High-Frequency Learning Goals: Using Self-Regulated Learning to Influence Day-to-Day Practice in Clinical Education

Mentoring New Veterinary Graduates for Transition to Practice and Lifelong Learning

A new veterinarian's smooth and rapid transition from education to clinical practice is critical to their success and that of their new professional homes. Successful mentoring relationships are critical to smoothing the transition to practice, particularly when independent clinical decisions are abruptly required. A mentor acts as a personal coach and teacher, providing both career and personal guidance. While the profession has focused on training mentors, it has paid little attention to teaching mentees how to maximize the benefits of the relationship. Veterinary colleges can do more to equip their graduates with the skills they need to manage their change to working life successfully. The Western College of Veterinary Medicine's (WCVM) substantive gap analysis revealed mentee training as an important issue to address in support of mentorship and established a mentee training program within the curriculum. The program teaches needs assessment, goal setting, identification of appropriate learning activities, and reflection skills as an iterative and cyclical process. Learning activities include working with one's selected mentor (or mentors). These skills are important for lifelong learning and continuing professional development, as well as transition to practice.

Relationships between medical students' co-regulatory network characteristics and self-regulated learning: a social network study

INTRODUCTION

Recent conceptualizations of self-regulated learning acknowledge the importance of co-regulation, i.e., students' interactions with others in their networks to support self-regulation. Using a social network approach, the aim of this study is to explore relationships between characteristics of medical students' co-regulatory networks, perceived learning opportunities, and self-regulated learning.

METHODS

The authors surveyed 403 undergraduate medical students during their clinical clerkships (response rate 65.5%). Using multiple regression analysis, structural equation modelling techniques, and analysis of variance, the authors explored relationships between co-regulatory network characteristics (network size, network diversity, and interaction frequency), students' perceptions of learning opportunities in the workplace setting, and self-reported self-regulated learning.

RESULTS

Across all clerkships, data showed positive relationships between tie strength and self-regulated learning (β = 0.095, p < 0.05) and between network size and tie strength (β = 0.530, p < 0.001), and a negative relationship between network diversity and tie strength (β = -0.474, p < 0.001). Students' perceptions of learning opportunities showed positive relationships with both self-regulated learning (β = 0.295, p < 0.001) and co-regulatory network size (β = 0.134, p < 0.01). Characteristics of clerkship contexts influenced both co-regulatory network characteristics (size and tie strength) and relationships between network characteristics, self-regulated learning, and students' perceptions of learning opportunities.

DISCUSSION

The present study reinforces the importance of co-regulatory networks for medical students' self-regulated learning during clinical clerkships. Findings imply that supporting development of strong networks aimed at frequent co-regulatory interactions may enhance medical students' self-regulated learning in challenging clinical learning environments. Social network approaches offer promising ways of further understanding and conceptualising self- and co-regulated learning in clinical workplaces.

Deconstructing the ABC’s of leadership for successful curriculum development and implementation in residency education

Purpose

Leadership decisions occur frequently throughout the day, yet as clinicians, who balance multiple roles and responsibilities, the authors seldom label them explicitly. This translates to missed opportunities to foster the requisite skill sets junior trainees to require in their current and future contexts. While there is clear evidence for a purposeful leadership curriculum, developing, implementing and assessing these competencies remains challenging. The purpose of this paper is to provide educators with a curricular approach to incorporate leadership opportunities in their own teaching and supervisory practices.

Design/methodology/approach

A dyadic “teaching and assessment” strategy may overcome leadership curricular challenges. The authors propose a new framework that breaks down leadership opportunities into their requisite learning settings. Like fine wine and cheese, these learning experiences are paired with assessment strategies to provide further formative and summative feedback, all in the context of educational theories and frameworks.

Findings

In this paper, the authors recommend six unique learning environments for educators to consider, captured in the abbreviation ABC’S3 for administrative, bedside, classroom, simulation, self-awareness and summarization, all of which lend themselves to leadership development opportunities for resident physicians. The authors provide tested examples and pair these teaching options with a variety of assessment strategies to choose from.

