The relationships between the use of self-regulated learning strategies and depression among medical students: an accelerated prospective cohort study

Self-Regulated Learning and Learning Outcomes in Undergraduate and Graduate Medical Education: A Meta-Analysis

Self-regulated learning (SRL) plays a pivotal role in medical education. There is a pressing need for a meta-analytical review to comprehensively evaluate the effect sizes of SRL strategies across diverse learning outcomes and levels of medical trainees. A meta-analysis was executed by searching five databases and resulted in 61 studies that met our inclusion criteria. A three-level meta-analysis was performed to examine the association between SRL strategies and various levels of learning outcomes (i.e., affective, cognitive, and behavioral learning outcomes). Moderator analyses were conducted using meta-regression, considering factors such as types of learning outcomes, training levels, SRL subscales, and quality of the studies. The analysis yielded an average effect size of .212, using Pearson's correlation coefficient, demonstrating a positive and significant association between SRL strategies and overall learning outcomes. Although our moderator analyses indicated that SRL subscales and study quality did not significantly influence the relationship between SRL strategies and learning outcomes, SRL strategies had a more pronounced effect on affective outcomes than on test scores, behavioral outcomes, and mental health outcomes. In addition, the association between SRL strategies and learning outcomes were significantly higher among the clerkship phase of undergraduate medical education than the pre-clerkship phase.

Association of performance in medical residency selection with a psychiatric diagnosis, and depressive and anxiety symptoms

OBJECTIVE

Few studies have focused on medical students and residents' mental health impact on medical residency selection (MRS) performance. The authors evaluated the association of performance in MRS with depressive and anxiety symptoms and with a reported psychiatric diagnosis (rPD).

METHODS

The authors enrolled candidates after the second round of MRS examinations at a Brazilian Medical School. Performance was assessed by final grade. Depressive and anxiety symptoms were assessed by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) and the State-Trait Anxiety Inventory (STAI). The authors performed mediation analysis and multiple linear regression analysis to investigate the impact of rPD, state and trait anxiety, and depressive symptom severity on performance.

RESULTS

515 of the 643 MRS candidates (80.1%) participated in the study. Higher age, attending a preparatory course for MRS, rPD, and the number of MRS applications that year were associated with poorer performance. In mediation analysis, trait anxiety was associated with a direct effect on performance and an indirect effect mediated by rPD.

CONCLUSION

The data suggest that psychiatric diagnosis is associated with poorer performance on MRS, regardless of current symptoms of anxiety and depression. Additionally, increased levels of trait anxiety may negatively impact performance, directly and indirectly.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

A Model Curriculum For New Faculty Coaches in Undergraduate Medical Education

OBJECTIVES

Coaching is an interactive process of performance improvement accomplished by fostering a coachee's ability to critically self-evaluate, create goals, and develop a plan for action. It is being increasingly used in medical education, both at the undergraduate and graduate levels. The American Medical Association (AMA) recommends robust faculty development for any coaching program. Our institution created a mandatory coaching program for students starting in August 2022 with 22 faculty coaches.

METHODS

We used Kern's 6-step model for curriculum development to create our institution's faculty development for coaches. This manuscript describes the process of development, implementation, and early program evaluation for the curriculum for faculty coaches for the first 4 months of our mandatory coaching program. The objectives and teaching strategies are outlined. Our program evaluation consisted of immediate and follow-up surveys of faculty attendees.

RESULTS

Content in the faculty development program describing the medical student curriculum, assessment, and student resources improved faculty perceived knowledge and confidence. Specific training in coaching skills, including a simulation using standardized students was used and found to be essential. We offer lessons learned from our coaches regarding timing and content for any faculty development curriculum for new coaches.

CONCLUSIONS

Considerations for future faculty development curricula for academic coaching programs include timing of the faculty development, content consideration after three coaching sessions, and potential content additions and deletions. The curriculum outlined can be taken and immediately adapted for any school of medicine embarking on a coaching program for students.

Basic psychological needs satisfaction as a mediator between clinical learning climate, self-regulated learning and perceived learning in the nursing education context

PURPOSE

Self-regulated learning (SRL) can enhance students' learning process. Students need support to effectively regulate their learning. However, the effect of learning climate on SRL behavior, its ultimate effect on learning and the underlying mechanisms have not yet been established. We explored these relationships using self-determination theory.

