자기조절학습을 다룬 의학교육연구에 대한 자성적 분석 (Med Educ, 2012)

자기조절학습을 다룬 의학교육연구에 대한 자성적 분석 (Med Educ, 2012)

A reflective analysis of medical education research on self-regulation in learning and practice

Ryan Brydges & Deborah Butler

의학에서 자기조절에 관한 연구는 그 역사가 길다.

The study of self-regulation in medicine has a long and rich history.

자기조절에 대한 연구는 의료전문직으로서 필요한 요건의 한 가지로서 관심이 집중되어왔고, 의료전문직이란 자기조절을 하는 전문가로서 지속적인 전문성 개발을 적극적으로 이뤄내서 최소한의 역량을 유지할 수 있어야 하기 때문이다. 유사하게 의학을 배워나가는 학습자들도 의학교육에 유능한, 자기조절적 학습자로서 참여할 것이 기대된다.

Correspondingly, attention has also focused on self-regulation as a requirement of medical professionals, who as part of a self- regulating profession, are expected to identify and willingly engage in ongoing professional develop- ment activities that serve to maintain a minimum level of learning and competence.2,3 Similarly, in preparation for joining medical practice, medical trainees are also expected to engage in medical education as capable, self-regulating learners.4

SRL은 '스스로 생각, 감정, 행동을 만들어서 자신의 목표를 달성할 수 있도록 계획하고 주기적으로 적용해나가는 것'으로 정의되어왔다.

Self-regulated learning (SRL) has been defined classically as: ‘self-generated thoughts, feelings and actions that are planned and cyclically adapted to the attainment of personal goals.’6

임상실습을 도는 학생을 상상해보자.

Firstly, let us consider a medical student engaged in her first clinical clerkship.

학생은 이 기간동안 주로 그전 학습환경에서 사용해온 학습전략을 지속적으로 활용하나, 여러 근거들을 종합하면 임상환경에서 그러한 전략들은 대체로 효과적이지 못하다.

Evidence suggests that during this transition she will persist in using learning strategies (e.g. memorisation) that may have worked in previous settings, yet are not as effective in the clinical environment.8,9

이 학생은 도움을 요청해야 할 때가 언제인지 적절한 판단을 내림으로써 유능하게 보일 수도 있지만, 동시에 환자의 안전도 담보해야 한다. 동시에 임상경험을 통해서 학습 진행을 관리해야 한다. 학생은 학습, 봉사, 의료의 우선순위가 서로 상충한다는 것을 곧 깨닫게되며, 자신의 시간관리를 스스로 해야한다.

She must make careful judgements about when to ask for assistance so that she can appear compe- tent, but preserve patient safety. Simultaneously, she must manage her learning about and through her practice experiences. She quickly realises that learn- ing, service and patient care can be conflicting priorities, and that she must manage her time largely on her own.9

로테이션 시스템에서 학생은 길을 잃은 느낌을 받거나 그 구조의 불합리성을 비난하고, 임상에서의 위계질서는 병원에서 있느니 책 한글자라도 더 보는 것이 배우는 것이 많겠다는 생각을 하게 한다.

She may start to feel lost and blame the work structure in the form of the rotational system and clinical hierarchy for making her feel as if she learns more from reading a textbook than she does from her time at the hospital.9

둘째로, 임상의사는 지속적으로 전문성을 함양하여 역량을 유지하고 최신 지식을 유지하면서 자기조절을 하게 된다. 그러나 자기조절에 대한 주위의 기대치는 임상 교사와 같은 그들이 맡은 또 다른 역할에서도 드러난다.

Secondly, practising clinicians self-regulate when they engage in ongoing professional learning to maintain competencies and stay up to date. However, expecta- tions for self-regulation also emerge within other of their roles, such as that of the clinical teacher.11,12

학계든 지역사회든 모든 환경에서 의사는 교수자로서 자기조절(피교육자에 대한 교육을 어떻게 할 것인가)와 평생학습에 대한 자기조절(어떤 참고자료를 찾아봐야 하며 언제 조언을 구해야 하는가)의 균형을 유지해야 한다.

academic or community care setting. In all settings, he must balance self-regulating his practice as teacher (e.g. in how he educates his trainees and patients) and self-regulating his lifelong learning (e.g. in how he makes decisions about what to look up and when to consult with colleagues).

