Table 2 Summary of included studies
From: The self-regulated learning of medical students in the clinical environment – a scoping review
Authors | Year | Country | Population and sample | Study design | Instruments used | Primary Findings/ Key findings relevant to the scoping review question/s | Processes of SRL theoretical framework explored (areas of self-regulation explored) |
|---|---|---|---|---|---|---|---|
Turan, Demirel and Sayek | 2009 | Turkey | 862 preclinical and clinical medical students from 4 medical schools with different curriculum models | Cross-sectional | Self – Regulated Learning Perception Scale (author’s own)- internal consistency α = 0.76-0.91Metacognitive Awareness Inventory [72] | • Clinical students had higher scores than preclinical students in planning and goalsetting (p = 0.001), strategies for learning and assessment (p = 0.043) and overall levels of self-regulated learning (p = 0.037). • Students with previous exposure to learner centred methods during high school had higher scores in motivation and action to learning (p = 0.017). • There were significant differences in all self-regulating scores across different curriculum models | • Planning (cognition, behaviour) • Control (motivation. Behaviour) |
Song, Kalet and Plass | 2011 | USA | 58 3rd year medical students (first clinical year) | Cross-sectional | Self–Regulation Measure for Computer–based learning (authors’ own)- Measures Strategies Use (SU) and Strategies Frequency (SF)- high internal consistency (SU α = 0.96-0.99, SF α = 0.97-0.99)- high inter-rater reliability (Interclass correlations of SU = 0.93 (95% CI: 0.89-0.95), Interclass correlations of SF = 0.96 (95% CI: 0.91-0.98) | Strategies Use and Strategies Frequency were significantly correlated with USMLE step 1 scores (p < 0.01) | • Planning (cognition, behaviour, environment) • Self-monitoring (cognition, behaviour) • Control (cognition, behaviour, environment) |
Sobral | 2000 | Brazil | 103 medical students beginning clinical activities | Cohort | 10 – item self-report questionnaire used to measure self-reflection in learning (authors own) | • Significant change in the levels of reflection after the intervention (p < 0.001). • 4 items of the Course Valuing Inventory had the strongest relationship with reflection scores (relating and making sense of course contents, r = 0.46; Achievement of personal goals, r = 0.44; Acquiring a clear and integrated notion of learning processes, r = 0.36; Sense of self-esteem related to course experience, r = 0.34). • Reflection scores post–intervention were significantly correlated with the following Diagnostic Thinking Inventory scores: flexibility in reasoning (p < 0.01) structure of knowledge in memory (p < 0.001) and total score (p < 0.001) • Reflection scores post–intervention were significantly correlated with grade point average (p < 0.01) | • Self-monitoring (cognition) |
White | 2007 | USA | 36 medical students – 18 from a PBL medical school and 18 from a traditional medical school | Qualitative | Semi-structured interview | • PBL students effectively transitioned into their clerkship. • Traditional curriculum students had difficulty transitioning from the classroom to the clerkship environment – they felt difficult to find their place and assume responsibility for their learning. | • Planning (cognition) • Self-monitoring (cognition, motivation) • Feedback loop (cognition, behaviour) • Control (cognition, behaviour, motivation) |
Cleary and Sandars | 2011 | USA | Seven 3rd year undergraduate medical students | Qualitative | Self – regulated learning microanalysis | • Students who successfully obtained a blood sample on the first attempt had high levels of strategic thinking in planning, goal setting, self-monitoring and self-evaluation. • Four students indicated that the primary goal was to perform the process of venepuncture correctly. • The 2 students who were needed 3 attempts to obtain a blood sample focused on outcome when planning the procedure and did not monitor their progress. | • Planning (cognition, behaviour, motivation) • Self-monitoring (cognition, behaviour, motivation) • Feedback loop (cognition, behaviour, motivation) |
Nguyen, Laohasiriwong, Saengsuwan, Thinkhamrop, Wright | 2015 | Vietnam | 623 medical students across 5 academic years | Cohort | The Depression Anxiety and Stress Scales 21 items [73] the Motivated Strategies for Learning Questionnaire [32] | After controlling for the effects of depression T1, anxiety, stress and other demographic covariates, there were significant negative associations between depression scores and: intrinsic goal orientation, task value, control of learning beliefs, self-efficacy for learning, rehearsal, elaboration, organisation, critical thinking, metacognitive self-regulation, time and study environment, effort regulation and help seeking (all p < 0.05). | • Planning (cognition, behaviour, motivation, environment) • Self-monitoring (cognition, behaviour, motivation, environment) • Feedback (cognition, behaviour, environment) • Control (cognition, behaviour, environment) |
Turan and Konan | 2012 | Turkey | 309 medical students during their surgical clerkship | Cross-sectional | Motivated Strategies for Learning Questionnaire (MSLQ) [32] Case based examinationObjective Structured Clinical ExaminationTutor evaluations | • Significant but weak correlation between overall MSLQ and OSCE scores (R = 0.32, R2 = 0.10; p < 0.018) • Two most important subdimensions of MSLQ for OSCE scores were self-efficacy (r = 0.16) and control over learning beliefs (r = −0.17) • No correlation between MSLQ and case-based examination • Significant but weak correlation between MSLQ and tutor evaluation scores (R = 0.31;R2 = 0.05; p < 0.03) | • Planning (cognition, behaviour, motivation, environment) • Self-monitoring (cognition, behaviour, motivation, environment) • Feedback (cognition, behaviour, environment) • Control (cognition, behaviour, environment |