MATERIALS AND METHODS

Nursing students (N = 244) filled in questionnaires about SRL behavior, perceived learning, perceived pedagogical atmosphere and Basic Psychological Needs (BPN) satisfaction after their clinical placement. Structural equation modelling was used to test a model in which perceived pedagogical atmosphere affects SRL behavior and subsequent perceived learning through BPN satisfaction.

RESULTS

The tested model had an adequate fit (RMSEA = 0.080, SRMR = 0.051; CFI = 0.972; TLI = 0.950). A positively perceived pedagogical atmosphere contributed to SRL behavior, which was fully explained by BPN satisfaction. SRL partially mediated the contribution of pedagogical atmosphere/BPN to perceived learning.

CONCLUSIONS

A learning climate that satisfies students' BPN contributes to their SRL behavior. SRL behavior plays a positive but modest role in the relationship between climate and perceived learning. Without a culture that is supportive of learning, implementation of tools to apply SRL behavior may not be effective. Study limitations include reliance on self-report scales and the inclusion of a single discipline.

Understanding the interplay of self-regulated learning strategies in medical education: A cross-sectional structural equation modeling study

Background and Aims

Although previous studies have investigated self-regulated learning strategies, a holistic study has not been conducted on note-taking, environmental structuring, self-evaluation, and self-consequence strategies among medical students. The current study focused on the relationships between these four self-regulated learning strategies in a medical context.

Methods

A conceptual model of the four strategies was developed, supported by the relevant literature. This cross-sectional study used an electronic structured questionnaire. The sample consisted of 557 medical undergraduates. The data were analysed using confirmatory factor analysis and structural equation modeling to investigate the hypothetical model.

Results

The conceptual model fits the data well. All relationships between the strategies were significantly positive, except for a regression between environmental structuring and self-evaluation, which was nonsignificant. Self-evaluation strategies represented the highest mean, whereas self-consequence strategies represented the lowest.

Conclusion

The findings of this study have implications for medical students, their teachers, and their universities regarding ways to enhance learners' regulated learning strategies. Future research should be conducted to develop additional statistical and comparison models for use in experimental studies and longitudinal investigations.

Nursing students' critical thinking and associated factors in Vietnam: A multicenter cross-sectional study

AIMS

This study aimed to evaluate the critical thinking abilities of senior nursing students in Vietnam and determine factors associated with their critical thinking disposition and skills.

BACKGROUND

Assessing critical thinking competence is crucial for determining senior nursing students' preparedness for entering the healthcare workforce and can be used to examine current nursing education's ability to cultivate nursing students' critical thinking. However, little research was found on critical thinking among Vietnamese nursing students.

DESIGN

A multicenter cross-sectional research design.

METHODS

A convenience sample of 533 senior nursing students from six universities in Vietnam participated in this study. All participants completed the online questionnaires, including basic information, a subscale of the Motivated Strategy for Learning Questionnaire (MSLQ), Critical Thinking Disposition Scale (CTDS), and Critical Thinking Self-Assessment Scale (CTSAS).

RESULTS

The mean score for the CTDS was 42.81 (standard deviation (SD) = 5.29), while the mean score for the CTSAS was 168.29 (SD = 44.43). Results of the multiple linear-regression analysis showed that an increase in self-study hours per day (B = 0.41, p = 0.007), higher self-efficacy in learning and performance (B = 0.26, p < 0.001), and a more-supportive environment (B = 0.97, p < 0.001) were predictors of critical thinking disposition. Moreover, an increase in self-study hours per day (B = 4.09, p = 0.001), higher self-efficacy in learning and performance (B = 2.65, p < 0.001), a more-supportive environment (B = 7.74, p < 0.001), and more experience with research (B = 7.03, p = 0.03) were predictors of critical thinking skills.

CONCLUSIONS

This study revealed that senior nursing students in Vietnam possess a moderate level of critical thinking abilities. Those students who dedicate more hours to self-study, demonstrate higher self-efficacy in learning and performance, experience a supportive environment, and engage in more research activities exhibit better critical thinking disposition and skills. The findings highlight the ongoing need to enhance critical thinking disposition and skills of nursing students in Vietnam. It is suggested that nursing faculty members should develop the appropriate strategies to improve nursing students' critical thinking disposition and skills.