이 두 가지 사례는 우리가 의학교육에서 자기조절에 대해 생각하는 방식을 묘사한다.

These two examples illustrate current ways of think- ing about self-regulation in medical education.

어떤 영향력은 학습자 외부에 있고, 어떤 영향력은 학습자에 내재되어 있다.

Some influences are external to learners, Other influences can be associated with a learner,

이러한 사례를 기반으로 보면, 의학교육에서 자기조절이란 다양한 내적, 외적 영향력에 주의를 기울일 것이 요구된다.

Given these examples, it would seem that understanding self-regulation in medical educa- tion requires attending to a range of internal and external influences.5

Figure 1 A model of self-regulation (adapted from Butler et al.5; see also Cartier and Butler16)

개개인이 학습환경에 가져오는 것

What individuals bring to the learning context

그러나 개개인이 자기조절에 대해 접근하는 방식은 학습환경을 곧바로 반영하는 것은 아니다. 개개인은 다양한 오랜 기간에 걸쳐서 발전되어온 지식, 신념, 행동, 역사, 경험 등을 특정 환경에 가져온다. 성공적인 학부 의과대학생은 의과대학에 처음 입학했을 때는 자신감에 넘쳤을 수 있지만 머지 않아 자기주도적 교육과정의 낯선 요구에 겁을 먹을 것이다.

However, an individual’s approach to self-regulationis not a direct reflection of context. Individuals bring to contexts a variety of knowledge, beliefs andemotions that have developed over time through their history and experiences and that emerge in particular settings. Successful undergraduate learn- ers, for example, might be confident when enteringmedical school, but then may be rattled by the unfamiliar demands of a self-directed curriculum.19

자기조절 관련 행동의 사이클

A cycle of self-regulation in action

역사적, 사회적, 문화적 세팅에서의 자기조절

Self-regulation in historically, socially and culturally situated settings

문화적 규약과 교육적 행동, 개개인의 해석과 열망으로부터 자기조절이 어떻게 드러나는지를 보여준다.

This research underlines the importance of considering how observed patterns in 

• self-regulation (e.g. the pattern demonstrated by a medical trainee who fails to ask for help when he needs it to ensure patient safety) 
• emerge from 
• complex interactions between cultural norms (e.g. expectations to act independently), 
• pedagogical practices (e.g. feedback) and 
• individuals’ interpretations and aspirations (e.g. the desire to assume the identity of a doctor).

SRL을 요구하거나 촉진하는 학습환경

Learning environments that demand or foster SRL

또 다른 연구에서 어떻게 교육환경이 자기조절을 촉진하는지 알아보았다. 

In another group of studies, medical education researchers have focused on how pedagogical envi- ronments might foster self-regulation.26 An impor- tant example can be found in the rich history of articles that invoke the term ‘self-directed learning’ (SDL). Mapped on to our theoretical framework, one contribution of this line of research is that it attends specifically to how environments can be designed to provide opportunities for and expect self-regula- tion,13 such as by using tools like PBL and life-long learning modules.27 Evidence to support such SDL initiatives is encouraging, if still in its early stages.

White의 연구를 보면, 학생들에게 SRL을 요구하는 것은 궁극적으로는 도움이 된다. SRL은 SR을 기대하거나 가능하게 하는 환경에서부터 촉진될 뿐만 아니라, 그러한 환경에서 자기조절을 지원하고, 개개인에게 어떻게 SRL을 할 수 있는지 알려주는 것으로부터도 촉진된다.

As we considered the study by White19 (and other similar studies) in relation to emerging strands of research, our analysis suggested that, although it is ultimately beneficial for students to experience demands for self-regulation, either in an early PBL experience or when transitioning to clerkship, students in both groups may have been similarly disoriented and challenged at the moment when learning expectations changed (i.e. in PBL in Year 1 or in the clerkship in Year 3), and may have benefited from support to navigate those changes.13 This obser- vation is grounded in evidence which suggests that self-regulation is fostered not only by establishing environments that afford or expect self-regulation, but also by supporting self-regulation in those contexts and by assisting individuals to learn how to self-regulate their learning. Medical educators are starting to study self-regulation from this perspective by drawing on the seminal work of Irby12,28 to consider how to manage trainees’ progression toward independent learning and practice.10,11

self-directed learning에서 중요한 것은 그것을 너무 문자 그대로 해석하지 않는 것이다.

