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

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

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

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.

의대 과정동안 자기주도적학습 능력이 향상될까 줄어들까? (Acad Med, 2013)

Does Medical Training Promote or Deter Self-Directed Learning? A Longitudinal Mixed-Methods Study

Kalyani Premkumar, MBBS, MD, MSc (Med Ed), PhD, Punam Pahwa, PhD,

Ankona Banerjee, MSc, Kellen Baptiste, MD, Hitesh Bhatt, MSc, and Hyun J. Lim, PhD

Campbell 등은 SDL을 Maslow가 '자기실현적 개인'이라고 칭한 고도로 주도적인 자기 학습자와 같이 학습 프로그램에 참여하는 것에 있어서 스스로 주도하고, 스스로 기획하는 행동이라 정의했다. Hammond와 Collins는 SDL을 학습자가 주도권을 쥐고 다른 사람의 지원과 협력하에 진행되는 프로세스라고 묘사했다. 그러나 가장 잘 정의된 것은 Knowles가 개개인이 이니셔티브를 쥐고, 다른 사람의 도움이 있거나 없는 상황에서 스스로의 학습요구를 진단하고, 학습목표를 설정하고, 인적 물적 학습자원을 찾아서 적절한 학습전략을 선택 및 도입하고 스스로의 학습결과를 평가하는 것이다.

Campbell et al1 define SDL as behaviors that range from participation in programmed learning to the self- initiated, self-planned activities of such highly directed self-learners as Maslow’s self-actualizing individuals.2,3 Hammond and Collins4 describe SDL as a process in which learners take the initiative, with the support and collaboration of others. But we believe the concept of SDL is best captured by Knowles5 as a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes."

왜 의학에서 SDL이 중요한가? Why is SDL important in medicine?"

SDL은 의학 분야에서 매우 강조되어왔는데, 예컨대 CanMEDS에서 scholar role을 보면, 의사들이 일생에 걸친 자기성찰적 학습을 해야 한다. 또한 ABMS와 WFME는 SDL을 의학교육에서 반드시 평가해야 하는 특징으로 보았다.

SDL has been increasingly emphasized in the medical field. For instance, the scholar role of the CanMEDS 2005 Physician Competency Framework emphasizes SDL by requiring physicians to demonstrate a lifelong commitment to reflective learning,9 and both the American Board of Medical Specialties and the World Federation for Medical Education include SDL as a characteristic that should be evaluated during medical education.10,11"

ACGME 역시 practice-based learning and improvement를 여섯 개의 핵심 역량 중 하나로 보았으며, 추가적으로 CME 역시 의사들이 자기주도적으로 스스로의 학습요구, 목표, 학습활동 선택 등을 잘 할 수 있다는 가정하에 이뤄지는 것이다.

The Accreditation Council for Graduate Medical Education, too, identifies practice-based learning (a form of SDL) and improvement as one of its six core competencies.12 In addition, continuing medical education for physicians is based on the assumption that physicians are self-directed leaders who can accurately predict their own learning needs, set goals, engage in appropriate learning activities, and regularly and accurately assess the outcomes.13,14"

SDL의 역량 

Competencies of SDL"

SDL의 역량은 여러 사람이 묘사했는데, 학습 격차에 대한 이해, 자신과 타인에 대한 평가, 성찰, 정보 관리, 비판적 사고, 비판적 평가 등이 있다.

The competencies of SDL have been described by many.5,15,16 They include proficiency in assessment of learning gaps, evaluation of self and others, reflection, information management, critical thinking, and critical appraisal.15"

이런 것들이 '자율성'을 의미하는 것 같지만, SDL은 동료 및 선생님들과 서로 정보를 교환하는 것을 포함한다.

Although all these characteristics seem to indicate autonomy, SDL involves interaction with peers and teachers to exchange information.17"

SDL이 교육될 수 있는가? Can SDL be taught?"

SDL is often described as a continuum, present in all individuals to some extent, with those who are least self-directed being totally dependent on the teacher for learning.5,16 The other end of the spectrum is the totally self-directed learner, who independently determines what is to be learned, identifies the resources, solves problems, and evaluates. It should be noted that a person who is highly self- directed in a particular situation may be very much less self-directed in a new and unfamiliar context.18"

Grow는 SDL의 단계 모델을 만들면서, 학습자를 자기주도적 학습의 네 단계 중 하나에 있다고 보았다.

Grow,16 in his staged SDL model, describes the learner, at any given time or learning situation/ context, to be in one of four stages: 

• dependent (stage 1), 
• interested (stage 2), 
• involved (stage 3), and 
• self-directed (stage 4)."

교육자들은 학습자가 어느 단계에 있는가를 진단하고 더 높은 단계로 준비히켜주어야 한다.

Educators need to diagnose the learner’s stage of self-direction and prepare the learner to advance to higher stages."

According to Grow, although learning in a dependent mode goes against the principle of student-centered styles of teaching and adult learning, there is nothing demeaning or destructive in promoting temporarily dependent relationships as long as the purpose is to advance learners to higher stages."

SDLRS는 자기기입식 설문지로 다음의 구인을 평가한다.

The SDLRS consists of a self-report questionnaire of 58 questions and is one of the most common instruments used to assess SDL readiness.24 It measures eight constructs: 

• Openness to learning opportunities 

• Self-concept as an effective learner 

• Initiative and independence in learning 

• Informed acceptance of responsibility to one’s own learning 

• Love of learning 

• Creativity 

• Positive orientation to the future 

• Ability to use basic study and problem- solving skills"

질적분석 

Qualitative. 

연구 후반부에 인터뷰를 실시하였고, 여섯 명으로부터 반구조화 면접을 수행했다.

At the end of the study, all instructors in the medical school were invited to participate in interviews. Six instructors volunteered, and we conducted semistructured interviews with them."

녹취된 인터뷰와 포커스그룹은 세 명의 coder에 의해서 independently 분석되었고, 반복적인 토론을 통해서 합의달성

The recorded interviews and focus group discussions were transcribed. The transcriptions were independently examined for common themes by three coders (K.P., A.B., and another qualitative research expert). Repeated discussions were held until agreement among coders was attained."

입학 당시 SDL 준비도

SDL readiness and age at admission 

연령이 높아질수록 SDLRS 점수에 긍정적 효과가 있었다. 종합적으로, 더 나이를 먹은 학생이 더 점수가 높았다.

Age was considered to be a continuous variable in this study, and an increase in one year of age at admission had an overall positive impact on SDLRS scores. Overall, students who were older had significantly higher scores (P = .002) than did younger students."

SDL과 premedical university education 기간

SDL and years of premedical university education"

SDL 준비도의 변화

Changes in SDL readiness of medical students from admission to graduation."

입학 후 1년이 지났을 때 SDLRS점수에 유의미한 하락이 있었다. 입학시 점수보다 지속적으로 낮았다.

There was a significant drop (P < .001) in SDLRS scores in all cohorts one year after admission. The scores of all cohorts continued to be significantly lower than that at admission throughouttraining and at graduation."

SDL을 촉진하는 현 교육과정 내의 활동들

Activities in the current curriculum that promote SDL "

SDL에 배정된 시간을 중요시하여, 교육과정의 한 부분으로서 1학년 때 매일 오후는 SDL로 할당되었다. 그러나 지침이나 관리 없이 시간만 주는 것은 SDL을 오히려 악화시켰다.

The instructors and students identified some of the activities within the current curriculum that promote SDL: The time allocated for SDL—especially in the first year—was considered valuable. As part of the curriculum, a few hours of every afternoon in year 1 is earmarked for SDL. However, it was felt that being giventime, without direction and monitoring, deterred SDL."

SDL 촉진/악화 요인

Factors that facilitate/deter SDL 

두 가지 주제가 드러났다. 하나는 학습 환경과 관련된 것이고 다른 하나는 평가에 관련된 것이다.

Two themes clearly emerged: one related to the learning culture and environment and the other related to assessment."

SDL이 교육과정 전체에 걸쳐서 주요한 주제가 되어야 한다. 한 두 개의 과목만으로는 안된다.

Instructors felt that SDL has to be a theme throughout the curriculum, not introduced in just one or two courses."

SDL은 guide process로 여겨졌으며 SDL의 기술들은 교육될 수 있다

SDL was thought to be a guided process, and skills in SDL had to be taught."