How self-regulated learning influences undergraduate medical students to conduct student-centred learning: a scoping review protocol

INTRODUCTION

Self-regulated learning is one of the influencing factors in successful learning. There is a need to understand the factors influencing self-regulated learning in undergraduate medical students in implementing a student-centred learning curriculum. This scoping review aims to systematically identify and map undergraduate medical students' self-regulated learning during student-centred learning implementation and to learn the tools used to measure it.

METHODS AND ANALYSIS

The scoping review will use Arksey and O'Malley's proposed five-stage framework guideline. A search for published literature between 2012 and 2022 in the five electronic databases of EBSCOHost, Science Direct, Scopus, ProQuest and PubMed will be conducted using keywords to identify relevant studies. Articles will be limited to the English language. Mendeley software will eliminate duplicates, and results will be exported into abstracts for two stages of the screening process: title and abstract reviews and full-text reviews. The selection process of eligible literature will be reported using the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist recommendations. Studies using qualitative and quantitative data from all world regions will be considered. To be included, studies should examine medical students' self-regulated learning in a student-centred learning approach curriculum. A data chart will capture relevant information from all the included studies. As a scoping review, no assessment of the studies' quality and risk of bias will be made. Results will be presented in tabular form and a narrative report.

ETHICS AND DISSEMINATION

No Ethics Committee or Institutional Board approval is required. The findings of this study will be disseminated through peer-reviewed publications, conference presentations and professional networks.

Assessment of the psychometric properties of the Vietnamese version of the Critical Thinking Disposition Scale

BACKGROUND

The Critical Thinking Disposition Scale is a valid and reliable tool for assessing an individual's attitudes towards critical thinking. However, it is unclear if the scale can be used with Vietnamese nursing students.

OBJECTIVES

This study aimed to translate the scale into Vietnamese and examine the psychometric properties of the Vietnamese version of the Critical Thinking Disposition Scale (CTDS-V).

SETTINGS

Data were collected from senior nursing students at four universities in southern Vietnam in October and December 2022.

PARTICIPANTS

In total, 398 senior nursing students participated in this study.

METHODS

A cross-cultural adaptation of the CTDS-V was carried out with participants obtained through convenience sampling. Data were collected through an online survey. The study evaluated the validity of the CTDS-V by examining the content validity, concurrent validity, and construct validity, employing both Exploratory and Confirmatory Factor Analyses. The study also reported the internal consistency reliability using Cronbach's alpha and test-retest stability of the CTDS-V.

RESULTS

The CTDS-V had a good content validity index with a score of at least 0.85 for each item and an excellent overall content validity index of 0.96. Exploratory Factor Analysis identified two factors, critical openness, and reflective scepticism, with 11 items. Confirmatory Factor Analysis provided an acceptable fit model and supported the factor structure of the original scale. Cronbach's alpha coefficient of the scale was 0.88, and those of the two subscales were each 0.84. The test-retest stability of the CTDS-V was good with an intraclass correlation coefficient of 0.98 (95 % confidence interval = 0.96, 0.99).

CONCLUSIONS

This study indicated that the CTDS-V is a valid and reliable tool for assessing the critical thinking disposition of nursing students. The scale is short, rendering it feasible for regular use in education and research.

Emotions in self-regulated learning: A critical literature review and meta-analysis

Emotion has been recognized as an important component in the framework of self-regulated learning (SRL) over the past decade. Researchers explore emotions and SRL at two levels. Emotions are studied as traits or states, whereas SRL is deemed functioning at two levels: Person and Task × Person. However, limited research exists on the complex relationships between emotions and SRL at the two levels. Theoretical inquiries and empirical evidence about the role of emotions in SRL remain somewhat fragmented. This review aims to illustrate the role of both trait and state emotions in SRL at Person and Task × Person levels. Moreover, we conducted a meta-analysis to synthesize 23 empirical studies that were published between 2009 and 2020 to seek evidence about the role of emotions in SRL. An integrated theoretical framework of emotions in SRL is proposed based on the review and the meta-analysis. We propose several research directions that deserve future investigation, including collecting multimodal multichannel data to capture emotions and SRL. This paper lays a solid foundation for developing a comprehensive understanding of the role of emotions in SRL and asking important questions for future investigation.