A key implication is that the term ‘self-directed learning’ should not be interpreted too literally.31

어떻게 자기조절이 co-regulated practice의 형태로 guide될 수 있으며, support될 수 있는지를 강조하고자 한다.

Thus, we join others in calling for greater emphasis on how self-regulation can be guided and supported as a form of co-regulated practice (i.e. practice that is shaped by context and by others).13,29–32

개개인이 학습환경에 가져오는 것

What individuals bring to the learning context

의학교육연구는 어떻게 이전 지식, 신념, 감정이 수행능력을 좌우하며, 왜 SRL이 항상 이상적으로 작동하지 않는지에 대해 설명해주었다.

Medical education research has examined how prior knowledge, beliefs and emotions mediate perfor- mance and can account in part for why self-regulation may not always unfold in an ideal manner.

종합하면, 이전 경험에서의 지식과 헌신이 새로운 환경과 상호작용하여 self-regulation에 영향을 준다.

Collectively, these studies show that knowledge and commitments from prior experience interact with context (e.g. clarity of expectations) to influence self-regulation.8,32

자기조절행동의 사이클

A cycle of self-regulation in action

최근까지 자기평가에 대한 연구는 학습자들이 얼마나 자기 지식의 한계를 잘 판단하며 그 정보를 가지고 전문성개발의 가이드로 삼는지에 대한 것이었다.

Until recently, most self-assessment research has focused on measuring how well trainees or practitioners can judge the extent or limits of their knowledge and use that information to guide their professional development.37

그러나 최근의 연구는 분석의 입자 크기에 보다 집중하고 있다. 

However, recent research has paid closer attention to the grain size of analysis,39 which has important implications for understanding the potential for trainees and doctors to adequately self- assess.

자기평가의 이전 연구는 개개인이 자신들의 경험을 축적하여 총괄적 자기평가를 할 수 있다는 가정에 이뤄졌지만, 보다 최근의 연구는 어떻게 주어진 SRL 사이클에서 실제 수행 중에 self-monitor 혹은 self-assess를 할 것인가에 집중되어 있다. self-monitor에 대한 최근의 두 가지 연구는 특정 순간에 self-monitor를 하는 것이 global self-assess보다 더 정확하고 민감하다는 것을 보여준다.

That is, previous study of self-assessment assumed that individuals are capable of aggregating across experiences to generate global self-assessments which will spur professional learning. By contrast, more recent work has focused on how an individual self-monitors or self-assesses within a situated SRL cycle during practice (Fig. 1). Two recent studies of the self-monitoring process suggest that individuals are more accurate and sensitive when self-monitoring in the moment than they are in making global self- assessments.35,37

의학교육의 복잡성

Complexity of medical education

첫째로, 우리는 자기조절에 대한 분석이 학습과 진료의 복잡성을 고려해야 한다고 본다.

Firstly, we recommend that any analysis of self- regulation in medical education recognise and take into account the complexity of learning and practice.

자기조절에 대한 개념

Conceptualising self-regulation

앞에서 제시한 프레임워크르 사용하는 것이 다양한 SRL에 대한 연구를 조화롭게 엮어주는 것을 확인했다.

We found that a benefit of using our integrative framework in our analysis was that it enabled us to connect different lines of research on self-regulation in a coordinated and coherent manner.

입자 크기에 대한 관점의 유용성

Grain size: a useful perspective

자기조절에 대한 연구로부터 우리는 연구자들이 grain size에 관심을 두어야 함을 주장하고자 한다. grain size란 연구자가 연구를 위해 선택하는 분석 혹은 디테일의 수준이다.

Building from research in self-assessment, we recom- mend that researchers attend to the grain size of analyses of self-regulating processes. Grain size refers to the level of detail or analysis one selects for study. 

• For example, a fine-grained analysis might focus on instances of self-regulating processes as they play out in context (such as when a medical trainee interacting with a patient with diabetes decides that his expertise is exceeded and that he needs help from a supervisor), 
• whereas a more global analysis might ask for a generalised assessment of knowledge relevant to practice (such as when the same trainee rates how much he knows about diabetes to guide his learning).

