'고군분투자'들을 다른 관점에서 보기: 어떻게 SRL의 관점이 평가와 재교육에 있어 의학교육자들을 도울 수 있는가(Acad Med, 2011)

'고군분투자'들을 다른 관점에서 보기: 어떻게 SRL의 관점이 평가와 재교육에 있어 의학교육자들을 도울 수 있는가(Acad Med, 2011)

Perspective: Viewing “Strugglers” Through a Different Lens: How a Self-Regulated Learning Perspective Can Help Medical Educators With Assessment and Remediation

Steven J. Durning, MD, Timothy J. Cleary, PhD, John Sandars, MBChB, MD, MSc, Paul Hemmer, MD, MPH, Patricia Kokotailo, MD, and Anthony R. Artino, PhD

수행수준이 떨어지는 일부 학생/레지던트/의사들이 있으며, 이들이 의학교육자, 대중, 규제기구들의 주요 관심대상이 된다. 이들의 고군분투자들은 여러 이유로 수행의 어려움을 겪고 있을 수 있다.

There are, however, some medical students, residents, and practicing physicians who underperformand, as a result, become major concerns for medical educators, the public, and regulating bodies. These struggling trainees and practicing physicians may exhibit performance difficulties for a wide variety of reasons,1–4 such as

• knowledge deficits,5,6
• unprofessional attitudes, beliefs, or behaviors,6–9 and/or
• difficulty applying their knowledge and skills to authentic clinical contexts.5,10,11

비록 의사들 중의 고군분투자들의 보여주는 유형과 그 심각성이 의과대학생의 그것과 다를 수 있다는 것은 인정하나, 기량 발휘에 어려움을 겪는 혹은 성취 수준이 떨어지는 이들을 종합하여 'struggler(고군분투자)'로 칭하고자 한다.

Although we recognize that the types and depths of struggles exhibited by practitioners may differ from those of first-year medical students, we will collectively refer to underachieving or underperforming medical students, residents, and practicing physicians as strugglers.

비록 고군분투자들이 교육훈련 기간과 의료현실에서 소수자일 수는 있으나, 단기적은 물론 장기적으로도 위협이 되고, 의학교육자들과 전문직 차원에서 심대한 시간과 자원의 투자를 필요로 하는 대상이 된다.

Although strugglers represent a minority of those in training and practice, these individuals are at risk for poor performance in the short term(e.g., failure to graduate) and long term(e.g., disciplinary action by a state medical board), which may lead to substantial investments in time and resources by medical educators and professionals.

사회적으로 더 중요한 점은 일반 대중들에게 해(harm)을 가할 위험이 있다는 것이다.

Of even greater societal importance is that medical students, residents, and practitioners who exhibit poor clinical judgment, knowledge, and/or skills may pose a risk of significant harmto the public at large.12

이 연구의 일차 목적은 SRL-MAT이라고 불리는 평가프레임워크를 소개하는 것이다. 우리는 이것이 전통적인 의학에서의 평가 프레임워크를 보완할 수 있는 것으로 고군분투자들을 찾고 재교육하는데 활용될 수 있을 것으로 본다. SRL-MAT는 자기조절이론과 사회-인지 연구를 바탕으로 하며, 따라서 피훈련자의 행동과 수행능력은 그들의 그들이 의료를 배우고 수행하는 맥락 뿐 아니라 동기와 조절프로세스에 달린 것으로 본다.

The primary purpose of this article is to introduce an assessment framework, called Self-Regulated Learning–Microanalytic Assessment and Training (SRL-MAT), which we believe could complement traditional medical training assessment frameworks that have been used to identify and remediate strugglers. The SRL-MAT is grounded in self-regulation theory and social–cognitive research and thus assumes that the behaviors and performance of trainees are a function of their motivational beliefs and regulatory processes, as well as the contexts in which they learn and performtheir clinical skills.13,14

대부분의 연구자들은 자기-조절을 역동적이고 맥락-특이적 프로세스로 보며, 교육이 가능하고 직접적 지도, 적절하게 안내된 수행(guided practice), 튜터링 등을 통해서 강화될 수 있다고 본다. 이러한 개념이 갖는 주요 함의는 특정 영역 또는 맥락에서 특정 활동을 하는 "동안"에 자기주도학습의 역동적이고 유동적인 특성을 잘 잡아낼 수 있는 평가도구를 사용해야 한다는 것이다.