Influencing factors of self-regulated learning of medical-related students in a traditional Chinese medical university: a cross-sectional study

BACKGROUND

In recent years, self-regulated learning (SRL) has become a hot topic in medical education. However, the factors that affect the SRL ability of medical-related specialties, such as clinical medicine, traditional Chinese medicine (TCM), and nursing specialty in TCM colleges and universities are unclear. Whether the teaching of learning strategies can help improve students' SRL also needs to be further examined.

METHOD

A cross-sectional survey was distributed, and 878 medical-related students who were from a TCM university were recruited for this study. Descriptive statistics illustrated the status quo of SRL and learning strategies, and an independent t-test and analysis of variance were used to analyze the factors associated with SRL. The relationship between SRL and learning strategies was analyzed with multi-linear regression analysis.

RESULTS

The scores of SRL on learning motivation, learning setting, self-regulation, and total scores were 34.76 ± 4.62, 41.14 ± 4.30, 39.26 ± 4.74, and 115.16 ± 12.42, respectively. The metacognitive, emotion, cognitive, resource management and total scores of learning strategies were 58.54 ± 12.02, 43.24 ± 8.42, 35.49 ± 7.34, 22.89 ± 4.20, 160.16 ± 29.45, and the mean was all above the midpoint. Learning strategies were positively correlated with SRL (r = 0.421, P < 0.01). Some factors can predict 32% of the variation of SRL, including whether they liked their specialty, educational system, specialty, score ranking, scholarship, whether they were taught by a tutor in middle school, gender, monthly family income, the father's educational background, metacognitive strategy, resource management strategy, and cognitive strategy.

CONCLUSIONS

The SRL of medical-related students was better. Learning strategies, as well as personal or social factors, can affect SRL. Educators should pay more attention to the cultivation of learning strategies, exercising learning skills, and monitoring, adjustment, and guidance of learning time. It should adopt various methods to improve the SRL of medical-related students according to the different factors.

Cyberbullying victimization and depression: self-esteem as a mediator and approach coping strategies as moderators

Objective: The percentage of victims of cyberbullying among college students seems to increase. However, research on the mechanisms by which cyberbullying victimization (CV) suffer from depression is scarce. This study has purpose to figure out the mediating role of self-esteem (SE) as well as the moderating role of approach coping strategies in the association between CV and depression among Vietnamese college students. Methods: A total of 606 Vietnamese university students completed the Self-Esteem Scale, The Self-Report Coping Scale, The cyberbullying victimization scale, DASS 21. Results: The results indicated that SE partially mediated the relation between CV and depression among Vietnamese college students as well as approach coping strategies moderated the involvement between CV and depression among Vietnamese college students. Conclusions: Our findings can help psychological service providers identify the methods by which cyberbullying sufferers related to depression and provide interventions to reduce depression for cyberbullying victims.

Influences of depression, self-efficacy, and resource management on learning engagement in blended learning during COVID-19

This study examined the structural relationships among self-efficacy, resource management, and learning engagement during the COVID-19 era based on self-regulation theory. We also investigated whether the level of depression moderates the structural relationships among the factors by comparing a non-depressed group and a moderate-to-high depressed group. This study confirmed that resource management influenced learning engagement regardless of the depression level. Self-efficacy for learning also influenced resource management. The implications of this study are that self-efficacy is a prerequisite for resource management for learning. However, the direct influences of self-efficacy on learning engagement were observed only in the non-depressed group. Self-efficacy for learning indirectly influenced learning engagement through resource management in the depressed group. The self-regulated behaviors, such as resource management should be encouraged to enhance learning engagement of depressed students. Students' depression should also be monitored on a regular basis to help improve learning engagement during as well as after the COVID-19 era.

The role of problem-solving ability, beyond academic motivation, in college students’ psychological adjustment

In the changing and demanding university context, various situations are experienced wherein abilities to maintain motivation and activate problem solving could be relevant in students’ adjustment. Beyond the widely analyzed role of academic motivation, this study focused on the added value of social problem-solving ability in student adjustment in the academic context. Analyses based on the responses obtained from 253 students (197 women and 56 men) indicated the significant role of social problem-solving ability in student adjustment, with a small additional amount (f2 = .09) 9% of variance in life satisfaction and medium additional amount (f2 = .17) 15% of variance in depressive symptoms, beyond academic motivation. In particular, negative problem orientation was an important predictor of depressive symptoms (β = .41, p < .001) and life satisfaction (β =  − .26, p < .001); however, positive problem orientation was only an important predictor of life satisfaction (β = .21, p < .01). This study also showed the predictive role of the value, expectancy, and affection components of motivation in student adjustment. Overall, the findings highlight the relevance of training in problem-solving orientation and motivational components to improve college students’ general well-being.

