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  • Fall 2011 - Self-Efficacy Case Study
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Case

John Smith is a 25 year old college graduate who had been aiming to apply to medical school. John's exceptional performance in high school as well as his excitement with regards to observing and analyzing surgical procedures helped to prompt his decision to pursue an undergraduate degree leading towards medical school. John's parents were very supportive of his decision to pursue medical school, and John had a great deal of pride in the confidence his peers and coworkers had in him. John was very sure of his path in life, especially after shadowing various doctors in various surgical units and experiencing exciting situations that spiked his adrenaline. His performance and hours he put in at the library we on par with the best and John had high hopes of admittance to top ranking medical schools. In John's 3rd year of his undergraduate degree he began the application process with a high level of enthusiasm and from an outsider’s view; it would seem John was a shoe in.

Later in the year John had a sports related injury, and in the recovery process he became addicted to pain killers. The addiction grew out of control and John was forced to attend a rehab facility. In the process of regaining his normal lifestyle, John lost a great deal of confidence in his ability to function on par with others in a professional environment, especially at the top of the medical field. He felt he was unable to perform consistently on a high enough standard to be able to put up with the rigors of medical school and the medical profession. The fact that he had lost control of his decision making process and was forced to seek out professional assistance for his mental health instilled fear in him that he was not as stable and capable of performing to the best of his ability on a reliable and consistent schedule in his future. John's parents, whose input was very important to him, were highly disappointed in his chemical dependency issues, and in John's opinion they now held him in a different light, looking down on him as more of a disappointment than a hopeful soon-to-be professional.

Upon re-entry to school, despite having overcome his addiction and still performing very admirably in his academics, John no longer continued his almost completed medical school application as he felt he was not cut out. He had fears of falling into the same traps as other addicts he had met in recovery who have futures much more bleak than his own. Though his situation is likely not an isolated case and similar situations may well have occurred before, John thought no 'addict' (as he had been labeled in treatment) could possibly succeed as a medical doctor. He saw his forced temporary withdraw from his undergraduate degree as being a temporary failure which would never be allowed to happen as a medical doctor, and he had doubts of his mental stability with regards to keeping it from happening again. Despite graduating near the top of his class with a biology degree, and successfully avoiding chemical dependency relapse, John never pursued his dream of becoming a medical doctor and settled into another career in which he felt his inability to mentally perform consistently would not hinder his job performance. To date, John has not had any lapses in his fight against his chemical dependence, and has had not situations in which the mental instability he fears exists has ever disabled him from performing his job, yet he still believes his previous temporary failure is something that speaks to his ability to perform consistently on a high enough level to successfully practice as a medical doctor.

Connections to Theory

According to Social Cognitive Theory (Bandura, 2006), there are four core properties of human agency: intentionality, forethought, self-reactiveness, self-reflectiveness.

Intentionality refers to people’s ability to create plans and to develop strategies to realize those plans. In the case of John, he planned to become a doctor and he made concrete step towards realizing that goal by starting applications to medical schools.

Forethought entails the anticipation of possible future outcomes to self-guide and motivate current behavior. Although John may have anticipated the possibility of getting rejected from a few medical schools or even from all of them, he could not have predicted that he would get injured in a sports-related accident. This unforeseen event created conditions that would later determine the course of John’s life.

Self-reactiveness is a form of self-regulation. People use a reactive strategy for self-regulation when they try to reduce the discrepancies between their achievements and their goals. Nonetheless, after people minimize those discrepancies, they proactively set newer goals. For example, we can see from the description of the case that after doing well in high school, John seemed to have set for himself the new goal of getting into medical school.

Self-reflectiveness comes about through self --awareness. In general, the most important self reflective mechanism is self-efficacy, which refers to a one’s belief that one has what it takes to achieve a goal. We can conclude from the case description that John developed self-efficacy from the following four sources:

  1. Mastery experiences: “shadowing various doctors in various surgical units.”
  2. Social modeling (vicarious experiences): seeing doctors successfully operating on patients.
  3. Social persuasion: the confidence, his peers and colleagues had in him.
  4. Physical and emotional states: “experiencing exciting situations that spiked his adrenaline.”