Most researchers conceptualize self-regulation as a dynamic, context- specific process that can be taught and enhanced through direct instruction, guided practice, and tutoring.15–17 The primary implication of this concept of self-regulation for assessment practices is that one needs to use assessment methods capable of capturing the dynamic, fluid aspects of self-regulated learning (SRL) by directly examining one’s use of regulation during specific activities and in particular domains or contexts.

 

기존 연구를 보면 고군분투자들이 목표를 설정하고, 전략적 계획을 세우고, 자기-모니터를 하고, 자기-평가를 하는 것이 학업 성취 뿐 아니라 학업 관련 행동을 관리하는데 요구되는 동기부여와 스킬(도움을 찾는 요령, 학습전략을 통해 수행능력을 최적화시키는 것)을 향상시키는데도 도움이 된다.

Of greatest practical importance is the volume of research showing that teaching strugglers to set goals, develop strategic plans, self-monitor, and self-evaluate (or reflect on) their performance improves not only their academic success but also their motivation and skills in managing academic behaviors, such as help-seeking and using learning strategies to optimize performance.18–20

 

자기조절과 관련된 인터벤션의 긍정적 연구결과는 초등/중고등/대학에서 모두 밝혀졌다.

Positive findings for self-regulation interventions have been found across elementary, secondary, and postsecondary school populations.18–20

왜 고군분투자에 대한 평가 프레임워크에 집중하는가?

Why Focus Our Assessment Framework on Strugglers?

최근의 연구를 보면 의과대학 교수와 행정가들은 물론 규제기구들이 고군분투자를 둘러싼 이슈에 대하여 상당히 불만을 가진다는 것을 알 수 있다.

Recent studies have demonstrated that medical school faculty and administrators, as well as regulatory bodies, are becoming increasingly dissatisfied, if not discouraged, with issues surrounding strugglers.1–3,25

이러한 상황에서 의학교육자들의 과제는 이들을 정확히 밝혀내는 것 뿐만 아니라 이러한 낮은 수행능력의 기저에 깔린 주 요인을 발견하는 것이다. 그 이유를 밝히는 것이 적절한 재교육의 첫 단계이다.

Given these problems, an emergent challenge for medical educators involves developing effective ways to not only accurately identify strugglers but also to better understand the primary causal factors underlying their poor performance. Identifying the reasons for one’s poor performance in medical school, residency, or practice is a key first step in developing adequate remediation plans.27

고군분투자 찾아내기: 전통적 평가 프레임워크

Identification of strugglers: Traditional frameworks of evaluation

현재의 의학교육에서의 프레임워크는 고군분투자들을 찾아내고 평가하고 재교육하는 것에 있어서 분석적/발전적/종합적/역량-바탕 접근을 사용한다.

Current frameworks in medical education focus on the identification, evaluation, and remediation of struggling trainees and can be broadly grouped into analytic, developmental, synthetic, and competency- based approaches.

• The analytic framework takes the trainee’s performance “apart”—Greek: ana (whole) plus lytic (apart)—typically dividing learning outcomes into the domains of knowledge, skills, and attitudes.
• Developmental frameworks, such as the Dreyfus and Dreyfus28 approach, describe learner performance in progressive steps (e.g., novice and early beginner through expert), typically within a domain of performance.
• Synthetic models put the learner’s performance together into discrete “steps,” or levels, with each step requiring a synthesis of greater knowledge, skill, and attitude. An example of the synthetic approach is RIME (Reporter, Interpreter, Manager, Educator).30
• Finally, competency-based frameworks include the widely adopted competencies of the Accreditation Council on Graduate Medical Education, as well as those of CANMEDS and the Good Doctor.31,32

종합적/역량-바탕 프레이워크는 '역할-기반'프레임워크의 사례이기도 하다.

Synthetic and competency-based frameworks are also an example of “role- based” frameworks.33

그러나 안타깝게도 현재의 평가 및 재교육 방법은 프로페셔널리즘이나 기초과학 지식, 임상기술 등과 같이 관심 대상이 되는 영역의 성과에 대해서 매우 작은 분산성분(보통 30% 이하)만을 설명해준다. 설명되는 분산성분이 작다는 것은 관심 대상이 되는 성과에 관계되는 요인이 더 있다는 것을 보여준다. 그리고 이는 고군분투자들에게 특히 중요하다.

