임상실습 학생의 SRL에 영향을 미치는 요인 탐구(Med Educ, 2015)

임상실습 학생의 SRL에 영향을 미치는 요인 탐구(Med Educ, 2015)

Exploring the factors influencing clinical students’ self-regulated learning

Joris J Berkhout,1 Esther Helmich,1 Pim W Teunissen,2,3 Joost W van den Berg,1 Cees P M van der Vleuten2

& A Debbie C Jaarsma1,4

INTRODUCTION

의학교육에서 SRL의 중요성은 널리 인정되고 있다.

The importance of self-regulated learning (SRL) in medical education has been broadly recognised by medical education institutions and regulatory bodies.1–4

학생들은 이 과정에 대한 지원을 받아야 한다. SRL개발을 지원하는 것은 쉽지 않은데, 왜냐하면 SR은 신체와 정신의 복잡한 상호작용 활동이기 때문이다. 이러한 활동은 개인과 환경의 특성, 그리고 그 둘간의 상호작용에 영향을 받아서 자기조절을 매우 맥락-특이적으로 만든다.

They need to be supported in this process.6,7 Supporting the development of SRL is challenging because self- regulation is a complex interactive process of physi- cal and mental activities. These activities are affected by personal and contextual attributes, and the interaction between them, which makes self- regulation highly context-specific.8–11

여러 이론적 모델이 SRL의 프로세스를 설명하기 위해서 개발되었다. 이 모델간 여러 유사점이 있는데 그 차이가 더 흥미롭다. 차이는 자기조절의 레벨(과제-특이적인지 보다 일반적인 것인지), 인지와 감정이 별도로 조절되는지에 대한 질문 등이다.

Several theoretical models have been developed to describe the process of SRL.8,10,12–14 There are many similarities among these models, but their dif- ferences are more interesting. These differences pertain to the level of self-regulation, such as whether it is task-specific or more general for a per- son, and the question of whether cognition and affect are separately regulated areas.15

의학교육에서 유명한 이론은 Zimmerman의 이론인데, 자기조절을 보다 일반적인 수준에서 메타인지와 감정의 조절을 포함하는 것이라 개념화했다. Zimmerman의 SRL에 대한 정의는 순환 과정으로서 학생이 능동적으로 참여하는 과정이다. 이 프로세스는 세 단계로 이뤄진다.

A popular theory in medical education is that of Zimmerman, who conceptualised self-regulation on a more gen- eral level that included metacognition and the regu- lation of affect.9 Zimmerman described SRL as a cyclical process in which a student is actively engaged.9,11 This process consists of three phases.8,16

• In the forethought phase, students set learning goals and choose a strategy for attaining those goals.
• In the performance phase, students monitor and control their behaviour to attain their learning goals.
• In the self-reflection phase, students self-evaluate their performance by gathering feed- back and choosing a strategy for a future, similar, situation.17

개인적인 특성 역시 교시 세팅에서의 SRL에 영향을 주는데 여기에는 다음과 같은 것이 있다.

Personal attributes found to affect SRL in a class- room setting include the student’s skills in regula- tory mechanisms such as

• planning,
• monitoring,
• metacognition,
• attention focusing,
• the employment of various learning strategies,
• persistence,
• time man- agement,
• environment structuring,
• help seeking,
• emotion control and
• effort control.18

 

이 외에도 동기부여와 관련한 신념(자기효능감), 학습의 중요성에 대한 인식 등이 있다. 더 높은 자기효능감과 더 높은 중요도 인식은 피훈련자로 하여금 목표를 달성하기 위해서 더 많은 자원을 쏟게끔 한다.

 

마지막으로 환경에 따라 설정된 과제와 이 과제에 대한 학생의 반응 역시 SRL에 영향을 준다. 교실 환경에서의 자기조절을 다음을 통해 더 촉진하는 것으로 알려진 맥락과 사회적 특성은 다음과 같다.

Other per- sonal attributes include motivational beliefs such as self-efficacy and attitudes about the perceived importance of the learning, with higher self-efficacy and higher levels of perceived importance resulting in trainees devoting more of their resources towards achieving their goals.18,19 Lastly, the task set by the context and the affective reaction of the student to this task affect the student’s SRL in the class- room.19–21 Contextual and social attributes known to stimulate self-regulation in more structured class- room settings include

• social support,
• feedback,
• the opportunity for guided and independent practice,
• the support of reflective practice, and
• the opportu- nity to make errors.18

 

METHODS

설계

Design

해석주의자 패러다임. 현실은 주관적이며 맥락 특이적이고, 궁극적 진실은 존재하지 않는다.