SDL이 학년이 올라가면서 낮아지는 것에 대해서 교사나 학생 모두 전혀 놀랍지 않다는 분위기였다.

Towards the end of the focus group/ interviews, students and instructors were told that preliminary findings of this study seemed to indicate that SDL readiness was decreasing with increasing years. Both groups were not surprised at the findings:"

SDL readiness and age. 

나이를 더 먹은 학생이 어린 학생보다 유의미하게 높았으며 이는 Reio와 Davis, Kell과 Van Deursen의 결과와 일치한다. (50세까지는 SDL이 향상됨) 학습에 대한 선호는 과거의 학습경험과 학습과정을 통제할 수 있다는 자신감에서 나온다.

Older students had significantly higher scores than younger students. This is consistent with the findings of Reio and Davis38 and Kell and Van Deursen41 and lends further support that SDL has a positive developmental trajectory until the 50s, consistent with SDL theory.42,43 The learning preference has been attributed to previous learning experience and confidence in controlling the learning process.44 "

SDL readiness and premedical training"

This finding is in contrast to that of Harvey et al,39 who found a significant positive trend in SDL scores (using SDLRS, the Oddi Continuing Learning Inventory [OCLI], and Ryan’s [ability] scores) associated with the highest level of premedical education achieved (undergraduate only, master’s, or doctoral)."

SDLRS scores with increased medical training."

SDL점수가 1학년 말에 유의미하게 하락했다.

Our findings indicate that SDL readiness scores decreased significantly at the end of one year."

이러한 연구 결과는 U of Toronto의 결과와도 비슷하다.

our findings are similar to the findings of researchers at the University of Toronto Faculty of Medicine, who did a cross- sectional study on first- and second-year medical students (N = 280). Of the three instruments that they used (SDLRS, OCLI, and Ryan), the scores obtained with Ryan’s instrument showed a decrease with more training.39"

이런 차이는 어떻게 설명가능할까?

How can these differences be explained?"

이러한 차이는 어떻게 설명할 수 있을까? Knowles는 학습을 교수주도과 자기주도를 양측에 둔 연속체로 묘사하였다(pedagogical - androgogical). 이 연속체는 학습자가 학습에 대하여 얼마나 통제권을 가지고 있으며, 학습목표를 달성하기 위하여 필요한 평가와 전략에 대해 얼마나 자유도를 가지는지에 의해 달라진다. 예컨대 특정한 학습 영역에서 자기주도적이 되기 위해서는 학습자는 특정 수준 이상의 지식을 가지고 있어야 한다. SDL에 대해 얼마나 준비가 되어있느냐는 학생마다 매우 다르고, 이는 학생마다 경험이 다르기 때문이다. 학생이 지식이 적을 때는 높은 수준의 구조화가 필요하다. SDL에 대한 준비도와 틀에 짜여진 교육시간에 대한 선호도와는 분명한 역의 상관관계가 있다. 학부 교육과정동안 학생들은 과도한 정보를 주입당하는데, 학생들은 그 시간동안 자기들의 스스로의 흥미에 대해 공부할 시간이 거의 없다. 따라서 의대 기간동안 SDLRS가 떨어지는 것이 놀라운 것은 아니다.

How can the differences in SDLRS scores with training be explained? Knowles5 describes learning as a continuum with teacher-directed (pedagogical) learning at one end and self-directed (androgogical) at the other. This continuum can be explained in terms of how much control the learner has over learning and the amount of freedom given to evaluate and implement strategies to achieve learning goals. In medicine, the learning environment tends to keep students in the pedagogical end of the spectrum. For instance, to be self-directed in a specific content area, a person must possess a certain level of knowledge. The readiness for SDL is variable in any given student population, as each student enters medicine with a different academic background. When students have a low level of knowledge, they prefer a high degree of structure. It has been shown that there is a definite inverse correlation between SDL readiness and student preference for structured teaching sessions.47,48 Throughout undergraduate training, students are overloaded with information. Moreover, the competencies required are well defined by regulatory bodies, and there is very little time for students to pursue their own interests. As our faculty note, it is therefore not surprising that SDLRS scores decrease with training."

Knowles에 따르면 학생과 교사 모두 SDL기반 교육과정 도입에 필요한 스킬을 갖출 필요가 있다.

According to Knowles,5 both teachers and students have to possess the skills necessary for the implementation of an SDL-based curriculum."

• role of facilitators"
• learning environment that is collaborative rather than competitive."
• diagnose learning needs"
• help learners diagnose their own needs.5"
• Training plays a key role"

학생과 교사의 준비가 부족한 것 외에 다른 SDL의 장애물로는 Shokar는 "전문성, 교육과정, 법, 조직 내규, 외부 제약, 시간 제약, 학습할 내용 등으로부터 오는 제한"이라고 했다.

Apart from lack of teacher and student preparation, other factors may serve as barriers to SDL. Shokar et al50 list some of these barriers as “restrictions imposed by professional, curricular, legal, and institutional requirements, statutory educational regulations, time constraints, and the need to ensure that specific content is covered.”"

모든 상황에 SDL이 적용가능한 것이 아님을 염두에 둘 필요가 있다. 학생이 과거 경험이 매우 적거나 학습의 초점이 과목 그 자체보다는 내용(구체적 학습목표)에 있을 때 SDL은 적절하지 않다. 학부의학교육은 - 특히 1학년은 - 거의 지식에 대한 기반이 약하고 따라서 학생들이 교사-의존적이 되는 것은 이해할 만 하다.

One must also remember that not all situations are applicable for SDL. SDL may not be appropriate in situations where the student is new or has very little previous experience of the subject and when the focus of learning is on the content (e.g., specific learning objectives) rather than the subject itself.47 In undergraduate medical training— especially in the first year—most students have very little foundational knowledge. It is therefore understandable that students are more teacher-dependent and require that the education program be more structured."

SDL에 영향을 주는 요인들이 복잡함을 고려할 때 많은 모델이 SDL을 대표한다. Garrison의 모델, Brocket과 Hiemstra의 모델, Candy의 모델.

Given the complexity of factors that influence SDL, a number of models have been proposed to represent SDL. 

• Garrison’s51 model focuses on three psychological constructs: self- monitoring (cognitive responsibility), self-management, and motivation (see Figure 2). 
• Self-monitoring refers to the ability of learners to monitor both their cognitive and metacognitive processes. 
• Self-management focuses on goal setting, use of resources, and external support for learning. 
• Motivation has two dimensions: entering and task motivation. 
• Entering motivation is what compels the learner to participate in the learning process, whereas 
• task motivation is what keeps the learner on task and persisting in the learning process. To promote SDL, each of these constructs needs to be addressed."

• Brocket and Hiemstra’s52 model of SDL (see Figure 2) focuses on learner control of responses to a situation even if there is no control over the circumstances; the model considers SDL and learner self-direction as two dimensions, with personal responsibility connecting the two. To facilitate SDL, focus on promoting personal responsibility is required."

• Candy’s53 SDL model (see Figure 2) illustrates two interacting laminated (layered) domains. One dimension relates to the amount of control within an institutional setting, with one end of the continuum showcasing teacher control and the other learner control. The second dimension relates to amount of control over informal learning: autodidaxy. In this model, one needs to help the organization and its teachers choose appropriate strategies based on the content and level of knowledge of students, and to facilitate movement of students along the continuum."

다갈래의 전략이 필요하다. 학생이 SDL궤도를 따르도록 도와줄 수 있는 네 가지 원칙을 요약하였음.

From the different SDL models it can be deduced that a multipronged approach has to be taken to promote SDL in students. Francom54 summarizes four principles instructors can use to help students move along the SDL trajectory: 

• Match the level of SDL required in learning activities to student readiness 

• Progress from teacher to student direction over time 

• Support the acquisition of subject matter knowledge and SDL skills together 

• Have adults practice SDL in the context of learning tasks"

학생이 학습에 대한 책임을 지게 하는 교육자의 여섯 가지 역할을 제시하였음

Hiemstra55 describes six foundational roles that instructors need to take on to enable students to adopt personal responsibility for their learning: 

• Content resource (sharing expertise and experiences using various forums) 

• Resource locator (locating and sharing various resources to meet student needs)"

• Interest stimulator (arranging for resources that maintain student interest in the subject, e.g., games, discussions; guest presentations) 

• Positive attitude generator (through positive reinforcement; prompt, useful feedback) 

• Creative and critical thinking stimulator (through study groups; journal writing; logs; simulation; role-play) 

• Evaluation stimulator (learner evaluation and promotion of self-evaluation)"

Figure 2 Three models of self-directed learning (SDL).51–53 See the text for a discussion of these models. Used with permission."