Unfortunately, current methods of assessment and remediation in medical education tend to explain little variance (typically, studies explain less than 30%of the variance) in the outcomes of interest, such as professionalism, basic science knowledge, and/or clinical skill.1,5–8 The fact that little variance is explained suggests that other factors are contributing to these outcomes of interest, a notion that is particularly important for those who struggle.

추가로, 평가 프레임워크는 그 자체로 인과관계를 밝히는데 집중하지는 않는다.

In addition, medical education assessment frameworks, per se, typically do not focus on identifying the causal factors underlying poor performance

피훈련자의 성취도가 낮은 것의 중심 이유를 찾지 못하고는 가장 효과적인 개선법도 찾지 못할 것이다. 더 나아가 우리의 현재 평가 프레임워크가 기본적으로 잘 연구된 교육모델이나 이론에 기반하지 않기 때문에 교육자들이 다양한 평가자료를 통합하여 실용적인 권고안을 만들기도 어렵다.

Without identifying and understanding the proximal causes of trainee underachievement, it is difficult to pinpoint the most effective ways to assist trainees in improving their performance. Furthermore, because our current assessment frameworks are generally not based on well-researched educational models or theories, it is challenging for educators to use and integrate various types of assessment data to generate practical recommendations for the assessment of struggling trainees and professionals.

종합적으로, 이러한 한계점이 대안을 찾아야 하는 중요한 이유이다. SRL-MAT 과 같은 대안은 의과대학과 레지던트의 실제 과제를 수행하는 과정에서 피훈련자의 동기부여나 조절기술에 대한 정보를 얻기 위해 설계된 것이다.

Collectively, these shortcomings are important reasons to consider alternative approaches, such as the SRL-MAT, an assessment framework designed to generate information about trainees’ motivation and regulatory skills as they engage in authentic tasks in medical school and residency, such as taking comprehensive exams and performing clinical tasks.

SRL의 정의(그리고 자기 평가와 어떻게 다른가)

Self-regulation defined (and how it differs from self-assessment)

사회-인지 연구자들은 SRL을 개개인이 스스로 피드백을 생성해냄으로써(self-generated feedback) 개인의 목표를 달성하기 위한 전략적 접근을 최적화하는 순환적 프로세스라고 정의한다. 사회-인지적 관점에서 자기-조절은 전형적으로 교육이 가능한 스킬이며, 세 단계의 순환적 고리를 따른다.

Social–cognitive researchers have defined SRL as a cyclical process whereby individuals use self-generated feedback about their learning to optimize their strategic pursuit of personal goals.34,35 From a social–cognitive perspective, self- regulation is typically conceptualized as a teachable skill that operates as a three-phase cyclical loop (see Figure 1).

 

• 사전숙고: 학습노력(수행능력에 관한 통제), 성공과 실패에 대한 판단(자기-성찰), 목표 설정과 전략 기획
  In short, processes preceding action (forethought) have an impact on learning efforts (performance control), which in turn influence how learners react to and judge their performance successes and failures (self-reflection). Forethought processes, such as goal-setting and strategic planning, help to mobilize students’ efforts to learn.
• 과제 수행능력 촉진(자기-통제 전략), 이러한 방법의 효과성 추적(자기-모니터링)
  Once trainees engage in learning tasks, such as studying for a major exam or drawing blood from a patient, they typically enlist performance-phase processes such as using specific tactics to facilitate task performance (self-control tactics) and tracking the effectiveness of these methods (self- monitoring).
• 성공 실패 여부 판단(자기-평가), 결과의 이유 분석(귀인), 미래 수행능력 최적화(적응적 추론)
  The information that trainees gather from task performance is used to judge whether they succeeded or failed (self-evaluation), to judge why this performance occurred (attributions), and to decide what they need to do to optimize future performance (adaptive inferences).