Artino, Dong, DeZee, Gilliland, Waechter, Cruess, Durning | 2012 | USA | 304 medical students at different stages of training | Cross-sectional | 30 item survey which included:the authors’ own questions3 subscales adapted from the Patterns of Adaptive Learning Scale [74] The metacognition subscale from the MSLQ [32] The procrastination subscale [75] The avoidance–of–helping-seeking subscale [76] Grade point averageClinical pointsExam pointsRemediation referral | • Mastery goal structures were positively correlated with metacognition (r = 0.26, p < 0.01) • Metacognition was negatively correlated with procrastination (r = −0.12, p < 0.05) | • Planning (cognition, behaviour, motivation, environment) • Self-monitoring (cognition, behaviour, motivation) |
Woods | 2011 | Canada | 313 medical students in their 3rd and 4th year of training (clerkship) | Qualitative | Series of focus groups | • As students felt a lack of learning opportunities during clerkship rotation, they had to choose and create learning opportunities wisely • There was a lack of critical self-reflection in students self-regulated learning activities | • Planning (cognition, behaviour, environment) • Self-monitoring (cognition, behaviour, environment) • Control (environment) |
Alegria, Boscardin, Poncelet, Mayfield and Wamsley | 2014 | USA | 15 students on their Longitudinal Integrated Clerkships | Qualitative | Two focus groups | • Students used tablet computers to read content, collect learning resources and access question banks to assess and track their learning. • Students found tablet computers particularly useful for its ability to access learning issues quickly. • Most students did not use tablet computers to access information during face-to-face interactions with patients | • Feedback (cognition) • Control (environment) |
Berkhout, Helmich, Teunissen, van den Berg, van der Vleuten and Jaarsma | 2015 | Netherlands | 17 medical clerkship students – 8 from a PBL medical school, 9 from a traditional medical school | Constructivist grounded theory | Semi structured interviews – Day Reconstruction Method + follow up questions | SRL was supported or inhibited by: • Personal factors: emotional control, metacognition, ability to focus, ability to deal with pressure beliefs about learning • Contextual factors: curriculum, patient-related factors, engagement with team, available time • Social factors: familiarity with staff and colleagues, level of guidance/mentorship from these people • Goals: Supervisors setting goals for student could inhibit student SRL. Goals created by the clerkship students supported SRL. • Opportunities: In order to self-regulate, students felt they needed the opportunities to do so • Experienced autonomy: The more autonomy students felt they had, the more they were able to self-regulate • Anticipated outcomes: Students self-regulated their learning when they expected positive outcomes. | • Planning (cognition, behaviour, environment), • Self-monitoring (cognition, motivation, behaviour), • Control (cognition, behaviour, environment) |
Lyons-Warren, Kirby and Larsen | 2016 | USA | 56 medical students on their surgical clerkship | Mixed-methods | 18 question electronic survey | • Learning goals were important to maximize learning on surgery clerkship. • 73% of students had defined learning goals at the commencement of their rotation. • Low interest among attending residents in the student’s learning goals. • 48% of students felt the faculty was responsible for initiating the conversation to share learning goals, 16% reported the student was responsible and 12% reported that either the faculty or the student could initiate the conversation • Students felt little flexibility in changing the context of their learning. • Students felt varying degrees on discomfort when asking for opportunities to practice procedural tasks and presenting patient histories/examinations | • Planning (cognition) • Control (behaviour, environment) |
Berkhout, Hemlich, Teunissen, Van der Vletuen and Jaarsma | 2016 | Netherlands | 14 medical clerkship students in their 4th, 5th and 6th year | Grounded theory | Interview | Compared to novice learners, experienced learners were: • More proactive in their learning • Less dependent on their peers for support, • More dependent on consultants to help them have adequate learning opportunities • More likely to communicate personal goals with seniors • Less affected by residents in their SRL • More affected by nurses in their SRL However, not all senior students reported learning like an experienced learner. | • Planning (cognition, behaviour, environment) • Feedback (cognition, behaviour, environment) • Control (cognition, behaviour, environment) |
Berkhout, Teunissen, Helmich, Exel, Vleuten, Jaarsma | 2017 | Netherlands | 74 clerkship medical students in their 4th, 5th or 6th year. | Q methodology | 52 Q-sort statements (author’s own instrument) | Five patterns were retained: • Engaged: actively shape their learning and are motivated to learn from every situation and in a SRL fashion • Critically opportunistic: learn mainly through social interaction, but otherwise are not effortful in their learning. • Uncertain: overwhelmed, frightened, passive and a reactive behavioural pattern. • Restrained: want to learn, but hesitant to include others due to fear of appearing inferior. • Effortful: want to work hard, but depend on others to guide them as they are not capable to structure their learning environment. | • Planning (cognition, behaviour, environment) • Self-monitoring (cognition, behaviour, environment) • Feedback (cognition, behaviour) • Control (cognition, motivation, behaviour, environment) |