Does medical training promote or deter self-directed learning? A longitudinal mixed-methods study.

자기주도학습 - 개념과 맥락의 중요성 (Med Educ, 2005)

Self-directed learning – the importance of concepts and contexts

G C Greveson & J A Spencer

두 가지 논문 모두 교육자에게 교육접 접근법과 이니셔티브의 효과를 정확히 평가하려면 거기에 깔린 개념을 정확히 이해할 것을 강조한다. Candy는 SDL을 바라보는 여러 상이한 개념이 있다고 말한다. 다양한 교육철학에 따라서 이념적인 것부터 도구적인 것까지 다양한 세팅에서 다양한 함의를 갖는다. Miflin등에 따르면, SDL에 기반한 graduate medical course를 도입할 때 교사와 학생들이 여기에 대해서 가지는 서로 다른 해석때문에 어려움이 있었다고 말한다.

Both papers highlight that it is crucial that educators understand concepts underpinning educa- tional approaches and initiatives, in order to evaluate whether they are likely to be effective. Candy sug- gested there are several conceptu- ally distinct ways of viewing SDL, based on varying educational phi- losophies, from the ideological to the instrumental, which may have different implications for practice in different settings.3 For example, Miflin et al. reported the difficulties in implementing a graduate med- ical course based on the idea of SDL when there were many differ- ent interpretations of the concept amongst the teachers and students involved.4"

Medical educators are exhorted to adopt SDL with the principal aim of producing learners who can manage their own learning throughout their careers."

그러나 Coffield는 너무 오랫동안 평생학습이 근거도 없이, 연구도 부족하고, 이론도 없는 채로 비판받지도 않아왔다고 지적한다. SDL에 대해서도 마찬가지다.

Yet Coffield caustically claimed that for too long life-long learning has remained an evidence-free zone, under-researched, under-theorised, unencumbered by doubt and unmoved by criticism .5 The same could probably be said of SDL."

Canday와 Schimidt는 한 상황에서 SDL을 강조하는 것이 다른 상황으로도 전이될 수 있는가에 대한 의문을 가져왔다.

Both Candy3 and Schmidt6 ques- tioned whether encouraging SDL processes in one context would enable self-management or learner control to be transferred to other learning contexts."

Norman은 자기주도적 학습자들이 자기평가에도 효과적이어야 하지만, 연구 근거는 많은 보건전문직이 이것을 잘 하지 못한다는 것으로 나타난다.

Norman draws attention to the fact that self-directed learners need to be effective at self-assessment, yet research evidence suggests that many health professionals (pre- or post-qualification) have difficulties with this.7"

Schmidt는 전문가 양성에 있어서 SDL 기술이 지나치게 강조되어왔음을 지적한다.

Schmidt put forward similar arguments for his claimthat the importance of SDL skills in professional practice had been overemphasised.6"

인지주의자들은 학습에 있어서 개인적 특성을 강조하지만 Candy는 자기주도적 학습이란 집단성보다 개인성을 강조하는 형태로 잘못 인도되어 왔는데, 사실 지식과 학습은 본질적으로 학습자를 다른 학습자와의 관계 속에 두는 것이다 라고 주장했다.

Cognitivists stress the private and individual nature of learning. However, Candy claims: The termself-direction has misled many into elevating the individual above the collective – but the nature of knowledge and learning inherently puts learners in relationship with others .3"

Self-directed learning--the importance of concepts and contexts.

의과대학생들은 임상실습에서 어떻게 자기주도적인 방법으로 학습할까? Design-based research (Med Educ, 2005)

How can medical students learn in a self-directed way in the clinical environment? Design-based research

Tim Dornan,1 Judy Hadfield,1 Martin Brown,2 Henny Boshuizen3 & Albert Scherpbier4

영국의 GMC는 의과대학생에게 자신의 학습 방향을 스스로 결정하라고 하면서 의학교육을 새로운 트랙에 올려놓았다. 성인학습자 원리에 따르면 - 이 권고안의 근간이 되는 - 학습자와 그의 열망은 교수-학습 공식에서 중요한 위치를 갖는다. 그러나 '자기주도학습'이란 말은 단일한, 일반적으로 동의되는 의미를 가지고 있지 않는다. GMC는 스스로의 학습요구를 조직하고 관리하는 것을 의미하였으며, 성인학습자 원리를 처음 주장한 Knowles는 SDL을 스스로의 동기를 찾고 교사와 보다 동등한 관계를 갖는 것을 의도하였다.

The UK General Medical Council (GMC) set medical education off on a new track when it called for medical students to direct their own learning.1 Adult learning principles ,2 which underpin that recom- mendation, have served a useful role in putting the learner and his or her individual aspirations back in the teaching)learning equation .3 However, the term self-direction does not have a single, generally agreed meaning. The GMC meant organising and managing one s own learning needs.’1 Knowles, who first articulated adult learning principles, meant finding one’s own motivation and having a more equal relationship with teachers.2"

PBL에서의 자기주도적 행동 성향이 임상교육현장으로 잘 전이되지 않는 것은 (1)낯섦, 복잡성, 권력관계, 정서적 요인 등이 젊은 학습자들로 하여금 임상환경에서 자발적인 행동을 어렵게 하며, (2)외부의 방향제시가 필요하다는 결론에 이르게 한다.

The limited transfer of self-directed behaviour from PBL to placement learning6 led us to hypothesise that: unfamiliarity, complexity, power differentials and 1 emotional factors make it hard for young learners to act autonomously, and more external direction is needed in the clinical 2 environment."

iSUS는 학습 관리 시스템으로서, 교육과정 목표를 알고 있고, 각 학생에 대하여 그 목표에 대한 자기보고를 지속적으로 추적하여 전체 그룹과의 향상정도를 비교하고 관련된 교육을 받을 수 있게 도와준다. 학생은 예컨대 신장요로계 질환을 더 학습해야 한다고 할 때, 신장투석 클리닉을 관련 학습기회의 장소로 찾아주고, 그 장소에 참석할 수 있도록 예약을 해준다. 여기까지 몇 번의 클릭과 7초 정도만 소요된다. iSUS는 1명의 학생에게만 공간이  가능하다는 것을 알고, 다른 학생의 예약을 차단해준다. 이전 학생으로부터의 피드백은 유용한 선택의 길라잡이가 된다. 학생이 다음 번 로그인하면 iSUS는 그 클리닉에서의 경험에 대해 코멘트하도록 권한다.

Intelligent signup system ) iSUS The learning management system, described in detail elsewhere,12 is intelligent in that it knows the curriculum objectives, keeps track of each student’s self-reported progress towards them, compares pro- gress against the whole peer group, suggests signups or other relevant experiences, and helps access them. A student might, for example, see they need to learn more about renal ⁄ urological disease, particularly chronic renal failure, identify the predialysis clinic as a relevant learning opportunity, and reserve a place to attend it. That would take 7 mouse-clicks and a few seconds. iSUS would know there was space for only 1 student to attend, and restrict booking to someone who had no other timetabled activity. Feedback from previous students would be available online to guide the choice. The next time the student logged on, the system would ask for a free text comment about their experience at the clinic."

질적연구방법

Textual materials were coded, back-referenced to the complete transcripts, assembled into an evolving interpretation, and reduced to a single narrative using NVivo software (QSR, Doncaster, Victoria, Australia). Three types of statement were identified: 

• 1 Statements describing the behaviour of a student on a specific occasion in a practice setting, coded as performing , observing , discussing or being taught and subcoded as active ( I did ), passive ( I was directed ) or mutual ( We did ). 
• 2 General descriptions of learning were coded for the degree of autonomy expressed by the student, and sources of guidance or support. 
• 3 Conceptualisations of self-direction. "

한 명의 연구자가 일차 코딩을 수행하고, 다른 연구자들은 자료를 읽고 그 코딩의 bias, 생략된 부분, 의견의 차이 등을 찾아내였다. 최종 결과는 3 가지의 statement의 카테고리를 삼각층량함으로서 도출하였다.