 

 

SRL이 자기평가와 다르다는 것을 알아야 한다. 자기평가는 SRL의 여러 구성요소 중 하나일 뿐이다. 의학교육 문헌들을 보면 수행능력이 떨어질 수록 자기평가 기술도 떨어진다. 이러한 실제 수행능력과 그것을 인식하는 능력의 부족은 고군분투자들이 과제를 수행하는데 필요한 지식 뿐 아니라 스스로의 지식이나 전문성에 대한 이해도 떨어질 것을 시사하며, 자기조절스킬 차원에서 또 하나의 문제영역이 되는 것이다. 즉, 비효과적으로 학습전략을 활용하고 동기부여 신념을 잘못 적응하는 것이다.

It is important to note that self-regulation and, more specifically, SRL, differs from self-assessment (calibration of one’s perceived performance with actual performance36); self-assessment constitutes just one of the several features of SRL. The medical education literature has found that poor performers are often the most unaware, that is, have the poorest self- assessment skill.37,38 This deficit between actual performance and awareness (self- assessment)38,39 also suggests that strugglers may possess poor knowledge of task demands or requirements, as well as of their own levels of knowledge or expertise, and may exhibit other problematic self- regulatory skills, such as ineffective use of learning strategies and maladaptive motivational beliefs.

교육심리학자들의 연구를 보면 학생들은 자기조절훈련을 통해서 더 독립적이고 자율적인 학습자가 될 수 있다. 이것이 특히 중요한 이유는 고군분투하는 학생들도 내용전문가나 교사에게 효과적인 피드백을 받고 구체적인 내적-피드백 생성 전략(에러 탐지, 자기-모니터링)을 교육받으면 자기평가의 정확도를 향상시킬 수 있다는 점이다.

Decades of work by educational psychologists suggest that students can be taught to become more independent and autonomous learners through self- regulation training.2,18 Of particular importance is that researchers have begun to show that struggling students can improve the accuracy of their self- assessments regarding personal capabilities and knowledge if they are provided with effective feedback from content experts or teachers and if they are taught specific strategies to generate internal feedback, such as error detection and self-monitoring.40–42

SRL-MAT 프레임워크

The SRL-MAT Framework

가설

Assumptions

SRL-MAT 프레임워크는 사회-인지 이론에 기반

The SRL-MAT framework is grounded in social–cognitive theory and research and thus makes a variety of important assumptions about student learning,

Bandura의 상호적 결정론(reciprocal determinism)에 따르면 ,학생의 행동이나 스킬, 개인적 프로레스(신념, 감정), 환경적 요인(교사, 교실) 등이 상호적으로 작용한다는 것이다. 그러나 가장 강조되는 것은 인간 인식의 역할인데, 특히 자기-효능감 인식을 학생의 행동에 영향을 주는 핵심 프로세스로 본다. 따라서 의과대학생이 자기효능감이 낮고, 과제-특이적 자신감이 낮으면(채혈 등) 이러한 임상경험에 대한 동기부여가 덜 되고, 회피하고자 하며, 이는 부정적 피드백을 받는 결과를 초래하게 된다. 반대로, 만약 교수가 학생에게 어떻게 임상 술기를 향상시킬지 전략적 피드백을 준다면, 학생의 인식이나 역량은 불안감이 감소함에 따라서 향상될 수 있고 이는 더 높은 수준의 행동적 참여(behavioral engagement)와 동기부여의 개인적 요인이 될 것이다.

According to Bandura’s13,14 model of reciprocal determinism, student behaviors or skills, personal processes (beliefs, affect), and environmental factors (teachers, classroomclimate) interact and influence each other in reciprocal ways. However, primary emphasis is placed on the role of human cognition and, in particular, self-efficacy perceptions, as a key personal process affecting student behavior. Thus, a medical student who possesses low self- efficacy, or low task-specific confidence, for drawing blood froma patient may exhibit low motivation and/or avoid these types of clinical experiences, which may further elicit negative feedback from his or her professors in medical school. Conversely, if faculty advisors or professionals provide this student with strategic feedback on how to improve his or her clinical skills, the student’s perceptions of competence may increase while anxiety about this procedure lessens—personal factors that may prompt higher levels of behavioral engagement and motivation.