Our research was based within an interpretivist para- digm in which reality is subjective and context-spe- cific, and no ultimate truth exists in the experience of workplace learning.28 We carried out a construc- tivist grounded theory study, including purposive sampling and constant comparison methods, in which we iteratively collected, coded and inter- preted data until we reached saturation, after which we held two further interviews to confirm satura- tion.29 We used semi-structured interviews to create a safe environment in which students would feel free to offer their personal experiences on how theyregulate their learning. 

Setting

유의적 표집

Participants were purposively sampled to ensure variety in age, gender, experience and current clerk- ship. We sampled students from a traditional and a problem-based learning (PBL) university, knowing that PBL may influence SRL.30,31 Furthermore, we sampled students who were enrolled in different clerkships because of the influence of context on SRL, and who were in different years of the clerk- ships because we know prior experience influences SRL.11

Participants

이메일로 모집

Between June 2013 and February 2014, the first author (JJB) approached students by sending an e- mail. A total of 17 students agreed to participate in our study by replying by e-mail to the first author and signing an informed consent form. Details of the participants are given in Table 1. After each interview, the participant was given a gift certificate worth €12.50 in compensation for his or her time.

Data collection

1저자가 인터뷰 진행. DRM 활용

All interviews were conducted by the first author (JJB). Three pilot interviews were used to test an ini- tial interview guide. This resulted in the addition of the Day Reconstruction Method (DRM) as a tool to aid students’ recall of the diverse activities in which they had engaged.33,34 The goal of the DRM is:

 

‘...to get an accurate picture of the experience asso- ciated with activities and circumstances and to elicit specific and recent memories, [...] thereby reduc- ing errors and biases of recall.’33

 

This is achieved by making a diary consisting of a sequence of episodes. Because we introduced the DRM to reflect on the previous workday, only students who were able to schedule the interview the day after a clerkship day were included in the study. Two students were excluded from the study because of problems in scheduling that prevented them from meeting this requirement for the DRM.

시작시 DRM 작성을 요청함. 이를 main prompt로 활용. 주로 다음의 내용.

At the start of the interview, we asked the partici- pant to fill in the diary pages of the DRM. This was used as the main prompt for the interview. For each activity, the student was asked to describe

• what he or she had done,
• who had been involved in the activity,
• what choices the student had made,
• why he or she had made these choices, and
• what the results of the choices were.

 

이후 SRL cycle에 따라 아래의 질문

Follow-up questions focused on the three phases of the SRL cycle and included questions about

• learning goals,
• monitoring progress towards the student’s learning goals, and
• evaluation or reflective activities.9

각 학생은 가명처리. 1저자가 예비 분석하고, 학생들에게 1-페이지 요약을 제공하여 검토하게 함. 모든 참가자가 인터뷰 요약을 확인함.

The interviews were audio-recorded and transcribed verbatim. Each student was given an alias. After each interview, the first author performed a preliminary analysis and provided the participant with a single- page summary of the interview as a member checking process. All participants verified the summary of the interview. Two participants suggested small revisions.

 

Data analysis

8달동안 1저자와 2저자가 매주 만남.

The first and second authors met weekly over a per- iod of 8 months.

• The first five meetings involved the training of the first author (JJB) in coding within grounded theory by the second author (EH), who has substantial experience in this field. Both authors read the first five transcripts and assigned initial codes on a line-by-line basis for training pur- poses.
• Next, the first author interviewed the other participants.
• This stage was directly followed by open coding and subsequently by axial coding of the data and interpretive analysis.
• The first and sec- ond authors conducted subsequent meetings between the interviews and after the final interview to discuss the emerging concepts.
• To further develop our interpretations, the first and second authors kept memos in which they recorded reflec- tions and analytical ideas as they arose.
• We used the three phases described by Zimmerman as sensitising concepts, meaning that they provided starting points for the building of our analysis.8,35
• Data for students from the same university or enrolled in the same year were reanalysed after saturation had beenreached. This process was intended to elucidate whether salient differences between groups of stu- dents emerged within our purposive sample. 