One researcher carried out the primary coding. Three others read the material and sought bias in his coding, omissions, and disconfirmatory statements. The final conclusions were arrived at by triangulation between the 3 categories of statement, representative examples of which are cited."

1. 임상환경에서 학생의 행동유형

1. Behaviour of students in the clinical environment 

1.a. Performing 

1.b. Observing"

1.c. Discussing 

1.d. Being taught 

2. 학습에 대한 일반적 묘사

2. General descriptions of learning 

2.a. Learning autonomously 

2.b. Learning with support 

2.b.1a. Staff behaviours"

2.b.1c. Facilitation"

2.b.1d. Feedback"

2.c. Being told what to learn"

3. 자기주도학습의 개념

3. Conceptualisations of self-direction 

3.a. Definition of self-direction"

3.b. The value of self-direction"

3.c. Prerequisite conditions for self-direction"

3.c.1a. Objectives"

3.c.1b. Student attributes"

3.c.1c. The transition into self-direction"

3.c.1d. Support by teachers"

자기주도학습은 운전석에 앉는 것과 같아 자신의 학습에 책임을 지는 것이다. 종종 그 과목에서 부족했던 부분을 보충하는 것일 수도 있지만, 비효율적인 학습방법으로 인식되기도 한다. 한 학생은 direction (명확한 목표가 있는 것)을 motivation (direction이 선행될 때 가능한 것)과 구분하기도 했다. 자율이란 '어떻게'를 선택하는 것이었으며 '무엇을 학습할 것인가'를 결정하는 것을 의미하지 않았다. 학습의 다양성을 인정하면서도 응답자들은 핵심 목표를 다루고 싶어했다.

Self-direction involved being in the driving seat, or being responsible for one’s own learning. At times, it could be a compensation for deficiencies in the course, but that was seen as an inefficient way of learning (3.a.1). One respondent distinguished direction – having clear objectives – from motiva- tion – for which direction was a prerequisite (3.a.2). Autonomy meant being able to choose how, rather than what, to learn (3.a.3). Whilst valuing diversity of learning, respondents were concerned to cover coreobjectives. "

교육과정 평가에서 처음에는 학생의 태도에 실망했지만, 점차 '자기주도적 태도'에 대한 질문을 갖게 했다. 우리 학생들은 학습의 개념화와 행동적 차원에서 능동적이었지만, 교사가 그들을 지지해줄 때 더 능동적이고 동기부여를 받았다. 다양한 형태의 지원이 가능하다.

Curriculum evaluation has moved us from disap- pointment in students’ behaviour to a more ques- tioning attitude towards self-direction. Our students were active in their actions and conceptualisations of learning. However, they were most active and motivated when teachers supported them. Support took several forms:"

• organisational: opening up learning opportunities, particularly those that involved students in patient care; 
• pedagogic: suggesting objectives or methods, training skills, giving feedback, explaining con- cepts, and 
• affective: giving permission, helping students through the transition to a more independent learning style, nurturing, and placing demands."

본 연구는 문제바탕학습 방법이 왜 임상교육으로 자동적으로 전이되지 않는가를 설명해준다. 방향제시와 동기부여의 원천, 그리고 그들의 관계가 PBL과 임상교육에서 차이가 있었다. 튜터가 관리하는 PBL 그룹에서 불확실성은 그들로 하여금 지적인 호기심을 유발하고 학습목표로 이끈다.

This study confirms and helps explain our previous observation that problem-based methods do not transfer automatically to the clinical environment.6 The sources of direction and motivation, and their interrelationship, are different in PBL and place- ment learning. Uncertainty in a tutored PBL group in a seminar room motivates students by generating epistemic curiosity 14 and leads them to learning objectives."

본 연구와 다른 연구들은 자기주도적 학습이 임상환경에서의 기본적 전문성 교육에는 적용하기 어려움을 보여준다. 또한 Knowles 자신조차도 나중에는 정서적 지지가 중요함을 강조한 바 있다. 다른 연구자들은 자기주도적 행동과 주변 환경과의 상호작용을 강조한다. 이는 교육에 대한 인지적 이해(cognitive perception)에서는 잘 드러나지 않았던 것이다. Miflin 등은 교사가 임상교육의 필수적 조건임을 찾아낸 바 있다. PBL에 cognitive foundation을 제시한 Schmidt조차도 나중에는 임상환경에서 진정으로 자기주도적이 되기 얼마나 어려운지, PBL에서 임상환경으로 전이되는 것이 얼마나 어려운지 강조하기도 했다.

Our own and others’ research leads us to suggest that self-direction , as literally applied by many of our teachers, is inapplicable to basic professional education in the clinical environment. It is note- worthy that Knowles himself re-emphasised the place of affective support in late publications.15 Other writers have emphasised the interaction between self-directed behaviour and contextual factors,16 which are less emphasised in cognitive conceptions of education17 than new social theories.18 Miflin and colleagues found, like us, that the teacher is a vital condition for clinical learning.5 Their analysis anti- cipated, and has strong similarities with, our own critique of self-direction. Schmidt, who gave the problem-based method its cognitive foundation, later reaffirmed its benefits but recognised how difficult it is to develop truly self-directed behaviours and transfer them from PBL to the clinical envi- ronment.19"

우리는 임상교육을 PBL과 상보적일 수는 있어도 서로 별개의 것으로 바라보아야 한다는 결론에 이르렀다. PBL에서는 동료그룹 내에서라도 자율이 핵심이지만, 임상교육에서는 지지적 참여가 핵심 조건이 된다.

We conclude that placement learning should be seen as separate from, although complementary to, PBL. Whereas autonomy (albeit within a peer group) is key to PBL, supported participation is a core condition for placement learning."

적절한 지원이 있으면 의과대학생들은 매우 능동적인 학습자가 될 수 있으며, Harden 등은 이를 직무기반학습 이라는 새로운 관점에서 보았다.

Harden et al. approached the same problem from a different angle when they devised task-based learning .20"

Med Educ. 2005 Apr;39(4):356-64.

How can medical students learn in a self-directed way in the clinical environment? Design-based research.

학부 교육과정이 학생의 SDL에 미치는 영향 (Acad Med, 2003)

Effect of an Undergraduate Medical Curriculum on Students’ Self-Directed Learning 

Bart J. Harvey MD, PhD, Arthur I. Rothman, EdD, and Richard C. Frecker, MD, PhD

1992년, U of Toronto는 전통적인 강의중심의 교육과정을 소그룹의, 문제중심의, SDL을 장려하는 교육과정으로 개편하였다. 개편한 교육과정은 Barrows가 묘사한 "학생이 경험을 통해 자극받고, 그들이 배우는 내용이 미래에 그들이 감당할 책임과 어떻게 연결되는지 깨닫고, 높은 수준의 학습동기를 유지하고, 전문가적 태도의 중요성을 깨닫는" 것을 목표하였다. 우리는 교육과정 변화가 학생의 SDL에 어떻게 영향을 주는지 보고자 했다.

In 1992, at least in part to address this curricular goal and to enhance students’ self-directed learning (SDL), the Uni- versity of Toronto Faculty of Medicine revised its conventional, lecture-based medical curriculum into a “hybrid,” replacing much of the curriculum time devoted to large-group didactic lectures with small-group, problem-based, and SDL opportunities. The resulting curric- ular changes were designed and implemented to achieve the ideals Barrows describes: “That students would be stimulated by the experience, would see the relevance of what they were learning to their future responsibilities, would maintain a high degree of motivation for learning, and would begin to under- stand the importance of responsible pro- fessional attitudes.”4 We undertook this study to begin to learn whether the curricular revision enhanced students’ SDL (and, ultimately, their abilities as effective lifelong learners)."

총 280명의 학생이 참여하였으며, 각각 학년에서 70명 무작위 선택. 이 숫자를 선택한 이유는 60%응답자가 0.80의 study power와 5% difference를 제공하기 때문이다.