 

SRL-MAT 프레임워크의 또 다른 중요한 가정 중 하나는 행동과 신념이 유동적이고 역동적이어서 교육맥락에 따라 다르게 나타나며, 그 맥락 내에서도 구체적 과제에 따라 다르다는 것이다.  실제적, 진단적 관점에서 이러한 맥락-특이성이 중요한 이유는 효과적인 자기-조절 평가 도구는 그 맥락이나 과제, 행동의 특수성에 맞춰져야 하기 때문이다. SRL-MAT은 SRL  microanalysis라는 접근법을 활용하는데, 이는 학습자가 authentic 과제를 수행할 때 이뤄지는 조절 프로세스에 대해서 구체적으로 시간 순서에 따라 물어본다.

Another important assumption of the SRL-MAT framework is that behaviors and beliefs are dynamic and fluid in nature and thus will often vary across educational contexts, as well as for specific tasks within those contexts. From a practical and diagnostic perspective, this context- specific assumption is important because it suggests that effective self-regulation assessment tools should be tailored to specific contexts and tasks or activities within those contexts. The SRL-MAT uses an emergent assessment approach called SRL microanalysis, a procedure that involves asking temporally sequenced questions about specific regulatory processes as trainees engage in an authentic task or activity.23,24,43,44

학생들이 스스로의 인식/신념/행동을 특정한 상황에 따른 요구나 특정 맥락과 무관하게 보고하게끔 하는 전통적인 자기-보고 척도와 달리 microanalytic 척도는 특정 학업 과제나 활동에 맞춤형이며, 맥락-특이적 질문을 활용하여, 3단계 사이클의 다양한 프로세스를 타겟으로 한다. 이러한 관점에서 SRL microanalysis는 어떻게 학생들이 특정 과제에 대해 접근하고, 시행하고, 과제 시행 중 뿐 아니라 그 이후에 성찰하는지를 평가하게 해준다.

In contrast to traditional self-report measures that require students to retrospectively provide accounts of their perceptions, beliefs, and behaviors without reference to situational demands or particular contexts, microanalytic measures are customized to particular academic tasks or activities and involve using context-specific questions targeting the various processes of the three-phase cyclical loop (see Figure 1). In this sense, SRL microanalysis seeks to evaluate how students approach, execute, and reflect during (as opposed to a long time after) specific tasks or events.

자기조절 평가

Assessment of self-regulation

자기조절 문헌들을 보면 다양한 평가법이 논의되고 있다. 비록 자기보고 스케일이 MSLQ와 같이 가장 흔하게 사용되는 평가도구이고, 강력한 psychometric properties가 있지만, 종종 문제가 되는데 왜냐하면 회상과 응답 편향이 있고, 그 스케일이 맥락과 유리되어(decontextualize) 있기 때문이다. 이것은 특히 역동적이고 맥락 특이적인 SRL의 모습을 잘 보여주지 못한다는 문제가 있다. 더 나아가서 피훈련자에게 어떻게 의과대학 기간에 배우고  학습했으며, 어떤 전략을 사용하였는지 물어보는 것은 실제로 authentic 임상 과제를 하는 중에 보여주는 생각이나 행동에 대한 정보는 거의 주지 못한다.

In the self-regulation literature, a variety of assessments are discussed, including paper-and-pencil self-report scales, direct observation, think-aloud protocols, and self-regulation microanalysis.16,45–48 Although self-report scales, such as the Motivated Strategies and Learning Questionnaire, are the most frequent type of self-regulation assessment tools and typically have evidence of strong psychometric properties,46,47 they are often problematic because of recall and other response biases, as well as the decontextualized nature of the scales. This latter problemis of particular concern because such scales often fail to capture the dynamic, context-specific nature of self- regulation. Furthermore, asking trainees to retrospectively report howthey study or learn in medical school or the general strategies that they use (e.g., time management, organization) to succeed will yield minimal information about the thoughts and behaviors that they actually display while engaged in authentic clinical tasks, such as interviewing a patient, performing a procedure, or making a specific medical diagnosis.

대도적으로, 필수적 임상 과제와 화동을 수행하는 동안에 실시간으로 자기조절 프로세스를 직접적으로 측정하고자 하는 평가도구들은 교육자들에게 더 의미있는 정보를 준다.

In contrast, assessment tools designed to directly measure self-regulation processes as they unfold in real time during essential clinical tasks and activities have the potential to provide medical educators with more meaningful information

자기조절 연구자들은 지난 20년간 많은 평가도구 개발. SRL-MAT에서는 SRL microanalytic 를 특히 강조함. 일반적으로 말해서 이 평가 방법은 자기조절의 순환적 단계를 종합적으로 타게팅한다.