자기조절에 대한 지지

Supporting self-regulation

두 가지 주요한 가정에서 탈피해야 한다. 한 가지는 독립적으로 완수할 수 있는 학습활동을 설계하는 것이 내용 영역의 학습과 자기조절의 개발 모두를 달성할 수 있다는 것이며, 둘째는 자기조절이라는 것이 온전히 학습자 내부에서 진행되는 것이고 따라서 교수는 거의 할 일이 없다는 생각이다.

Our analysis of research suggests two major assump- tions to be avoided in the study of self-regulation in medical education. The first is the assumption that designing an activity so that it can be completed independently is sufficient to promote both learning of a content domain and the development of self-regulation. The second is the assumption that self- regulation is an activity conducted entirely within the learner and, consequently, that faculty members play little or no role in supporting self-regulation.13

의학교육자들은 SRL을 할 수 있는 환경을 설계하는 것 뿐만 아니라 자기조절 process에 대한 지원을 제공해야 한다.

Crucially, then, medical educators must assume responsibility, not just for designing environments that afford the opportunity for self-regulation, but also for providing support for the self-regulating processes.

또한 그러한 support가 얼마나 다양한 형태로, 그리고 다양한 자원으로부터 올 수 있는가를 말하고자 한다.

We also recommend learning from education research (in medicine and elsewhere) that has shown how support for professional learning can come in many forms, such as by facilitating, prompting, modelling or explaining, and from many sources, such as text, video, online modules, peers and instructors.

자기조절능력의 향상은 내용 전문가로서 발전하는 것과 함께, 그리고 그 한 부분으로서 도달할 수 있다. 

Indeed, improvements in self-regulation can emerge alongside and as part of the development of content expertise. Contexts and forms of support that foster explicit attention to learning expectations and pro- cesses as part of content area instruction have the potential to support both concept mastery and self-regulation.42 Ideally, one learns about content by self-regulating learning, whereas one builds knowl- edge about self-regulation via the experience of learning. More subtly, descriptions of the development of ‘discernment’ suggest that self-regulation as applied in a new area improves as a trainee acquires expertise.22

한 분야에 대해서 내용에 대한 지식과 효과적인 자기조절은 서로 협력적으로 발전해나갈 수 있다.

individual and that content knowledge and effective self-regulation in a given area can develop progressively and in tandem (i.e. bootstrapping can occur).

45 Eva KW, Regehr G. Exploring the divergence between self-assessment and self-monitoring. Adv Health Sci Educ Theory Pract. 2011;16(3):311–29.

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Med Educ. 2012 Jan;46(1):71-9. doi: 10.1111/j.1365-2923.2011.04100.x.

A reflective analysis of medical education research on self-regulation in learning and practice.

Brydges R1, Butler D.

Author information

• 1Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. ryan.brydges@utoronto.ca

Abstract

OBJECTIVES:

In the health professions we expect practitioners and trainees to engage in self-regulation of their learning and practice. For example, doctors are responsible for diagnosing their own learning needs and pursuing professional development opportunities; medical residents are expected to identify what they do not know when caring for patients and to seek help from supervisors when they need it, and medical school curricula are increasingly called upon to support self-regulation as a central learning outcome. Given the importance of self-regulation in both health professionseducation and ongoing professional practice, our aim was to generate a snapshot of the state of the science in medical education research in this area.

METHODS:

To achieve this goal, we gathered literature focused on self-regulation or self-directed learning undertaken from multiple perspectives. Then, with support from a multi-component theoretical framework, we created an overarching map of the themes addressed thus far and emerging findings. We built from that integrative overview to consider contributions, connections and gaps in research on self-regulation to date.

RESULTS AND CONCLUSIONS:

Based on this reflective analysis, we conclude that the medical education community's understanding about self-regulation will continue to advance as we: (i) consider how learning is undertaken within the complex social contexts of clinical training and practice; (ii) think of self-regulation within an integrative perspective that allows us to combine disparate strands of research and to consider self-regulationacross the training continuum in medicine, from learning to practice; (iii) attend to the grain size of analysis both thoughtfully and intentionally, and (iv) most essentially, extend our efforts to understand the need for and best practices in support of self-regulation.

© Blackwell Publishing Ltd 2012.

Comment in

• Layers within layers … self-regulation in a complex learning environment. [Med Educ. 2012]
• Future direction for research in self-regulated learning in medical education. [Med Educ. 2012]

PMID:

 

22150198

 

[PubMed - indexed for MEDLINE]