Participants A total of 280 students, 70 from each of the four years of the undergraduate med- ical curriculum, were randomly selected fromthe school’s population of 700. We chose this number because calculations showed that 60 respondents per class (85% response rate) would provide a study power of .80 to detect ( .05) a 5% difference among the four years.23"

네 가지 SDL 요소에 따라서 Rayn은 간략한 두 파트로 된 설문지를 개발하여 SDL의 중요도와 자기주도적 학습자로서의 능력을 평가하게끔 했다.

Guided by these four SDL components, Ryan6 developed and administered a brief, two-part questionnaire to assess students’ perceptions concerning the importance of SDL and their abilities as self-directed learners."

두 개의 가장 널리 사용되는 SDL 척도는 SDLRS와 OCLI이다. 타당도와 신뢰도에 대한 여러 연구가 되어있다.

The two most widely recognized, extensively used, and validated instruments for measuring SDL capability and readiness13–15 are Guglielmino’s Self- Directed Learning Readiness Scale (SDLRS)16 and Oddi’s Continuing Learning Inventory (OCLI).17,18 Several assessments of the reliability and valid- ity of the OCLI and SDLRS have been conducted,14 including dissertations re- porting positive associations between instrument scores and SDL activity."

Ryan의 설문지는 SDL의 네 가지 요소에 대한 것이며 그 요소들에 대해서 중요도와 능력을 0부터 6까지 응답하게 되어있다. SDLR은 58개의 명제로 되어 있으며 5점 척도로 응답하게 되어있다. OCLI는 24개의 명ㅈ제로 되어있으며 7점 척도로 응답하게 되어있다.

Ryan’s questionnaire asks respondents to consider the four identified components of SDL and rate each, from low (0) to high (6), on its importance and their ability with the component.6 The SDLRS contains 58 statements (e.g., “I learn several new things on my own each year”) with five-point responses, ranging from “Almost never true of me; I hardly ever feel this way” to “Almost always true of me; there are very few times when I don’t feel this way.” Total scores range from 58 (least ready for SDL) to 290 (most ready).16 The OCLI contains 24 statements (e.g., “I work more effectively if I have freedom to regulate myself”) with seven- point responses, ranging from “Strongly Disagree” to “Strongly Agree.” Total scores range from 24 (least characteris- tic of self-directed learners) to 168 (most characteristic).17,18 Brockett and Hiemstra,14 in their review of the use and validity of the SDLRS and OCLI, concluded that both are well-accepted measures of SDL."

여학생과 남학생은 SDL 점수가 비슷했다. SDLRS와 OCLI Ryan ability 점수는 나이가 높아짐에 따라 높아졌으며, 의예과 이전에 교육 수준이 높을수록 높았다. 그러나 여러 요인을 포함한 MLR 분석에서는 premedical education만이 유의한 요인으로 남았다.

Women and men had similar SDL scores. SDLRS, OCLI, and Ryanability scores increased significantly by age (data not shown) and highest level of premedical education achieved (under- graduate only, masters, or doctoral). However, only premedical education re- mained significant in a multivariate lin- ear regression including both factors."

SDLRS, OCLI, Ryan importance 점수가 학년간 유의하게 달랐지만, 지속적인 경향은 Ryan importance에서만 확인되었다. 

Although a significant between-yeardifference was found for the SDLRS(p .028), OCLI (p .011), andRyanimportance (p .021), a significanttrend by year was only evident forRyanimportance scores (p .007). Thistrend, however, indicated a decrease inperceived SDL importance by curricularyear."

SDL이 학년 간 차이가 컸지만, 교육과정을 진행함에 따라서 지속되는 경향은 없었고 1학년이 가장 높고, 2학년에서 가장 낮은 경향이 있었다.

Although significant interyear SDL differences were found, SDL scores did not follow a trend consistent with progression through the curriculum, with the first and second years having consis- tently the highest and lowest scores, respectively."

우리는 네 개의 SDLRS 문항이 학년에 따라 경향성을 갖는 것을 확인하였다. 그러나 이 모든 문항이 학년이 올라가면서 SDL이 감소하는 것으로 나타났다.

we found four, albeit different, SDLRS items suggesting a trend by curricular year. These, however, all indicated decreasing SDL into senior years."

본 연구 결과가 교육과정이 SDL을 촉진하지 않는다는 것을 보여주나 다른 해석도 봐야 한다.

Although the results of our study suggest that the curriculum does not foster students’ SDL, alternative explanations should be considered."

평가도구들은 SDL 변화를 보여주기에 충분히 민감한가? 두 가지를 보면 그러하다. (1) 모든 세 가지 평가도구가 유사한 결과를 보여준다. 즉, SDL이 premedical education 수준이 높을수록 높아지는 것이다. (2) 세 척도의 유사성이 우연히 나타났을 가능성은 낮다. 또한 응답률이 거의 일정했으므로 응답 편향의 가능성도 낮다.

the instruments sufficiently sensitive to detect SDL progress? Two factors sug- gest that they are: (1) all three instru- ments provide similar findings, with each able to detect the significant in- creasing trend in SDL associated with higher levels of premedical education; and (2) the similarity of results for each of the three measures of SDL ability (i.e., SDLRS, OCLI, and Ryanability) suggests that the significant results ob- served are unlikely to have occurred by chance (i.e., as a result of the multiple comparisons conducted). Further, re- sponse bias is not a likely explanation for the study’s inability to detect a year- by-year SDL trend because the response rates across the four years were uni- formly high—in excess of 85%."

추가적으로 고려할 점은, 이것이 단면연구라는 점이다. 

An additional consideration, how- ever, is the study’s cross-sectional design. Although this design is more efficient than a longitudinal approach, actual changes in SDL are not measured in the same groups of students over time. Instead, the cross-sectional design assumes the comparability of the four classes. Although the admission proce- dures and curriculum were similar for each of the four years, the failure to detect SDL progress over the curriculum could be the result of unmeasured differences between two or more of the classes. 

Effect of an undergraduate medical curriculum on students' self-directed learning.

보건의료인 교육에서 자기주도학습(SDL)의 효과: systematic review (Med Educ, 2010)

The effectiveness of self-directed learning in health professions education: a systematic review

Mohammad H Murad,1,2 Fernando Coto-Yglesias,3 Prathibha Varkey,1 Larry J Prokop4 &

Angela L Murad2

과연 SDL이 효과가 있는가에 대해 답하고자 할 때 어려운 점은 SDL을 정의하는 것의 어려움과 SDL 기반의 교육과정이 매우 이질적이라는 것이다. 1975년 Malcolm Knowles는 가장 흔하게 인용되면서 가장 포괄적인 SDL의 정의를 다음과 같이 내렸다. 

"SDL은 개개인이 이니셔티브를 쥐고, 다른 사람의 도움이 있거나 없는 환경에서 스스로의 학습 요구를 파악하고 목표를 설정하고 학습에 필요한 인적 자원과 물적 자원을 찾아서 적절한 학습 전략에 도입하고, 그 결과를 평가하는 것을 말한다.'

The main challenges to answering this question involve the difficulty of defining SDL and the heterogeneity of SDL-based curricula. In 1975, Malcolm Knowles provided one of the most commonly cited and comprehensive definitions of SDL: ‘SDL is a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating goals, identifying human and material resources for learn- ing, choosing and implementing appropriate learn- ing strategies, and evaluating learning outcomes.’4"

Knowles는 SDL의 여러 주요 요소에 대해서 말했다.

• the educator should be a facilitator of learning and not a content source; 
• learners should be involved in identifying their learning needs, objectives and resources, and 
• learners should be involved in implementing the learning process, should commit to a learning contract and should evaluate the learning process.4

Knowles described several essential components of SDL: the educator should be a facilitator of learning and not a content source; learners should be involved in identifying their learning needs, objectives and resources, and learners should be involved in imple- menting the learning process, should commit to a learning contract and should evaluate the learning process.4"

다양한 교육적 인터벤션은 SDL의 일부 요소들을 공유하며, 아주 제한된 요소만 가지고 그렇게 불리기도 한다.

Numerous educational interventions share some elements of SDL and are often labelled as such,"

그러나 학습자들이 진정으로 자기주도성을 갖추기 위해서는 Knowles가 내린 정의의 다른 요소들도 포함되어야 한다.

Yet, for learners to be truly self-directed, some of the other components contained in Knowles’ definition4 should be incorporated in the learning process"

학습자들은 42%에서는 무작위 배정되었지만, 무작위 배정의 세부 사항이나 질적 평가를 위한 연구의 다른 특징들은 제대로 보고되지 않은 경우가 많다.