전체 연구진 대상 해석 결과 논의. 연구진 구성의 다양성

We discussed all our interpretations within the entire research group, six times in total, both dur- ing the coding process and during the writing up of the material. The research group consisted of a heterogeneous group of researchers. This heteroge-neity helped the group to look at the data from different perspectives. Two authors (JJB and JWvdB) are recent MD graduates and are PhD stu- dents in medical education. All other authors have significant experience in medical education and come from different backgrounds. These back- grounds include elderly care medicine (EH), obstetrics and gynaecology (PWT), psychology and psychometrics (CPMvdV) and veterinary medicine (ADCJ). Data analysis was supported by the use of MaxQDA Version 11.0 (Verbi GmbH, Berlin, Germany). 

 

 

RESULTS

개인/맥락/사회적 특성

Personal, contextual and social attributes

개인/맥락/사회적 특성이 상황에 따라 SRL을 어렵게 하거나 지지하였다.

Personal, contextual and social attributes could either hamper or support SRL depending on the situ- ation.

• Personal attributes affecting SRL included
• skills in regulatory mechanisms such as
• emotion con- trol,
• metacognition,
• attention focusing and
• effort control. Furthermore,
• beliefs about learning,
• motiva- tion,
• previous experiences and
• the perceived level of a task had effects.
• Attributes relating to self-efficacy, such as
• ability to deal with pressure,
• insecurity,
• per- ceptions of expectations, and
• knowledge of one’s own limits and needs, also played a role.
• Contextual attributes affecting SRL pertained to the
• curriculum,
• facilities,
• atmosphere,
• patient-related factors,
• avail- able time,
• the people present, and
• engagement in the team.
• Social attributes affecting SRL pertained to
• familiarity with the other people present in a certain setting,
• the type(s) of relationship with them,
• the experience in and motivation for teaching of these other people, and
• whether they created possibilities for the student to self-regulate learning.

목표

Goals

개인차원 목표

Two specific types of personal goal were iden- tified:

• 무언가를 배워야겠다. (i) the goal of learning something, and
• 좋게 보여야 겠다. or 안좋게 보이지 말아야 겠다.(ii) the goal of looking good or avoiding looking bad.

 

외부적 목표

External goals were those that involved

• (다른) 학생들의 학습을 도와준다. helping students to learn or
• 조직 차원에 도움이 된다 (행정 업무 지원 등) to provide some benefit to the organisation, such as by performing administrative tasks.

SRL의 기회

Opportunity

SRL을 하려면 그렇게  할 기회가 있어야 한다. 이러한 기회가 있는 기회의 발견인지, 만들어지는 것인지, 주어지는 것인지 등은 개인/맥락/사회의 특성에 달려있으며, 학생간 차이가 컸다.

Students stated that in order to self-regulate their learning, they need to have opportunities to do so. Whether these opportunities were seen by, created by or given to students was influenced by the per- sonal, contextual and social attributes described ear- lier; large differences emerged among individuals.

자율성에 대한 경험 수준

Experienced autonomy

임상실습에서 학생의 SRL에 영향을 주는 또 다른 요인은 학생이 경험하는 자율성의 수준이었다.

Another factor influencing students’ SRL in the clinic was the degree of autonomy they experienced. This autonomy was also affected by personal, con-textual and social attributes and could influenceself-regulatory mechanisms

기대 성과

Anticipated outcomes

SRL 활동에 따른 기대 성과과 학생이 특정 활동의 참여에 영향을 미쳤다. 긍정적인 성과가 기대되면 SRL을 하였다. 긍정적인 성과에는 역량의 향상, 학습기회의 증가, 정서에 대한 긍정적 영향 등이 있다.

The anticipated outcomes of an SRL activity influ- enced students’ engagement in a particular activ- ity. Students often self-regulated their learning if they expected favourable outcomes. A favourable outcome might be an increase in competencies, an increase in future learning opportunities, or an anticipated positive effect on the student’s emo- tions.

 

 

 

 

 

 

 

Example of a narrative

 

 

DISCUSSION

 

우리의 연구는 개인/맥락/사회의 특성과 네 가지 요인(목표, 기회, 자율성 경험, 기대 성과)가 학생의 임상환경에서 SRL을 지지하거나 억제하는 것으로 나타났다. 임상환경에서 SRL은 다양한 것들이 상호작용하는 복잡한 프로세스로서 개인에 따라 매우 다르며 맥락-특이적 과정이다.

Our study determined the personal, contextual and social attributes and the four factors (per- ceived goals, opportunity, autonomy experienced and anticipated outcomes) that support or ham- per SRL by students in the clinical workplace. Self-regulated learning in the clinical workplace is a complex process in which many different influences interact, making it a highly individual, context-specific process.

