Monitoring and regulation of learning in medical education: the need for predictive cues

Abstract

ContextBeing able to accurately monitor learning activities is a key element in self‐regulated learning in all settings, including medical schools. Yet students’ ability to monitor their progress is often limited, leading to inefficient use of study time. Interventions that improve the accuracy of students’ monitoring can optimise self‐regulated learning, leading to higher achievement. This paper reviews findings from cognitive psychology and explores potential applications in medical education, as well as areas for future research.Cognitive PsychologyEffective monitoring depends on students’ ability to generate information (‘cues’) that accurately reflects their knowledge and skills. The ability of these ‘cues’ to predict achievement is referred to as ‘cue diagnosticity’. Interventions that improve the ability of students to elicit predictive cues typically fall into two categories: (i) self‐generation of cues and (ii) generation of cues that is delayed after self‐study. Providing feedback and support is useful when cues are predictive but may be too complex to be readily used.Application to Medical EducationLimited evidence exists about interventions to improve the accuracy of self‐monitoring among medical students or trainees. Developing interventions that foster use of predictive cues can enhance the accuracy of self‐monitoring, thereby improving self‐study and clinical reasoning. First, insight should be gained into the characteristics of predictive cues used by medical students and trainees. Next, predictive cue prompts should be designed and tested to improve monitoring and regulation of learning. Finally, the use of predictive cues should be explored in relation to teaching and learning clinical reasoning.ConclusionsImproving self‐regulated learning is important to help medical students and trainees efficiently acquire knowledge and skills necessary for clinical practice. Interventions that help students generate and use predictive cues hold the promise of improved self‐regulated learning and achievement. This framework is applicable to learning in several areas, including the development of clinical reasoning.

Metacognitive awareness and the link with undergraduate examination performance and clinical reasoning

“…The positive correlations between the sub-scales of the Regulation of Cognition domain and the fifth year KFP and OSCE examinations highlight the importance of metacognitive awareness for undergraduate clinical examination performance. Our evidence along with the literature, support reviewing the need to support raising the metacognitive awareness of medical students which may benefit both their examination performance and their clinical reasoning skill acquisition (Berkhout et al, 2015;Bruin et al, 2017).…”

“…Seeking to better understand self-regulated learning among medical students has attracted attention from medical educators in recent years for two reasons (Bruin, Dunlosky, & Cavalcanti, 2017;Song, Kalet, & Plass, 2011). Firstly, self-regulated factors have been identified as a source of achievement differences between students (Zimmerman & Pons, 1986).…”

“…Metacognitive awareness skills include the Knowledge of cognition, which enable a person to have knowledge about their thinking and learning processes (Gönüllü & Artar, 2014;Schraw, 1998 an individual to self-monitor the effectiveness of their learning and decision making, regarded as vital to all clinicians, regardless of whether they are students or experts (Bruin et al, 2017).…”

“…Although metacognitive skills are widely regarded as important for the development of clinical reasoning, they are seldom directly taught or assessed at medical school (Colbert et al, 2015). Metacognitive skills are a component of SRL which manage the cognitive aspects of learning and thinking (Bruin et al, 2017;Gönüllü & Artar, 2014). Effective SRL skills are positively associated with superior levels of student achievement, as well as expertise in clinical reasoning .…”

Bridging the gap between uncertainty, confidence and diagnostic accuracy: calibration is key

“…This helps them to maintain the ability to act even in ill-defined environments that are characterised by an inherent uncertainty. Junior physicians by contrast first need to obtain experience and learn how to cope with uncertainty by identifying cues to monitor their actions 15. For example, if a patient reacts to a treatment as expected, this signals to a physician that (s)he is ‘on track’, but if the patient is not responding to treatment, physicians need to reconsider their diagnosis and ask for help because the conditions may be beyond their abilities to control or manage 14…”