explanation for Dawn’s behaviour, it suggests the potential need for educators to re-consider the branding of “feedback” to support greater actualisation of the learner’s “self”. Additionally, it opens up a debate about the mechanisms used within the feedback process and highlights the potential use of reflection and

questioning to increase learner self-efficacy and agency in the learning process. This will be explored in greater depth in the chapter “Questions, Reflection and Ownership”.