Self-Regulated Learning Practice of Undergraduate Students in Health Professions Programs

BACKGROUND

University students are expected to take charge of their learning without being dependent on teachers. Self-regulated learning (SRL) is the process by which students direct their learning to achieve their set targets and goals in a timely and controlled manner. This study was undertaken to explore the practice of SRL by undergraduate students from different programs in a health science focused university during COVID-19 pandemic.

METHOD

Thirty-three undergraduate students of five health professions education programs were recruited to take part in focus group discussions to explore their SRL practice with online learning. Their responses were subjected to thematic analysis.

RESULT

Our students appeared to practice SRL, going through the phases of forethought and goal setting, performance and self-reflection. They set goals for academic as well as personal development in the university. Academic goals like achieving target GPA or marks were achieved by following different study techniques, personal management including time management, and by creating a conducive learning environment. Personal development such as interpersonal skills, social networking was achieved through socializing and participating in extracurricular activities. The students also engaged in self-reflection and analysis of their own performance followed by designing strategies to manage the challenges they faced.

CONCLUSION

Undergraduates of health professions programs appear to show evidence of practicing SRL. Although impacted by COVID-19 induced lockdown and online learning, they seem to have strategized and achieved their goals through individualized SRL processes. Promoting and fostering an atmosphere of SRL in universities to cater to the needs of the students would help them be more successful in their careers.

Putting self-regulated learning in context: Integrating self-, co-, and socially shared regulation of learning

Processes involved in the regulation of learning have been researched for decades, because of its impact on academic and workplace performance. In fact, self-regulated learning is the focus of countless studies in health professions education and higher education in general. While we will always need competent individuals who are able to regulate their own learning, developments in healthcare require a shift from a focus on the individual to the collective: collaboration within and between healthcare teams is at the heart of high-quality patient care. Concepts of collaborative learning and collective competence challenge commonly held conceptualisations of regulatory learning and call for a focus on the social embeddedness of regulatory learning and processes regulating the learning of the collective. Therefore, this article questions the alignment of current conceptualisations of regulation of learning with demands for collaboration in current healthcare. We explore different conceptualisations of regulation of learning (self-, co-, and socially shared regulation of learning), and elaborate on how the integration of these conceptualisations adds to our understanding of regulatory learning in healthcare settings. Building on these insights, we furthermore suggest ways forward for research and educational practice.

Depression among patients with type 2 diabetes mellitus: Evidence from the Northeast region of Vietnam

BACKGROUND AND AIMS

Herein, we aim to examine the prevalence of depression in type 2 diabetic patients at a provincial general hospital located in the Northeast region of Vietnam and to explore its relationship with some sociodemographic, lifestyle and medical history characteristics.

MATERIALS AND METHODS

This was a single-centre cross-sectional descriptive study. The patients of both sexes who were at the age of 18 years or above, were treated at our institution and were diagnosed with type 2 diabetes mellitus, previously or during the study period. A total of 220 patients were included in the study.

RESULTS

Depression prevalence was 32.27% according to ICD-10. The severity of depression was categorized as mild in 77.46% patients, moderate in 19.72% patients and severe in 2.82% patients. The odds of depression was 0.18 (95%CI 0.05-0.69, p = 0.012) less for those known as the upper social class compared with those in lower social class. Those who were not on insulin treatment had significantly higher odds of depression than those on treatment with insulin (OR 2.06, 95%CI: 1.01-4.21). Individuals on treatment without oral diabetes drugs had higher odd of depression compared to those being treated with oral diabetes drugs (OR 2.77, 95%CI: 1.14-6.73). Also, hypertension was an increasing contributor to the depression prevalence (OR 2.32, 95%CI: 1.10-4.90).

CONCLUSIONS

A high prevalence of depression among type 2 diabetic patients was documented. Only significant factors for depression were lower social class, co-morbid hypertension and none of the insulin treatment or oral diabetes drugs.