Learners were randomly allocated to SDL in 25 studies (42%); however, details about randomisation and other study characteristics needed for quality assessment were poorly reported."

분석한 연구 논문들의 목록

A detailed description of included studies is presented in Table S1."

40개의 연구가 지식 영역, 9개 연구가 술기 영역, 5개 연구가 태도 영역

Forty studies reported outcomes in the knowledge domain, nine studies reported outcomes inthe skills domain, and five reported outcomes intheattitudes domain."

상호작용화된 컴퓨터 모듈 사용이 13개 연구, 나머지는 비-상호작용 (책, 시청각자료) 자료 활용

Learning resources included interactive computer- ised modules in 13 studies (22%) and non-interactive (reading materials, audiovisual resources) in the remaining studies."

지식 영역에서는 중등도의 향상이, 태도와 술기 영역에서는 통계적으로 유의미하지 않은 매우 작은 향상이 있었음.

When data were pooled in meta-analysis and out- comes compared with those of traditional teaching methods, SDL was associated with a moderate increase in the knowledge domain (SMD 0.45, 95% CI 0.23–0.67; I2 = 92%) (Fig. 2), a trivial and non- statistically significant increase in the skills domain (SMD 0.05, 95% CI ) 0.05 to 0.22; I2 = 2%) (Fig. 3), and a non-significant increase in the attitudes domain (SMD 0.39, 95%CI ) 0.03 to 0.81; I2 = 91%) (Fig. 4)."

학습자들의 learning resource를 선택할 경우에 다른 경우에 비해서 지식 영역에 통계적으로 유의미한 향상이 있었다.

There was a statistically significant interaction suggesting that when learners were involved in choosing learning resources, they made larger improvements in the knowledge domain."

SDL 인터벤션의 기간과 effect size 사이에는 상관관계가 없었다. 

In meta-regression, there was no correlation betweenthe observed effect size and the length of SDL intervention (p = 0.64) or the time interval between the completion of the intervention and outcome assessment (p = 0.14)."

SDL은 학습자들이 학습자원 탐색에 참여했을 때 더 효과적이었다.

In addition, SDL seemed to be more effective when learners were involved in identifying their learning resources."

Knowles suggested that learners who are self-directed should consult with educators and determine the methods and resources that best fit their learning style and the curriculum objectives.4 For example, cognitive objectives can be achieved using written resources or panel discussions; behavioural objectives can be attained using role-play and case-based learning, and psychomotor objectives are best fulfilled by role-play and simulation. Simi- larly, self-directed learners should have the ability to choose the learning method that suits their individual learning styles (e.g. a visual learner may choose a video-based method, etc.)."

이렇게 이질적인 분석결과를 다음과 같이 설명할 수 있다. (1)SDL의 잇점은 학습자가 학습 방법, 전략, 자원을 선택할 때 가장 잘 나타난다. (2)초보 학습자보다 advanced 학습자가 SDL로부터 더 많이 배운다 (3)전공(학과)에 따라서 SDL 의 기대 효과가 다르다.

We were able to partially explain the heterogeneity by finding that: (i) the benefit of SDL increases when learners are involved in choosing their learning methods, strategies and resources, a key component that defines SDL according to Know- les;4 (ii) advanced learners may benefit more from SDL compared with less advanced learners, and (iii) learner type (discipline) may also affect the anticipated benefits of SDL (nurses had a larger SMD compared with other health professionals)."

이 리뷰에서 추론할 수 있는 것은 SDL이 기존의 교육방법과 거의 비슷한 수준으로 효과적이라는 것이다. SDL은 특정 상황에서 추천되어왔으며(성인학습자, advanced 학습자, 학교 시설과 교사에 대한 접근이 어려운 상황), 학습할 내용이 많을 때 보조적인 방법으로 사용되어왔다. SDL은 비용-효과적이기도 하다.

Inference from this review implies that SDL is likely to be as effective as traditional learning methods. Self-directed learning has been suggested in certain settings (e.g. for adult learners and advanced learn- ers, and in contexts in which access to academic institutions or teachers is limited) and as a supple- mental method of learning when learning content is large.6 It is also plausible that SDL is cost-effective."

SDL에 대한 다양한 묘사가 존재하지만 Knowles가 아마 가장 포괄적이고 가장 빈번하게 인용될 것이다. 그 정의는 하지만 타당화되지 않았으며, 교육자들은 교육과정을 개발하면서 Knowles가 말한 요소 일부 중 그들의 환경에 활용가능하고 관련성이 있어 보이는 부분만 포함시킨다.

Although several descriptions of SDL exist, that byKnowles4 is perhaps the most comprehensive and most frequently cited. This definition has not beennecessarily validated; thus, educators developing SDL curricula have incorporated some of the elements described by Knowles as they have deemed relevant and feasible in their learning environments"

현재까지는, 우리의 판단은 SDL은 기존의 교육방법에 비해서 세 가지 영역 모두에서 비슷하게 효과적이라는 것이다.

At present and according to our findings, we believe that SDL in health professions education is at least as effective as traditional learning in all three domains."

SDL은 지식 영역에서 더 효과적인 것으로 보인다. 우리는 교육자들이 SDL 교육과정을 도입할 때 다음을 고려해야 한다.

Self-directed learning may preferentially be more effective in the knowledge domain. We recommend that educators embarking on developing SDL curricula for learners in health professions should: 

• involve learners in choosing learning resources and strategies to enable them to find the most appropriate resources to fit their individual learning styles as well as the overall learning objective; 
• consider SDL as an effective strategy for more advanced learners (e.g. those in the later years of medical school or residency and doctors in practice), and 
• consider SDL particularly when the learning outcome falls in the knowledge domain."

Med Educ. 2010 Nov;44(11):1057-68. doi: 10.1111/j.1365-2923.2010.03750.x.

The effectiveness of self-directed learning in health professions education: a systematic review.

"나는 절대 프로 축구선수는 못 될거야" - 자기평가의 오류들 (J Contin Educ Health Prof. 2008)

“I’ll Never Play Professional Football” and Other Fallacies of Self-Assessment

KEVIN W. EVA, PHD; GLENN REGEHR, PHD

자기평가라는 용어가 사용되는 다양한 맥락 각각은 '자기평가'라는 용어의 사용을 정당화해줄지도 모르지만, 종합적으로 보면 그렇게 다양한 개념들을 하나의 이름 아래 두는 것은 교육자와 이론가 모두에게 혼란과 갈등의 원인이 될 뿐이다.

While each of these contexts may, individually, be a justifiable use of the term self-assessment, collectively, couching such very different concepts under a single label can be a significant source of confusion and conflict for educators and theoreticians alike."

Self-assessment라는 용어가 여러 커뮤니티에 수출되어 사용됨에 따라서 모든 것을 포괄하는 용어가 되었고, 결국 "어떻게도 정의되지 않는" 것이 되어버렸다.

It is important, however, to recognize that when such terms are exported to the larger community, they run the risk of becoming so all- encompassing as to include everything and, therefore, ul- timately define nothing."

Lingard와 Haber는 "우리가 쓰는 용어가 우리가 가질 수 있는 사고의 폭을 열어주기도 하고 제한하기도 한다"

Lingard and Haber have stated that “the language we use both makes possible and constrains the thoughts we can have.”4"

Self-Assessment Versus Self-Directed Assessment Seeking"

보건의료인에게 있어 자기평가가 CPD cycle에서 매우 중요하다는 것은 일반적으로 잘 알려진 사실이다. 이는, '자기조절에 능한 전문직'의 원형이 계속적 교육 활동에 대한 길잡이로서 정기적으로 자신의 약점을 찾아내는 것이기 때문이며, 이를 통해서 현실에서의 격차를 좁혀나가는 것이다. 이러한 점에서 '자기평가'란 종종 은연중에 개인적이고, 누군가 지도해주지 않는 와중에 이뤄지는 성찰과정으로 여겨진다. 예컨대 이러한 개념은 Colliver가 말한 "니 점수를 맞춰봐" 형식의 자기평가 연구 모델에 부합하는 것이다. 이러한 연구 결과의 결과는 '자기평가 점수는 대체로 정확하지 못하다'라는 결과를 반복해서 생산해냈다.

