How medical students co-regulate their learning in clinical clerkships: a social network study

Abstract

Background Self-regulated learning is a key competence to engage in lifelong learning. Research increasingly acknowledges that medical students in clerkships need others to regulate their learning. The concept of “co-regulated learning” captures this act of regulating one’s learning by interacting with others. To effectively cultivate such skills in students, we need to increase our understanding of co-regulated learning. This study aimed to identify the purposes for which students in different phases of clinical training engage others in their networks to regulate their learning. Methods In this social network study, we administered a questionnaire to 403 medical students during clinical clerkships (65.5% response rate). The questionnaire probed into the composition of students’ co-regulatory networks and the purpose for which they engaged others in specified self-regulated learning activities. We calculated the proportion of students that engaged others in their networks for each regulatory activity. Additionally, we conducted ANOVAs to examine whether first-, second-, and third-year students differed in how they used their networks to support self-regulation. Results Students used others within their co-regulatory networks to support a range of self-regulated learning activities. Whom students engaged, and the purpose of engagement, seemed to shift as students progressed through clinical training. Over time, the proportion of students engaging workplace supervisors to discuss learning goals, learning strategies, self-reflections and self-evaluations increased, whereas the proportion of students engaging peers to discuss learning strategies and how to work on learning goals in the workplace decreased. Of all purposes for which students engaged others measured, discussing self-reflections and self-evaluations were consistently among the ones most frequently mentioned. Conclusions Results reinforce the notion that medical students’ regulation of learning is grounded in social interactions within co-regulatory networks students construct during clerkships. Findings elucidate the extent to which students enact self-regulatory learning within their co-regulatory networks and how their co-regulatory learning behaviors develop over time. Explicating the relevance of interactions within co-regulatory networks might help students and supervisors to purposefully engage in meaningful co-regulatory interactions. Additionally, co-regulatory interactions may assist students in regulating their learning in clinical workplaces as well as in honing their self-regulated learning skills.

It Takes a Village: an ethnographic study on how undergraduate medical students use each other to learn clinical reasoning at the workplace

“…In this research, we observed a reduced trust of some students in their peers' (developing) expertise. The same-level peers they use for co-regulated learning during their Bachelor's, are typically replaced with clinical supervisors during their Master's program, as is also shown in other research [19,35]. This could be attributed to the fact that students are a part of a community of learners [36,37] during their Bachelor's program, and that when they enter clinical practice they feel the need to take part in that speci c community of practice with the medical specialist at the center [33,34].…”

“…Whereas PAL is widely used in the preclinical teaching of medical students, recent literature states that PAL is particularly useful to students in the clinical stages of their education where the clinical-reasoning learning process accelerates [6,18]. Nevertheless, there is a notable decline in the extent to which students use each other for their own learning processes during clinical clerkships compared to the preclinical years [19]. Nowadays, the current generation of students is characterized by a stronger individualistic orientation compared to their predecessors [20].…”

Las prácticas clínicas y la motivación de los estudiantes de medicina

“…Los resultados de nuestro estudio coinciden con los encontrados por Bransen et al (2022) quienes confirmaron la importancia de los pares en el aprendizaje en clínicas de los estudiantes y cómo las redes de relaciones que se establecen en las prácticas clínicas refuerzan la autorregulación del aprendizaje y el aprendizaje de habilidades. También, el estudio de Atman y Yildiz (2022), ya mencionado, señaló la influencia de la motivación del estudiante en su autonomía y cómo un ambiente colaborativo de aprendizaje influye en la regulación de la motivación de los estudiantes universitarios, así, estrategias de planificación, seguimiento y autorregulación pueden ser fuerzas impulsoras de la autonomía del estudiante en las actividades de aprendizaje colaborativo.…”

Making goals count: A theory‐informed approach to on‐shift learning goals

“…This not only promotes SRL but embodies the ideals of coregulated learning, in which social influences (e.g., a supervisor's expertise) help to shape the learner's approach. 21,22 A nonspecific goal such as "being more efficient" could be followed up with questions about perceived areas of inefficiency. This may then lead to an opportunity to discuss strategies for workflow management that can then be directly observed and serve as the basis for feedback in the moment or after shift.…”