Why Does This Learner Perform Poorly on Tests? Using Self-Regulated Learning Theory to Diagnose the Problem and Implement Solutions.

Abstract

Learners who underperform on standardized tests are common throughout all levels of medical education and require considerable faculty time and effort to remediate. Current methods for remediating test-taking difficulties are typically not grounded in educational theory or supported by high-quality evidence. A test-taking assessment was developed based on self-regulated learning (SRL) microanalytic assessment and training and used during academic year 2012-2013. This method assesses the SRL subprocesses of strategic planning, self-monitoring, causal attributions, and adaptive inferences during the educational task of answering test questions. The method was designed for one-on-one use by teacher and learner, and for learner self-assessment and practice. At one academic institution, this method was used to categorize learners into struggling test-taker subtypes which correspond to deficiencies in the SRL subprocesses outlined above. A learning plan based on the SRL deficiency was developed for each struggling test-taker subtype. In a small number of internal medicine residents with low in-training examination scores, use of this method yielded improvements in 2013 in-training examination score that doubled the expected improvement based on historical averages. This method is a novel application of SRL theory to a commonly encountered problem in medical education: the learner who performs poorly on tests. Large-scale, multicenter studies of medical learners at a variety of training levels and program types are needed to determine the effectiveness and generalizability of this intervention.