Practical implications

Three practical implications are put forth in this paper, namely, leadership competencies are needed for everyone, not just for those with leadership titles or positions; multiple learning settings (and all aspects of work) can be harnessed to provide diverse leadership opportunities; and advancement beyond Miller’s knows is needed to create opportunities to hone practical leadership competencies in the shows how and does levels.

Originality/value

This paper uniquely pairs learning opportunities with assessment strategies across diverse practical settings and environments. These techniques and opportunities will serve to stimulate ideas and kick-start dialogue about incorporating a practical leadership curriculum within clinical training programs.

Sustainable Engaged Accountable Learners

The development of lifelong learners is among the most challenging goals for medical educators. The authors identify two important scholarly works that profoundly altered their understanding and approach to lifelong learning and curriculum design: L. Dee Fink's Taxonomy of Significant Learning and Cutrer et al.'s Master Adaptive Learner model. By applying these guides to their teaching and related research, three important characteristics of lifelong learning became evident: sustainability, engagement, and accountability. These are abbreviated "SEALs," for sustainable engaged accountable learners. This paper defines these qualities as they relate to emergency medicine training, significant learning, and the development of adaptive expertise. Connections to Fink's and Cutrer's works are offered for each learner characteristic. Educational and psychological theories that support the SEALs model are paired with practical suggestions for educators to promote these desired qualities in their trainees. Relevant features of adult learning are highlighted, including self-regulation, motivation, agency, and autonomy.

Beyond the self: The role of co-regulation in medical students' self-regulated learning

CONTEXT

Medical students are expected to self-regulate their learning within complex and unpredictable clinical learning environments. Research increasingly focuses on the effects of social interactions on the development of self-regulation in workplace settings, a notion embodied within the concept of co-regulated learning (CRL). Creating workplace learning environments that effectively foster lifelong self-regulated learning (SRL) requires a deeper understanding of the relationship between CRL and SRL. The aim of this study was therefore to explore medical students' perceptions of CRL in clinical clerkships and its perceived impact on the development of their SRL.

METHODS

We conducted semi-structured interviews with 11 purposively sampled medical students enrolled in clinical clerkships at one undergraduate competency-based medical school. Data collection and analysis were conducted iteratively, informed by principles of constructivist grounded theory. Data analysis followed stages of open, axial and selective coding, which enabled us to conceptualise how co-regulation influences the development of students' self-regulation.

RESULTS

Data revealed three interrelated shifts in CRL and SRL as students progressed through clerkships. First, students' CRL shifted from a focus on peers to co-regulation with clinician role models. Second, self-regulated behaviour shifted from being externally driven to being internally driven. Last, self-regulation shifted from a task-oriented approach towards a more comprehensive approach focusing on professional competence and identity formation. Students indicated that if they felt able to confidently and proactively self-regulate their learning, the threshold for engaging others in meaningful CRL seemed to be lowered, enhancing further development of SRL skills.

CONCLUSIONS

Findings from the current study emphasise the notion that SRL and its development are grounded in CRL in clinical settings. To optimally support the development of students' SRL, we need to focus on facilitating and organising learners' engagement in CRL from the start of the medical curriculum.

Goal-Setting on a Geriatric Medicine Rotation: A Pilot Study

BACKGROUND

Formal goal-setting has been shown to enhance performance and improve educational experiences. We initiated a standardized goal-setting intervention for all residents rotating through a Geriatric Medicine rotation.

OBJECTIVES

This study aims to describe the feasibility of a goal-setting intervention on a geriatric medicine rotation, the resources required, and the barriers to implementation. As well, this study aims to describe the learning goals residents created regarding content and quality.