Self-regulation researchers during the last 20 years have developed a variety of alternative assessment tools, such as think-aloud protocols, behavioral traces, and microanalytic assessment approaches, to directly measure self- regulation during specific events.16,47,49 The SRL-MAT endorses the use of think- aloud protocols and direct observations, but it places primary importance on using SRL microanalytic methodology to evaluate the regulatory skills and processes of trainees. In general, this assessment methodology involves comprehensively targeting the cyclical phase processes of self-regulation (e.g., goal-setting, metacognitive monitoring, strategy use, causal attributions) as an individual engages in a well-defined task or activity.24

잘못된 조절 프로세스를 찾아서 개개인의 접근법, 모니터, 성찰에 있어서 부족한 부분을 알게 해주는 것은 대체로 인지적 접근이다. SRL microanalysis의 핵심 특성은 다음과 같다.

It is a largely cognitive approach that seeks to identify faulty regulatory processes so that examiners can isolate gaps or deficiencies in how individuals approach (forethought), monitor (performance), and reflect (self- reflection) during their engagement in some specific task.43,50 Some of the essential features of SRL microanalysis include the use of

• (1) 개별화된 평가 프로토콜
  individualized assessment protocols,
• (2) 모든 세 단계에 대한 개방형, 폐쇄형 질문
  open-ended and closed-ended questions targeting processes within all three phases of the self-regulation cyclical loop (see Table 1), and
• (3) 구체적 과제를 수행하는 과정에서의 전략적 지점에 관한 맞춤형 자기조절 질문
  customized self-regulation questions that are administered at strategic points during learning or performance on a specific task (see reference 43 for a more detailed overview of this procedure).

 

여러 연구로부터 SRL microanalysis의 절차와 유용성이 확인되었다. Cleary and Zimmerman49 는 최초 연구 중 하나인데 고등학생 대상 자유투 연구.

A variety of research studies have been conducted to illustrate the procedures and utility of SRL microanalysis. Cleary and Zimmerman49 conducted one of the first studies to microanalytically examine a comprehensive array of regulatory processes. Using a sample of high school students, the authors elected to use basketball free-throw shooting as the task around which to embed the forethought and self-reflection phase questions. 

예컨데 여기서 질문은 이러했다.

In that study, for example,

• 목표 관련 질문
  the goal question was, “Do you have a goal when practicing your free throws? If so what is it?”; whereas
• 전략 관련 질문
  the strategic planning question was, “What do you need to do to accomplish that goal?”
• 성찰 관련 질문
  The players were also asked a series of questions targeting their self-reflective thoughts following failure. For example, to examine their attributions and adaptive reactions following two missed shots in a row, the participants were asked, “What is the main reason why you missed those last two shots?” and “What do you need to do to improve your performance?”

Clearyand Zimmerman’s 농구 연구에서 모든 질문은 구체적인 조절 프로세스에 맞추어져 있었고, 특정 관심대상이 되는 과제에 맞춰져 있었으며, 학생이 자유투 연습을 하는 과정에 시행되었다. 이러한 과정은 연구자로 하여금 학생의 인식과 조절 프로세스를 실시간으로 볼 수 있게 도와준다. 연구의 경험적 중요성으로는, 저자들은 microanalytic  질문을 활용하여 전문가-비전문가-초보자를 구분할 수 있었던 것이다. 즉, 전문가 수준으로 잘 하는 사람은 높은 수준의 자기효능감, 더 많은 구체적 목표, 더 효과적 슈팅 전략 활용, 실패한 이후의 더 전략적 자기성찰을 하고 있었다.

An important point here is that in Clearyand Zimmerman’s basketball study, all questions were targeting specific regulatory processes, were customized to the specific task of interest (basketball free-throw shooting), and were administered as participants practiced their free-throw shooting. Such a procedure allowed the researchers to directly examine student cognition and regulatory processes as they unfolded in real time. Of empirical importance, the authors were able to show that the use of microanalytic questions clearly differentiated expert, nonexpert, and novice free-throw shooters. That is, expert free-throw shooters, who were defined as those shooting over 70%fromthe free-throw line, displayed higher levels of self-efficacy, set more specific goals, used more effective shooting and technique-related strategies, and were more strategic in their self-reflection following missed free throws than the two other groups. 

