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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)