Transition to Medical School: Use of Learning Strategies to Support Self-Regulated Learning in Integrated, Learner-Centered Curricula.

Abstract

Purpose: Medical education research has demonstrated the importance of supporting students during the transition to medical school, a transition rendered even more complex by many medical schools’ shift toward integrated, learner-centered curricula. 1 Despite prior academic success, many students begin medical school without the learning strategies needed to handle the depth, pace, and structure of the curricula. 2 When students are unable to transition effectively, their academic performance suffers. Self-regulated learning (SRL), a commonly used framework for teaching medical students effective study habits, is a process that students use to acquire academic skills, including setting goals, selecting and developing study strategies, and monitoring effectiveness. 3 Zimmerman proposed 3 phases of SRL: forethought, performance, and self-reflection. 4 While past research shows that successful medical students in a traditional 2 plus 2 curriculum engage in SRL, little is known about which specific strategies first-year medical students use to support SRL when transitioning to an integrated, learner-centered curriculum, and how they employ those strategies. The aim of this study was to document and codify the specific strategies students use in a learner-centered, integrated medical school curriculum to provide a roadmap that future students and educators can use to guide the transition to medical school. Method: Two United States medical schools with integrated, learner-centered curricula collaborated to examine which learning strategies students use to support SRL and how they use them. Thirty-two first-year medical students participated in an interview and were asked to reflect on their approach to SRL at the start and at the end of their first year of medical school. Students were asked to describe what strategies they used to plan (forethought), monitor (performance), and reflect (self-reflection) on their learning. A qualitative analysis of the data was performed using deductive coding that was based on a theoretical framework combining aspects of Zimmerman’s SRL model. Results: The data revealed that most students used a variety of learning strategies during all 3 stages of SRL described by Zimmerman 3 throughout their first year of medical school. Students were able to articulate specific examples of how they used strategies to plan, monitor, and reflect on their learning in an integrated, first-year medical school curriculum. Results indicated that as students progressed through their first year of medical school, they refined their strategy use to better fit the needs of an integrated, learner-centered medical curriculum. Discussion: This work contributes to existing medical education literature by providing concrete examples of strategies that first-year medical students in an integrated, learner-centered curriculum can use when adjusting to medical school. Medical educators recognize that SRL strategies need to be explicitly taught and that the specific SRL strategies used will vary based on the learning environment. The specific strategies, tasks, and behaviors identified in this study represent a bridge between theory and practical steps students can take to engage in SRL. Although students learn about the phases of SRL, they often have difficulty translating each phase into actionable steps as first-year medical students. The specific information provided by this study can aid in diagnosing gaps in learners’ existing processes or serve as concrete suggestions for new strategies, tasks, and behaviors to try when coaching first-year medical students. Significance: This work provides a roadmap of strategies for all stages of SRL that faculty, staff, administrators, and students can use to support learning in first-year, integrated medical school curricula.