우리는 Zimmerman의 3-시기 모델을 활용하였다. 이들 세 시기는 우리의 데이터에서 모두 드러났으나, 우리는 Zimmerman의 모델에서 다루고 있는 stage의 명확한 구분에 대한 근거는 충분히 얻지 못했다. 우리의 모델은 Butler의 recursive, dynamic, multidirectional and complex 모델과 더 잘 맞는다.

We used Zimmerman’s three-phase model as a sensitising concept for our analysis of the factors influencing students’ SRL in the clinic.8 These three phases could all be retrieved in our data, although we found little evi- dence for the distinct stages as they are portrayed in Zimmerman’s model.9 Our results are better aligned with Butler et al.’s36 description of the process as recursive, dynamic, multidirectional and complex.

SRL에 영향을 주는 것으로 드러난 개인 차원의 특징은 다른 연구에서 나타난 것과 비슷하다.

The personal attributes that affect SRL identified in the present study were largely the same as those found elsewhere, and included

• students’ skills per- taining to regulatory mechanisms to self-regulate learning,
• their self-efficacy,
• their attitudes towards learning,
• their previous experiences, and
• the task demands perceived and
• affective reactions to these.11,18,19,21

 

맥락과 사회적 특성

Contextual and social attributes per- taining to the

• teacher,
• curriculum pedagogy,
• time and
• different elements pertaining to the learning climate

 

have already been described in the literature as influencing SRL in the classroom.18,22

 

그러나 이번 연구의 결과에 기반하여 본다면, 우리는 임상 환경이 여러 독특한 특성을 가지고 있으며, 이것이 SRL에 영향을 준다.

However, based on the current findings, we emphasise that the clinical environment is characterised by several unique attributes that influence opportunities to self-regulate learning, such as the

• 활용 가능한 설비(시설) facilities available,
• 환자와 상호작용 the interaction with patients,
• 환자의 존재 the patients present,
• 동료 및 다른 병원 인력의 사회적 특성 social attributes pertaining to peers and other hospi- tal staff,
• 여러 교실 간 위계의 복잡성 the complexities of hierarchical depart- ments, and
• 팀 관여 engagement in the team.

 

이러한 맥락적 특성은 교실 세팅에서는 잘 확인하기 어려운 것이다.

These contextual attributes have not been described simi- larly in a classroom setting.

학생은 목표의 중요성을 언급했는데, 이는 목표가 동기부여와 관련된 기능을 하며, 종종 더 구체적인 목표를 향한 시작점이 되기 때문이다. 이는 교실 세팅에서 SRL 연구와 유사하다. 더 나아가 목표는 학생들이 학습 프로세스나 성과의 특정 측면에 집중하게끔 해준다.

Students described goals as important influencing factors because they serve a motivational function and often allowed a starting point from which to work towards a specific goal. This is consistent with earlier research on SRL in classroom settings, which stated that goals can function as regulatory agents for SRL.18 Furthermore, goals can direct students’ attention on specific aspects of the learning process or outcomes.16

학생들이 보거나/만들어내거나/주어진 기회, 그리고 학생이 경험한 자율성은 SRL에 영향을 주었다. 학생이 자율성을 느끼면 더 적극적으로 학습기회를 만들어내는 방식 등으로 더 통제권을 가지고 SRL을 한다. 이러한 맥락적 특성은 임상 환경 특이적이며, 왜냐면 환자 안전과 생산성과 관련된 문제가 중요할 뿐 아니라 자율성이나 기회를 제약할 수 있기 때문이다.

The opportunities that students see, create or are given, and the autonomy that students experience also have effects on SRL in the clinical context. It is understood that if students have some feeling of autonomy, they are better able to take control and self-regulate their learning, such as by more actively creating learning opportunities. These contextual attributes appear to be quite unique to the clinical context because issues regarding patient safety and productivity are also important and may limit the amount of autonomy and the opportunities students are given.

마지막으로, 학생의 SRL은 활동에 따른 기대 성과에 영향을 받는다. 임상 교육과정에 의해서 설정된 외부 목표들은 이러한 목표를 달성하기 위한 노력 투자에 별로 기여하지 않는데, 학생들은 왜 그 목표를 달성해야 하는지, 그리고 그러한 활동에서 무엇을 얻을 수 있는지가 불명확하기 때문이다. 이는 이전 연구에서 학생들이 학습과제에서 가치를 느끼지 못하면 목표 설정과 전략기획에 시간을 덜 소비하는 것으로 나타난 것과 유사하다.