It seems generally well accepted in the health professions that self-assessment is a key step in the continuing pro- fessional development cycle. That is, the archetype of the self-regulating professional is seen as one who regularly self- identifies areas of professional weakness for the purposes of guiding continuing education activities that will overcome these gaps in practice.6 In this construction, self-assessment is often ~implicitly or otherwise! conceptualized as a per- sonal, unguided reflection on performance for the purposes of generating an individually derived summary of one’s own level of knowledge, skill, and understanding in a particular area. For example, this conceptualization would appear to be the only reasonable basis for studies that fit into what Colliver has described as the “guess your grade” model of self-assessment research,7 the results of which formthe core foundation for the recurring conclusion that self-assessment is generally poor.8"

이러한 "지도받지 않는, 내적으로 생성되는" 자기평가에 대한 구조는 Boud가 말한 "자기평가란 고립되고 개인적인 활동이 아니라 동료와, 교사와 다른 정보원을 동반하게 된다"와 대비된다.

This “unguided, internally generated” construction of self- assessment stands in stark contrast to the model put forward by Boud, who argued that “the phrase self-assessment should not imply an isolated or individualistic activity; it should com- monly involve peers, teachers, and other sources of in- formation.”9"

Boud가 묘사한 자기평가는 '바깥을 바라보고' '외부적으로 피드백을 찾으며' '외부로부터 정보를 찾고' '이러한 외부 정보원 평가에 활용하여' '수행능력의 향상을 이뤄내는 것'이다. 이러한 측면에서 자기평가는 자신을 평가하는 교육학적 전략 그 이상이며, 한 사람이 마스터해야하는 능력이 아니라, 길러야하는 습관에 가깝다.

The conceptualization of self-assessment as enunciated in Boud’s description would appear to involve a process by which one takes personal responsibility for look- ing outward, explicitly seeking feedback and information from external sources, then using these externally generated sources of assessment data to direct performance improvements. In this construction, self-assessment is more of a pedagogical strategy than an ability to judge for oneself; it is a habit that one needs to acquire and enact rather than an ability that one needs to master."

Self-Assessment Versus Reflection"

인간은 스스로에 대한 총괄평가 결과를 내리는 것을 잘 못한다는 것은 여러 근거로부터 드러난 것 뿐만 아니라, 사람은 원래 이러한 형태의 자기평가를 잘 못하도록 태어난 것이기도 하다. 그 이유로는 여러 인지적 이유(정보 무시, 기억 편향), 사회생물학적 이유(긍정적 전망을 하도록 적응됨), 사회적 이유(동료와 상관으로부터 언제나 적절한 피드백을 받는 것은 아님) 등이 있다.

We, along with many others, have argued ~and continue to believe! that the evidence reveals not merely that humans are poor at producing self-generated summative assessments of their own performance or ability, but that humans are actually predisposed to being poor at this form of self-assessment. There are cognitive reasons ~eg, information neglect and memory biases!,11 sociobiological reasons ~it being adap- tive to maintain an optimistic outlook!,12 and social rea- sons ~eg, not always receiving adequate feedback from peers and supervisors!13"

그러나 사람이 자기평가를 잘 못한다는 결과가 수행능력에 대한 성찰이 무의미한 활동이라는 것을 의미하는 것은 아니다.

The conclusion that humans do not self-assess well, however, should in no way imply that reflection on performance is a useless activity."

즉, 자기성찰은 '왜 환자의 건강상태가 이러한 방식으로 악화되는가'를 이해하는 것, 혹은 '왜 어떤 사회적 관계가 특별히 성공적이었는가'를 이해하는 것 등의 활동이다. 이러한 "왜" 질문에 대한 답을 찾는 것은 교육학적 전략으로 매우 효과적임이 밝혀졌고, 세상에 대한 이해와 스스로 그것을 구성하는 방식에 도움이 된다. 이러한 방식으로 정신적 에너지를 재투자하는 경향의 차이가 진정한 전문가와 경험만 많은 비전문가를 결정짓는 요인이 된다. 그러나 다시 한번 강조하는데, 이러한 형태의 자기성찰적 행동 - 세상을 더 잘이해하기 위한 - 은 자기평가에 대한 능력과 동일하게 평가될 수 없다. '왜' 질문을 효과적인 방식으로 하는 것이 반드시 스스로의 지식과 능력 수준을 아는 것을 필요로 하지는 않기 때문이다.

Thus, reflection involves activities such as try- ing to understand why a patient’s health state deteriorated in the way it did or why a social interaction went partic- ularly well. Exploring these sorts of “why” questions may very well prove to be an effective pedagogical strategy that can lead to better understanding of both the world and the adequacy of one’s own personal constructions of it. Certainly the expertise literature would suggest that the tendency to reinvest mental energy in this way is a defin- ing determinant of who achieves true expert status in any given field and who evolves into an “experienced non- expert.”15 Again, however, promoting those sorts of re- flective behaviors—aimed at understanding the world better—should not be considered the same as promot- ing self-assessment as a mechanism for judging personal competence. Asking “why” in an effective manner does not require insight into one’s own level of knowledge or abilities,"

Self-Assessment Versus Self-Monitoring"

누군가는 자신의 약점을 인지할 수도 있다. 그러나 여전히 그러한 인식이 더 포괄적인 자기개념에 영향을 주지 않을 수도 있다. 부족한 수행능력에 대한 원인을 "~만 아니었으면 되었을텐데"와 같은 방식으로 깎아내리는 것은 매우 자연스러운 현상이다. 그러나 그러한 식으로 우리의 즉각적 수행능력의 효과성에 대해 인식하는 것으로는 그것들이 모여서 정확한 자기평가를 이루는 것을 보장해주지 않는다.

One may recognize weak- nesses in performance, in the moment, but still not have those observations impact upon one’s broader self-concept. It is easy ~and typically automatic! to find reasons to dis- count negative performances by saying things like “If only @insert favourite excuse here# hadn’t occurred.”18 The end result is that a series of moments in which we are aware of the effectiveness of our immediate performance does not guarantee that those moments will be aggregated to generate an accurate self-assessment overall."

한 의사가 자기의 역량을 넘어서는 특정한 상황을 인지하는 능력은 환자 안전의 중요한 결정요인이 된다. 그리고 이것은 그 의사가 지식과 술기의 격차를 효과적으로 극복해나가기 위해서 더 포괄적인 차원에서의 지속적 교육을 받을 수 있느냐보다 중요하다.

A physician’s ability to recognize when a particular situation is beyond his boundaries of compe- tence is likely to be a greater determinant of patient safety than whether or not that physician is able to determine which broad-based continuing education activities would most ef- fectively fill his gaps in knowledge0skill."

자기평가와 자기주도적 평가 탐색을 비교하였다. 또한 자기평가와 자기성찰을 비교하였고, 마지막으로 자기평가와 자기모니터링을 비교하였다.

In this section, we have contrasted self-assessment ~an abil- ity! with self-directed assessment seeking ~a pedagogical strat- egy! as potential mechanisms for determining one’s areas of strength and weakness, we have contrasted self-assessment ~an ability! with reflection ~a pedagogical strategy! as po- tential mechanisms for improving one’s understanding of the world, and we have contrasted self-assessment ~an ability! with self-monitoring ~an immediate contextually relevant re- sponse to environmental stimuli! as potential mechanisms for determining the need to recruit additional resources to facilitate performance in particular situations."

The Illusion of Personal Accuracy in Self-Assessment

"자기평가를 잘 하지 못한다"라는 말을 들으면 가장 먼저 보이는 반응은 "'걔네'는 왜 그렇데?"이다. 한발 더 나아가서 만약에 "우리"가 "그들"로 하여금 자기평가를 잘 하게 만들 수 있을 것이다라는 믿음을 갖기에 이른다. 이러한 반응은 무척 팽배해서 역설적으로 대부분의 사람들이 자신의 자기평가능력이 평균 이상이라고 생각하고 있다.