METHODS

A pilot goal-setting intervention was initiated. A goal-setting form was provided at the beginning of their rotation and reviewed at the end of the rotation. Residents were invited to complete an anonymous online survey to gather feedback on the initiative. Goals were analysed for content and quality. Feedback from the survey results was incorporated into the goal-setting process.

RESULTS

Between March and December 2018, 26 of 44 residents completed the goal-setting initiative. Explanations for the poor adherence included limited protected time for faculty and residents to engage in coaching, its voluntary nature, and trainee absence during orientation. Reasons for difficulty in achieving goals included lack of faculty and trainee time and difficulty assisting residents in achieving goals when no clinical opportunities arose. Although only 59% of residents completed the intervention, if goal-setting took place, most of the goals were specific (71 of 77; 92%) and 35 of 77 (45.5%) goals were not related to medical knowledge.

CONCLUSIONS

This pilot study outlines the successes and barriers of a brief goal-setting intervention during a Geriatric Medicine rotation. Adherence was limited; however, of those who did complete the intervention, the creation of specific goals with a short, structured goal-setting form was possible. To enhance the intervention, goal-setting form completion should be enforced and efforts should be made to engage in mid-rotation check-ins and coaching.

Assigning Medical Students Learning Goals: Do They Do It, and What Happens When They Don't?

Theory: Medical curricula now include more time for trainees to manage their studying independently, yet evidence suggests that time is not well spent without guidance. Social-cognitivist models of self-regulated learning suggest value when guiding learners to set goals related to their performance processes (actions producing outcomes) versus their performance outcomes (products of performance). Hypotheses: We expected participants oriented to set process goals would demonstrate better suturing skill retention compared with participants oriented to set outcome goals. Method: We randomly assigned 41 medical students to two groups: outcome oriented or process oriented. They self-scored their performance using a visual analog scale on every third trial during 25 training trials, and during 10 retention trials 2 weeks later. Two raters assessed participants' suturing performances (process) and final products (outcome). After finding weak support for our hypothesis, we calculated a "self-monitoring calibration coefficient" as the Pearson's correlation between the raters' average score and each participant's self-scores. We used a mixed-effects analysis of variance to compare participants' performance scores as well as t tests and an analysis of variance to compare their self-monitoring calibration coefficients. Results: Analysis of skill retention data revealed a significant Group × Trial interaction, suggesting a benefit for the process group only for the 10th retention trial (p = .03). During training, the process group had significantly better (p = .02) self-monitoring calibration (r = .71 ± .29) than the outcome group (r = .38 ± .55). In retention, participants in both groups were significantly better calibrated (p = .04) with rater's scores of performance processes (r = .39 ± .60) versus performance outcomes (r = .11 ± .63). Conclusions: Our findings provide limited evidence for our original hypothesis. Perhaps more important, however, our self-monitoring calibration data highlighted inconsistencies between our interventions and our participants' apparent preferences. Not all participants adopted their assigned goal setting orientation, showing that researchers and educators must consider the extent to which trainees adopt imposed instructions in any educational intervention.

Improving student midwives' workplace learning by moving from self- to co-regulated learning!

BACKGROUND

Contemporary perspectives on regulated learning are moving beyond models, emphasising individual learning (self-regulated learning) to models that position social transactions at the core of learning (co-regulated learning). In discussing this paradigm shift, it is important to study self- and co-regulated learning in situational context but research in the context of midwifery education is scarce.

OBJECTIVE

This study aimed to improve our understanding of regulating midwifery students' learning by exploring factors that promote or inhibit the capacity to independently self-regulate learning during internships.

DESIGN

We conducted a qualitative study involving semi-structured group discussions with final year undergraduate midwifery students (Belgium). Focus groups were audio-taped, transcribed verbatim and analysed in a thematic way.