Social Cognitive Theory states that human functioning is a product of the triadic interaction of intrapersonal, behavioral, and environmental determinants (Bandura, 2001). This model of human behavior can shed light on how unexpected events can influence future outcomes. To illustrate, although John had the personal agency to achieve his goals, the fortuitous (i.e. accidental) injury that he suffered set his life trajectory on a different path, a path in which drug addiction and mental problems ensued. As a result of the setback, John’s self efficacy decreased to such a level that even though he both graduated in the top of his class and overcame his substance dependency, he still became to believe that he no longer had what it took to become a doctor. According to Social Cognitive Theory, John’s behavior not to further pursue medical school can be understood as a form of helplessness that resulted from the interaction of John’s low self efficacy with his cognitions of an unresponsive environment (i.e. mental instability).

How the Theory Could Have Been Used

The Social Cognitive Theory is present in John's situation because even though he had overcame his addiction behavior, the situation, certain personal characteristics and the environment are affecting his decision to no longer pursue his medical career. This is referred to as Triadic Reciprocal Causation.

Self efficacy is referred to as a "self fulfilling prophecy". In John's case, this did come to fruition. Although John never had another problem with drugs, it forever altered his belief in how well he would be able to perform as a doctor. It may have been helpful to John if he had gone on to medical school and realized that his one lapse in judgment did not seal his fate to never become a doctor. Going on to medical school despite his misgivings may have helped John become more motivated as he would have seen that he is still competent and still able to fulfill his goal of becoming a doctor. If John continued to do well in medical school, his self-efficacy would have continued to increase and his reservations about his drug problem and mental state would have continued to decrease over time.

It would have also been helpful if John was able to see examples of other individuals who'd had a stumble along the way, yet still became successful in the medical field. These types of vicarious experiences would have boosted John's own self efficacy, as he would have seen that there were others out there who had went through an ordeal similar to his, but were able to realize their goal in spite of the setback. It would have also been beneficial to John if his parents had given him more positive encouragement once he got treatment and got back on track. It seemed that John wrote himself off and so did the support system closest to him. Had John's parents been more positive after his successful recovery, it might have given John the motivation he needed to continue his goal to complete medical school.

In the case of John, self-efficacy theory could have been used to boost John’s motivation by improving his own self-image. John could have tried to focus upon the skills he had and built them up little by little. It should have been more about what he was capable of once before and therefore had it in himself somewhere; he just had to keep trying. If he would have given himself small tasks or goals to complete at first, with each success his own confidence would have been boosted.


Theory Implementation

John's situation could be improved by utilizing techniques to increase one's self-efficacy. The root of John's loss of efficacy can be linked back to his drug addiction arising from a sports injury. When John was in rehab he perceived the notion of addiction as a detriment to his abilities to perform in a demanding career field such as medicine. There are a few intervention methods that could have been used in John's rehab to improve his self-efficacy.

First, John could have been surrounded by some addicts who had gone on to achieve great things for themselves, such as working in a demanding career field. Albert Bandura proposed that through vicarious experiences is one way that we evaluate our efficacy (Bandura, Self Efficacy, 1998). If we surround ourselves with persons who have overcome adversity, and we can identify with those people, then we will come to believe that we too can overcome adversity because we are similar to those who have overcome (Bandura, Self Efficacy, 1998). Verbal persuasion is also useful in increasing one's efficacy, if we are told that we are capable then we will begin to believe that we are (Bandura, Self Efficacy, 1998). If John was convincingly told that he was capable of pursuing a doctorate degree following rehab then he may have increased efficacy in his abilities (Bandura, Self Efficacy, 1998).

Finally, Bandura proposed that the most effective way to increasing one efficacy is accomplished by actually achieving goals, when persons achieve the goals that they thought they couldn’t then their efficacy will be improved (Bandura, Self Efficacy, 1998). This method is best done when a person is presented with a challenge that is neither too easy nor too tough, a person should make a goal that is attainable but needs effort and the ability to deal with any challenges that may arise in achieving that goal.

References:

Albert Bandura. (2001). social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, XIV.

Bandura, A. (1998). Self Efficacy. Retrieved October 06, 2011, from Self Efficacy: http://www.des.emory.edu/mfp/BanEncy.html.

Bandura, A. (2006). Toward a psychology of human agency. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE, 1(2), 164-180.


 


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