Lastly, students’ SRL was influenced by the expected outcomes of an activity. Many external goals set by the clinical curriculum led to the expenditure of little effort in working towards those goals because students did not see the point of achieving the goal or how they would benefit from conducting such an activity. This resonates well with earlier findings showing that if stu- dents do not see value in a learning task, they are likely to spend little time on setting goals and plan- ning strategies to accomplish that task.39,40

SRL에 있어서 학생별로 차이가 크다는 것을 통해서, 이 프로세스가 각 개인별로 매우 특화된 과정이라는 것을 강조하고자 한다. 예컨대 어떤 학생은 학습목표를 스스로 설정하는 반면 다른 학생은 단순히 주어진 기회에 의존한다. 학생들은 기회적(opportunistic) 학습전략을 사용하는 이유로 그들에게 기대되는 것이 무엇이고, 그들이 임상실습에서 무엇을 기대해야 하는지 모르기 때문이라고 응답하였다. 이러한 결과는 더 많은 LIC를 요구하는 것과 일치한다.

We noted large individual differences in students’ SRL, emphasising that it is a process that is highly specific for each person. For example, some stu- dents actively set learning goals for themselves, whereas others seemed to rely on a more opportu- nistic approach. Students explained that they used opportunistic learning strategies because they did not know what was expected of them or what they could expect from the clerkship. This finding aligns with the call for more longitudinal integrated clerkships.41

최근의 연구결과를 보면, 비록 학생들이 SRL하기를 기대되지만 많은 대학생들은 스스로의 학습을 모니터링할 능력이 부족하며, 종종 스스로 잘 하고 있다고 생각하며 비효율적 전략을 사용한다.

A recent review has shown that although students are expected to self-regulate their learning, many college students are insufficiently capable of moni- toring their own learning and often use inefficient strategies whilst thinking they are doing well.42

강점과 한계

Strengths and limitations

한 가지 장점은 DRM의 활용. 이는 오래 전 일을 회상하는데서 오는 bias를 최소화하기 위한 것으로 이런 회상은 기억/감정/신념에 영향을 받으며, 참가자가 가장 정서적으로 영향을 받은 사건에 초점이 맞춰진다. 그러나 회상 연구들은 언제나 이러한 기억-관련 bias에 따른 문제를 수반한다. 기억-관련 bias와 관련하여 참가자들은 많은 선택들을 '적극적 선택(active choice)'으로 기억하나, 사실 그것들은 그 일이 벌어질 때 무의식적으로 일어났을 가능성을 고려해야 한다.

One of the strengths of this study was its use of the DRM. This helped to minimise bias arising from the long-term recall of events, which has been shown to be subject to memory, emotions and beliefs, with participants’ often focusing on those events that have the greatest emotional impact.43 However, recall studies will always suffer from some degree of memory-related bias. One possible memory-related bias derives from the fact that many choices may be remembered as active choices when the individual is asked about them, but they may in fact have been subconscious choices when they happened.44

또 다른 연구는 최근 의대 졸업생이 인터뷰를 한 것.

Another strength of our study refers to the fact that all interviews were conducted by a recent MD gradu- ate.

함의

Implications for practice and future research

어떻게 SRL을 지원할 수 있을지를 일반화하는 것은 매우 복잡한데, 왜냐하면 이것은 모든 맥락의 모든 사람에게 독특한 복잡한 시스템이기 때문이다. 몇 가지 가능한 접근법이 있다. 예를 들면 학생이 스스로의 학습 프로세스에 대해 인식하도록 하는 것은 좋은 시작점이 된다.

It is very difficult to generalise how SRL might be supported because this complex system is unique for every person in every context. There are several possible approaches: for example, increasing students’ awareness about their own learning pro- cesses may represent a good starting point.

