How do postgraduate GP trainees regulate their learning and what helps and hinders them? A qualitative study

Abstract

BackgroundSelf-regulation is essential for professional development. It involves monitoring of performance, identifying domains for improvement, undertaking learning activities, applying newly learned knowledge and skills and self-assessing performance. Since self-assessment alone is ineffective in identifying weaknesses, learners should seek external feedback too. Externally regulated educational interventions, like reflection, learning portfolios, assessments and progress meetings, are increasingly used to scaffold self-regulation.The aim of this study is to explore how postgraduate trainees regulate their learning in the workplace, how external regulation promotes self-regulation and which elements facilitate or impede self-regulation and learning.MethodsIn a qualitative study with a phenomenologic approach we interviewed first- and third-year GP trainees from two universities in the Netherlands. Twenty-one verbatim transcripts were coded. Through iterative discussion the researchers agreed on the interpretation of the data and saturation was reached.ResultsTrainees used a short and a long self-regulation loop. The short loop took one week at most and was focused on problems that were easy to resolve and needed minor learning activities. The long loop was focused on complex or recurring problems needing multiple and planned longitudinal learning activities. External assessments and formal training affected the long but not the short loop. The supervisor had a facilitating role in both loops. Self-confidence was used to gauge competence.Elements influencing self-regulation were classified into three dimensions: personal (strong motivation to become a good doctor), interpersonal (stimulation from others) and contextual (organizational and educational features).ConclusionsTrainees did purposefully self-regulate their learning. Learning in the short loop may not be visible to others. Trainees should be encouraged to actively seek and use external feedback in both loops. An important question for further research is which educational interventions might be used to scaffold learning in the short loop. Investing in supervisor quality remains important, since they are close to trainee learning in both loops.

GP supervisors’ experience in supporting self-regulated learning: a balancing act

“…In the previous study, we interviewed GP trainees on their self-regulated learning (Sagasser et al 2012). That study revealed a short and long loop of self-regulated learning.…”

“…The literature reveals that informed self-assessment, facilitated reflection and directed self-guided learning can support SRL (Brydges and Butler 2012;Brydges et al 2010;Butler and Brydges 2013;Sargeant et al 2008;Schumacher et al 2013). Also, in postgraduate training supervisors can have a supportive role (Boendermaker et al 2000;Brydges et al 2010;Kilminster et al 2007;Mann et al 2001;Sagasser et al 2012;Sandars and Cleary 2011;Sutkin et al 2008;Wearne et al 2012). Supervisors, who are experienced clinicians and trained in their supervisory tasks, can help identify trainee skill levels and set an appropriate level of challenge, occasionally in ways trainees would not attempt themselves.…”

“…Additionally, they can aid by assisting, supervising or assessing the task to be mastered. To get a deeper understanding of how SRL works out in practice we performed a study into postgraduate trainees' experience with self-regulated learning (Sagasser et al 2012). Trainees reported that supervisors may encourage their selfregulated learning.…”

Scaffolding reflective learning in clinical practice: A comparison of two types of reflective activities

“…According to Schön, there is a difference between 'reflectionin-action' and 'reflection-on-action' (Schön 1987). Sagasser et al (2012) found that learning in practice occurred in a short and a long loop, both involving self-monitoring. Their analysis revealed that trainees reflected during and after activities, which suggests that their self-monitoring may reflect Schön's 'reflection-in-action' (short loop) and 'reflection-on-action' (long loop).…”

Evaluación de competencias prácticas clínicas por el alumnado y el profesorado a través del portafolios

“…La implicación de los estudiantes en su propia evaluación les permite llevar a cabo procesos de autoreflexión (Hudson, Rienits, Corrin y Olmos, 2012;Chaffey, de Leeuw y Finnigan, 2012;O'Sullivan et al, 2012;Van Schaik, Plant y O`Sullivan, 2013) que conllevan mecanismos de retroalimentación en su aprendizaje (Nicol y Macfarlane-Dick, 2006;Sagasser, Kramer y Van Der Vleuten, 2012;Dannefer y Prayson, 2013;Garner, Gusberg y Kim, 2014).…”