Integrating SRL Microanalysis Into Medical Education

SRL microanalytic 방법은 사실상 어떤 잘-정의된 과제나 사건, 활동에도 모두 사용가능하다

SRL microanalytic methodology can be applied to virtually any well-defined task, event, or activity.

의학교육자들이 수행능력의 미달에 대해서 이해가 부족한데, 이는 의학에서 수행능력을 구성하는 것들 - 특히 동기부여와 맥락 -  이 충분히 정의되거나 평가되지 않고, 실시간 피드백을 제공하지 않았기 때문이다.

Medical educators’ understanding of medical students’ or residents’ deficiencies in performance (and strugglers’ assessment of their performance) is limited. This may be because the component parts of performance in medicine—particularly emphasizing motivation and context— have not been sufficiently defined, assessed, or allowed for real-time feedback to trainees. 

이러한 실시간 피드백을 통해 교육자들은 더 관련된 정보를 많이 얻을 수 있다.

By generating this real-time feedback, educators would have more pertinent information to guide their remediation attempts with students who are disengaged and at risk for failure or for engaging in poor clinical practice.

기본적인 아이디어는 시작과 끝이 분명한 과제를 찾고, microanalytic 평가 접근법을 사용하여 과제를 둘러싼 사전숙고(before), 수행(during), 자기성찰(after)을 평가하는 것이다.

The basic idea is to identify a task that has both a clear beginning and end, and then wrap the microanalytic assessment approach—involving forethought (before), performance (during), and self-reflection (after)—around such a task. This would allowone to examine howstudents approach, learn or perform, and reflect on particular outcomes.

7 Hodgson CS, Teherani A, Gough HG, Bradley P, Papadakis MA. The relationship between measures of unprofessional behavior during medical school and indices on the California Psychological Inventory. Acad Med. 2007;82(10 suppl):S4–S7. http:// journals.lww.com/academicmedicine/ Fulltext/2007/10001/The_Relationship_ between_Measures_of.2.aspx.

38 Hodges B, Regehr G, Martin D. Difficulties in recognizing one’s own incompetence: Novice physicians who are unskilled and unaware of it. Acad Med. 2001;76(10 suppl):S87–S89. http://journals.lww.com/academicmedicine/ Fulltext/2001/10001/Difficulties_in_ Recognizing_One_s_Own.29.aspx. Accessed December 26, 2010.

 

 

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Acad Med. 2011 Apr;86(4):488-95. doi: 10.1097/ACM.0b013e31820dc384.

Perspective: viewing "strugglers" through a different lens: how a self-regulated learning perspective can helpmedical educators with assessment and remediation.

Durning SJ1, Cleary TJ, Sandars J, Hemmer P, Kokotailo P, Artino AR.

Author information

• 1Department of Medicine and Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA. sdurning@usuhs.mil

Abstract

Medical educators are responsible for training current and future generations of physicians; this includes the early and accurate identification of "struggling" medical trainees, which has implications for future training, practice, and success.The authors propose a theory-based framework, Self-Regulated Learning-Microanalytic Assessment and Training (SRL-MAT), that is specifically designed to foster individual medical trainee self-regulatory beliefs and behaviors, and thus provide a distinct method to assist medical trainees who struggle. The SRL-MAT is grounded in social-cognitive theory and research and makes a variety of important assumptions about learning and the essential techniques needed to evaluate trainee functioning. Two critical assumptions are that (1) self-efficacy beliefs are a key personal process affecting trainee behavior, and (2) trainee beliefs and behaviors are dynamic and fluid in nature and thus will often vary across educational contexts, as well as for specific tasks within those contexts. To address these assumptions, the SRL-MAT uses an emergent assessment approach called self-regulated learning microanalysis, a procedure that involves asking a series of temporally sequenced questions about specific regulatory processes as trainees engage in an authentic task or activity. The framework, which is grounded in a foundation of established educational research, is adaptable to practically any task that has a clear beginning and end. The authors believe this framework could make important contributions to traditional medical training assessmentframeworks that have been used to identify and remediate strugglers.

© by the Association of American Medical Colleges.

PMID:

 

21346503

 

[PubMed - indexed for MEDLINE]