The most common response to the findings that self-assessment is poor appears to be bewilderment at how“they” can be so bad, with a concomitant belief that if “we” can just get “them” to self-assess as well as we do, then everything will be okay. This reaction is suf- ficiently pervasive that, ironically, the majority of people think they are above average in self-assessment ability.19"

First, judging the quality of physical skills for which there is an objectively observable outcome is probably impor- tantly different from judging cognitive aptitudes or less ob- jective physical skills in that, unlike cognitive aptitudes, the mental processes required to judge the quality of physical performances are different ~often derived from external in- formation conveyed via the senses! fromthe internal mental processes required to enact the performance.20"

두 번째로 여기에는 논리적 헛점이 있다. 자세히 말하자면, 세상을 2x2 테이블로 본다고 하면, 스스로 잘 한다고 여기는 - 스스로 못 한다고 여기는, 그리고 다른 사람이 잘 한다고 인정하는 - 다른 사람이 못 한다고 인정하는 네 가지 조합이 있다.

To elaborate, we might think of the world as a 2 2 table in which there are some activities at which we thrive and others at which we perform poorly, crossed with some activities we think we do well and others we think we do poorly."

마지막으로, 이 특별한 상황은 극단적 상황에서의 추론이며, 흔히 오류를 범하기 쉬운 전략이다.

Finally, this particular example involves a process of rea- soning fromextreme examples, another erroneous rhetorical strategy."

안타깝게도, 이러한 개인 수준의, 오류 투성이의 자기 과신은 교육자로서의 우리가 스스로 하여금 자신의 강점과 약점을 효과적으로 찾아내는 것이 가능하다고 믿게 만든다. 그 결과 우리 교육자들은 해답의 일부가 되기는 커녕 문제의 일부가 되고 있다.

Un- fortunately, it is this personal, flawed self-confidence in our own self-assessment ability that has led us as educators to perpetuate the myth that the effective self-identification of strengths and weaknesses is even possible. As a result, we educators have not only failed to be part of the solution, we have actually been part of the problem."

Truths About Self-Assessment

우리의 뇌는 근본적으로 자신의 능력에 대해서 과도하게 긍정적인 태도를 갖도록 설계되어 있다.

Rather, the tendency to be overly opti- mistic about one’s abilities is a fundamental property of the way our brains are wired.25"

우리의 수행능력이 나쁠 때는 외부 환경을 비난하기가 쉽다.

When we have a poor performance, usually it is easy to find a way to blame external circumstances.18"

그러나 우리는 과도하게 긍정적이라는 일반적 원칙은 확고하다. Gilbert가 쓴 것과 같이 "진화는 이러한 정신적 과정을 우리 동의 없이 뇌에 설치했다는 점에서 MS window award를 받을 만하다."

we are betteroff being overly optimistic is a robust one. As Gilbert haswritten in another context, “Evolution deserves the Micro-soft Windows Award for installing these mental processes inevery one of us without asking permission.”28 "

The problem is not that these mental phenomena exist. It is that people do not appreciate that they are active."

온타리오에서의 PREP는 가정의학 의사들의 역량을 지속적으로 측정했고, '불충분한 역량'의 두 번째 뛰어난 예측인자는 '고립된 직무환경' 임을 밝혔다.

The Physician Review andEnhancement Program in Ontario, charged with evaluatingand assessing family physicians’ ongoing competence withinthe province, have reported that the second best predictor ofincompetence is working in isolation.29"

답은 분명하다. 자기평가라는 것은 절대로 스스로 개발할 수 있는 일반적 기술이 아니다.

The evidence is clear and overwhelming: self-assessment is not and will never be a generic skill that one can develop."

우리는 이러한 부정확한 자기평가가 '우리'의 문제이며 '그들'의 문제가 아님을 다시 강조하고 싶다.

We wish to reemphasize that the inadequacy of self-assessment must be viewed as a “we” problem rather than a “they” problem."

자기성찰 연습는 세상을 더 잘 이해하는 것에 목적이 있다. 

The focus of these exercises is not to determine that one is greator at least good enough, but rather to determine how oneunderstands the world and how one might increase this un-derstanding to the benefit of future performance."

"의사들은 자기평가를 얼마나 잘 하는가?" "어떻게 자기평가능력을 향상시킬 수 있는가?" "어떻게 자기평가 능력을 측정할 수 있는가?"와 같은 연구질문은 폐기되어야 한다. 대체로 연구자들이 자기평가 능력을 향상시켰다고 할 때를 보면 Ward가 묘사한 오류에 흔히 빠져있다. 집단 수준의 상관관계에 지나치게 빠져있거나, 실제 점수와 한 사람이 평가한 자기평가 점수 사이의 차이를 정확도의 척도로 보는 것이다. 대신 우리는 세 가지 분야의 연구를 해야 한다.

We believe that research questions that take the form of “How well do various practitioners self-assess?” “How can we improve self-assessment?” or “How can we measure self-assessment skill?” should be considered de- funct and removed from the research agenda. Usu-ally when researchers claimto have improved self-assessmentthey have fallen prey to one of the fallacies described byWard et al. ~eg, placing undue faith in group-based corre-lations or mistaking distance of individual guesses fromtruescores as a sensible measure of self-assessment accuracy!.30 Instead, we see three potential programs of research that parallel the three concepts we have distinguished from self- assessment in the first section of this article."

이런 것을 염두에 둔다면, 주요 주제는 역량을 어떻게 유지할 것인지, 그리고 어떻게 CPD를 유지할 것인지이다. Schon의 용어를 따르자면 자신의 행동에 대한 성찰은 '자기주도적 평가 탐구'의 습관을 기르고 외부의 피드백 소스를 흡수하여 자신의 장점과 단점을 인지하는 능력을 개발하는 것이다.

Withthis inmind, we wouldargue that the predominant concern regarding the professional issues of maintenance of competence and continuing professional development ~in Schön’s terms, issues of reflection on practice!31 should fo- cus upon developing habits of self-directed assessment seek- ing and upon understanding factors that influence our ability to absorb these external sources of feedback in developing a coherent self-awareness of our strengths and weaknesses."

중요한 것은 한 사람이 그 자신의 점수를 정확히 예상할 수 있느냐가 아니라, 자신의 점수를 알았을 때 무슨 행동을 하느냐이다.

The relevant issue is not whether a person can predict his score on a test, but what he does with the information when he finds out his score."

Self-directed assessment seeking에 대해서 우리가 해야 할 질문은 이런 것이다. 

Thus, we should be asking questions like “What forms of external data would helpindividuals recognize areas that require updating?” “How can we collect and deliver these data in a meaningful form?” “How can we convince people to believe this feedback and incorporate it into their self-concept?” and, more generally, “How can we get people to act on externally derived infor- mation?”"

• “What forms of external data would help individuals recognize areas that require updating?” 
• “How can we collect and deliver these data in a meaningful form?” 
• “How can we convince people to believe this feedback and incorporate it into their self-concept?” and, more generally, 
• “How can we get people to act on externally derived information?”

Self-reflective exercises에 관해서 우리가 물어야 하는 질문은 이런 것이다.

• “Does engaging in self-reflection result in improved performance” could parallel the emerging literature that reveals the pedagogical benefits of externally derived assessment strategies (eg, multiple-choice tests of knowledge).32,33 

• More sophisticated questions could address 
• (a) whether or not sharing one’s self-reflections with peers, a tutor, or a mentor is necessary to elicit full advantage of the activity and 
• (b) whether or not developing the habit of self-reflection in one context tends to transfer readily to maintaining that habit in novel contexts or at variable stages of one’s career

Self-Monitoring에 관해서 우리가 물어야 하는 질문은 이런 것이다. 

Thus, we should be asking questions like “Do individuals show behavioral indications of slowing down0help seeking when they reach the bound- aries of their knowledge0abilities in their moment-to-moment interactions with patients?” “What cues ~external or internal! initiate such slowing down processes?” “Does the initiation of these processes impact upon the appropriateness of the care provided?” and “Howbest can the skills associated with slowing down and help seeking be taught?”"

• “Do individuals show behavioral indications of slowing down/help seeking when they reach the boundaries of their knowledge/abilities in their moment-to-moment interactions with patients?” 
• “What cues (external or internal) initiate such slowing down processes?” 
• “Does the initiation of these processes impact upon the appropriateness of the care provided?” and 
• “How best can the skills associated with slowing down and help seeking be taught?”

J Contin Educ Health Prof. 2008 Winter;28(1):14-9. doi: 10.1002/chp.150.

"I'll never play professional football" and other fallacies of self-assessment.