FINDINGS

The majority of respondents did not experience an education intended to stimulate continuous self-regulated learning. They identified many social transactions (with mentors, teachers, teams of midwives, students, peer students, personal environments, personal coaches and curriculum managers) that were instrumental in promoting or inhibiting the ability to independently self-regulate. Flexibility and resilience to cope with the differences in practices, guidance, beliefs and behaviours of individual midwives within and between workplaces, was seen as paramount.

CONCLUSION

Broadening the perspective of the individual learner to the complex interplay between all the stakeholders involved with workplace learning is an essential step to move forward in the effort to improve student midwives' learning in the workplace.

Successful completion of clinical electives - Identification of significant factors of influence on self-organized learning during clinical electives with student focus groups

Background: The Medical Licensure Act prescribes a total of four months of clinical electives in which the medical students are to work in a self-organized manner in outpatient and inpatient care. Since no specific learning objectives or learning content are given and students come into contact with different structures of outpatient and inpatient care, the learning success in a clinical elective is often rather random. In order to make self-organized learning (SOL) in clinical electives as effective as possible, we identified factors in the area of inpatient care that have an influence on SOL and thus the learning success during a clinical elective. Methods: To investigate this question a qualitative and explorative approach was chosen. In 2015, a total of 21 students from semester 1 to 11 participated in six semi-structured focus group discussions at Hamburg Medical Faculty. In these, the students were asked about their experiences and expectations with regard to SOL in clinical electives. The interviews were transcribed literally and analyzed using Grounded Theory in parallel to further data collection. Results: Three main categories were identified, which had an impact on SOL in clinical electives, each with two sub-categories: People (elective students and physicians), learning itself (learning content and learning process) and the framework (local conditions and organizational structure). For example, elective students exhibiting openness and self-initiative as well as a good working atmosphere and few hierarchical structures were conducive to SOL, while shyness and lack of integration into the ward's medical team inhibited SOL. A mentor formally assigned to the student can promote SOL through guidance, supervision and the transfer of responsibility. Continuous feedback from mentors or peers promotes SOL. Framework conditions, such as a smooth administrative organization, also affect SOL, but elective students have limited influence over these. Conclusion: The creation of suitable framework conditions and considering the needs of the people involved in clinical electives and the requirements of learning itself are necessary steps in order to enable successful SOL during clinical electives. Suitable framework conditions could be compiled and widely disseminated on an empirical basis. Training for teachers and elective students on various aspects of clinical electives, from professional behavior to practical skills, could be a suitable preparatory measure to promote SOL in clinical electives and contribute to a better learning success of the elective students.

Tying knots: an activity theory analysis of student learning goals in clinical education

CONTEXT

Learning goal programmes are often created to help students develop self-regulated learning skills; however, these programmes do not necessarily consider the social contexts surrounding learning goals or how they fit into daily educational practice.

OBJECTIVES

We investigated a high-frequency learning goal programme in which students generated and shared weekly learning goals with their clinical teams in core Year 3 clerkships. Our study explores: (i) how learning goals were incorporated into the clinical work, and (ii) the factors that influenced the use of students' learning goals in work-based learning.

METHODS

We conducted semi-structured interviews with 14 students and 14 supervisors (attending physicians and residents) sampled from all participating core clerkships. Interviews were coded for emerging themes. Using cultural historical activity theory and knotworking as theoretical lenses, we developed a model of the factors that influenced students' learning goal usage in a work-based learning context.

RESULTS

Students and supervisors often faced the challenge of reconciling contradictions that arose when the desired outcomes of student skill development, grading and patient care were not aligned. Learning goals could function as tools for developing new ways of acting that overcame those contradictions by facilitating collaborative effort between students and their supervisors. However, for new collaborations to take place, both students and supervisors had to engage with the goals, and the necessary patients needed to be present. When any one part of the system did not converge around the learning goals, the impact of the learning goals programme was limited.

CONCLUSIONS

Learning goals are potentially powerful tools to mediate interactions between students, supervisors and patients, and to reconcile contradictions in work-based learning environments. Learning goals provide a means to develop not only learners, but also learning systems.