Beyond the self: The role of co-regulation in medical students' self-regulated learning.

Derk Bransen,Marjan J B Govaerts,Dominique M A Sluijsmans,Erik W Driessen

doi:10.1111/medu.14018

Abstract

ContextMedical students are expected to self‐regulate their learning within complex and unpredictable clinical learning environments. Research increasingly focuses on the effects of social interactions on the development of self‐regulation in workplace settings, a notion embodied within the concept of co‐regulated learning (CRL). Creating workplace learning environments that effectively foster lifelong self‐regulated learning (SRL) requires a deeper understanding of the relationship between CRL and SRL. The aim of this study was therefore to explore medical students’ perceptions of CRL in clinical clerkships and its perceived impact on the development of their SRL.MethodsWe conducted semi‐structured interviews with 11 purposively sampled medical students enrolled in clinical clerkships at one undergraduate competency‐based medical school. Data collection and analysis were conducted iteratively, informed by principles of constructivist grounded theory. Data analysis followed stages of open, axial and selective coding, which enabled us to conceptualise how co‐regulation influences the development of students’ self‐regulation.ResultsData revealed three interrelated shifts in CRL and SRL as students progressed through clerkships. First, students’ CRL shifted from a focus on peers to co‐regulation with clinician role models. Second, self‐regulated behaviour shifted from being externally driven to being internally driven. Last, self‐regulation shifted from a task‐oriented approach towards a more comprehensive approach focusing on professional competence and identity formation. Students indicated that if they felt able to confidently and proactively self‐regulate their learning, the threshold for engaging others in meaningful CRL seemed to be lowered, enhancing further development of SRL skills.ConclusionsFindings from the current study emphasise the notion that SRL and its development are grounded in CRL in clinical settings. To optimally support the development of students’ SRL, we need to focus on facilitating and organising learners’ engagement in CRL from the start of the medical curriculum.

Highlights

Self-regulated learning (SRL) is considered a core competence of physicians and one that is essential to the safeguarding of patient care.[1,2] Many medical curricula support medical students in developing SRL skills
Our findings suggest that three major shifts are key to students’ development over time: (a) a shift in the selection of co-regulated learning (CRL) partners, which moves from peers to clinician role models; (b) a shift in SRL behaviours, which tend to be externally driven in novice students and become internally driven and involving of the deliberate, proactive engagement of others in more experienced students; and (c) a shift in regulatory focus as learners move from well-defined tasks and task requirements to a broader view of professional competence in relation to the developing of a professional identity
These findings suggest relationships between SRL and CRL are reciprocal: SRL skills develop through interactions with others, whereas the mastery of SRL skills increasingly enables students to proactively engage in meaningful CRL to enhance their learning and competence development

Summary

Introduction

Self-regulated learning (SRL) is considered a core competence of physicians and one that is essential to the safeguarding of patient care.[1,2] Many medical curricula support medical students in developing SRL skills. Self-regulated learning is generally described as a cyclical process, often triggered by the formulating of goals and the subsequent employment of strategies to achieve and monitor advancement towards those goals, followed by engagement in reflection and the formulation of new learning goals.[2,3] Research findings, indicate that students often struggle to regulate their learning in clinical learning environments as a result of the unpredictable, dynamic and messy nature of clinical workplace settings.[4,5]. Surgical residents actively employ different strategies to engage their supervisors in the monitoring of performance during surgery.[13]

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