 

학생들이 스스로의 학습에 대해 더 인식할수록 그들은 서로 다른 상황에서 서로 다른 다양한 전략을 유연성있게 활용할 수 있고, 임상실습에서 확습 효과성이 높아진다. 학생이 스스로의 학습 프로세스에 대해서 인식하는 것을 도와주는 것들

Making students more aware of their learning may improve their flexibility in using different learning strategies in different situations, and thereby increase the learning effectiveness of clerkships.45 Students’ awareness about their own learning processes can be increased by

• 메타인지에 대한 일반적 이해 향상 promoting general awareness about metacognition,
• 인지에 대한 지식 향상 improving knowledge about cogni- tion,
• 인지의 조절 향상 improving the regulation of cognition, and by
• 수행능력(performance)보다는 숙달(mastery)에 초점을 둠으로써 메타인지에 대한 인식 향상 fostering an environment that promotes metacogni- tive awareness by focusing on mastery rather than performance.46
• 구체적 SRL 스킬 ㄱ육 Previous studies have looked at the effects of teaching specific SRL skills to students learning in academic contexts and have shown promising results.47–49

서로 다른 니즈를 가진 학생에 대한 맞춤형 학습기회와 지원

It also seems important to offer more tailored learning opportunities and the supports necessary for students to self-regulate their learning as stu- dents are known to have different needs.50

 

 

 

28 Bunniss S, Kelly DR. Research paradigms in medical education research. Med Educ 2010;44:358–66.

33 Kahneman D, Krueger AB, Schkade DA, Schwarz N, Stone AA. A survey method for characterising daily life experience: the day reconstruction method. Science 2004;306 (5702):1776–80. 34 Kahneman D, Krueger AB, Schwarz N, Stone AA. The Day Reconstruction Method (DRM): Instrument Documentation. 2004. http://sitemaker.umich.edu/ norbert.schwarz/files/drm_documentation_july_ 2004.pdf. [Accessed 1 June 2014.]

36 Butler DL, Cartier SC, Schnellert L, Gagnon F, Giammarino M. Secondary students’ self-regulated engagement in reading: researching self-regulation as situated in context. Psychol Test 2011;53 (1):73– 105.

42 Bjork RA, Dunlosky J, Kornell N. Self-regulated learning: beliefs, techniques, and illusions. Annu Rev Psychol 2013;64:417–44.

47 Labuhn AS, Zimmerman BJ, Hasselhorn M. Enhancing students’ self-regulation and mathematics performance: the influence of feedback and self- evaluative standards. Metacogn Learn 2010;5 (2):173– 94.

48 Hofer BK, Yu SL. Teaching self-regulated learning through a ‘Learning to Learn’ course. Teach Psychol 2003;30 (1):30–3.

49 Sandars J. Pause 2 Learn: developing self-regulated learning. Med Educ 2010;44:1122–3.

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Med Educ. 2015 Jun;49(6):589-600. doi: 10.1111/medu.12671.

Exploring the factors influencing clinical students' self-regulated learning.

Berkhout JJ1, Helmich E1, Teunissen PW2,3, van den Berg JW1, van der Vleuten CP2, Jaarsma AD1,4.

Author information

• 1Centre for Evidence-Based Education, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
• 2Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
• 3Department of Obstetrics and Gynaecology, VU University Medical Centre, VU University Amsterdam, Amsterdam, the Netherlands.
• 4Centre for Research and Innovation in Medical Education, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.

Abstract

OBJECTIVES:

The importance of self-regulated learning (SRL) has been broadly recognised by medical education institutions and regulatory bodies. Supporting the development of SRL skills has proven difficult because self-regulation is a complex interactive process and we know relatively little about the factors influencing this process in real practice settings. The aim of our study was therefore to identify factors that support or hamper medical students' SRL in a clinical context.

METHODS:

We conducted a constructivist grounded theory study using semi-structured interviews with 17 medical students from two universities enrolled in clerkships. Participants were purposively sampled to ensure variety in age, gender, experience and current clerkship. The Day Reconstruction Method was used to help participants remember their activities of the previous day. The interviews were transcribed verbatim and analysed iteratively using constant comparison and open, axial and interpretive coding.

RESULTS:

Self-regulated learning by students in the clinical environment was influenced by the specific goals perceived by students, the autonomy they experienced, the learning opportunities they were given or created themselves, and the anticipated outcomes of an activity. All of these factorswere affected by personal, contextual and social attributes.

CONCLUSIONS:

Self-regulated learning of medical students in the clinical environment is different for every individual. The factors influencing this process are affected by personal, social and contextual attributes. Some of these are similar to those known from previous research in classroom settings, but others are unique to the clinical environment and include the facilities available, the role of patients, and social relationships pertaining to peers and other hospital staff. To better support students' SRL, we believe it is important to increase students' metacognitive awareness and to offer students more tailored learning opportunities.

© 2015 John Wiley & Sons Ltd.

Comment in

• Self-regulated learning: the challenge of learning in clinical settings. [Med Educ. 2015]

PMID:

 

25989407

 

[PubMed - indexed for MEDLINE]