Self-regulated learning perception of undergraduate dental students during the COVID-19 pandemic: A nationwide survey in Brazil

Background

This study aimed to evaluate the perception of self-regulated learning of Brazilian undergraduate dental students during the COVID-19 pandemic.

Material and Methods

A nationwide cross-sectional survey was conducted. Data were collected in 2020, through an anonymous self-administered virtual questionnaire, which comprised an initial section related to the students' sociodemographic data, category of educational institution where they enrolled, and the possible impacts of COVID-19 pandemic on family income, teaching activities (maintained remotely or totally suspended), and self-perception of academic performance during e-learning. The second part comprising 31 questions related to the adapted Self-Regulated Learning Perception Scale (SRLPS). For statistical analysis, Student's t-test of independent samples, Kruskal-Wallis, and Mann-Whitney U test were used, considering a significance of 5%.

Results

From 779 students, 425 (54.6%) reported distance learning activities during the pandemic, and 354 (45.4%) experienced complete interruption of teaching activities. Students with good performance during e-learning were more skilled in self-regulated learning when compared to those who reported regular (p = 0.026), bad (p = 0.000), and very bad (p = 0.000) performance. In addition, students who stated a good performance during e-learning were more skilled in self-regulated learning than those with fully suspended teaching activities (p = 0.000).

Conclusions

E-learning performance of undergraduate dental students during COVID-19 pandemic influenced the self-regulated learning perception. In addition, the pandemic negatively impacted the self-regulated learning of students who experimented full suspension of teaching activities. Changes in family's income did not affect their self-regulated learning. Key words:Dental education, community health, e-learning, learning, pandemics.

Psychometric properties of the Nepali language version of the Depression Anxiety Stress Scales (DASS-21)

Aim

To assess the psychometric properties of the Nepali language version of the Depression Anxiety Stress Scales (DASS‐21).

Design

Descriptive, cross‐sectional survey.

Methods

The DASS‐21 was administered (May–July 2019) among 794 randomly selected older adults aged ≥60 years. Factor structure was evaluated using exploratory and confirmatory factor analyses. Cronbach's alpha was calculated, and correlation analyses with quality of life evaluated convergent validity.

Results

Exploratory factor analysis indicated that the 21 items loaded on three factors, with factor loadings ranging from 0.50–0.88. Confirmatory factor analysis suggested a four‐factor model including the three subscales and an additional common 'general distress’ factor, which demonstrated a better overall fit. Good reliability was found for each subscale, with Cronbach's alphas 0.79 for Anxiety, 0.91 for Stress, and 0.93 for Depression. The Nepali language version of the DASS‐21 satisfied convergent validity with all subscales depicting significant negative correlations with quality of life demonstrating adequate psychometric properties.

A qualitative study on self-regulated learning among high performing medical students

BACKGROUND

Self-regulated learning (SRL) is an important contributing element to the academic success of students. Literature suggests that the understanding of SRL among medical students is obscure as there is still some uncertainty about whether high performing medical students use SRL. This study explored the characteristics of high performing medical students from the SRL perspective to gain a better understanding of the application of SRL for effective learning.

METHODS

Twenty-one students who scored at the 90th percentile in written knowledge-based assessment consented to participate in this study. Each student wrote a guided reflective journal and subsequently attended a semi-structured interview. Students were prompted to explain the rationales for their answers. The data were then analysed using thematic analysis to identify patterns among these students from the SRL perspective. Two coders analysed the data independently and discussed the codes to reach a consensus.

RESULTS

High performing students set goals, made plans, and motivated themselves to achieve the goals. They put consistent efforts into their studies and applied effective learning strategies. They also employed coping mechanisms to deal with challenges. High performing students regularly evaluated their performance and adopted new strategies.

CONCLUSIONS

This study reported that high performing students applied SRL and described the rationales of practice. Medical schools could design SRL-driven interventions to enhance the learning experiences of medical students. Recommendations are made for students on how to apply SRL.

The effectiveness of different teaching methods on medical or nursing students: Protocol for a systematic review and network meta-analysis

BACKGROUND

One of the major challenges in nursing and medical education is to foster the critical thinking ability and autonomous learning ability for students. But the effect of different teaching methods on these abilities of nursing or medical students has not been conclusive, and few studies have directly compared the differences in the effects of different teaching methods. As a result, it is necessary for students to evaluate the impact of different teaching methods on critical thinking ability and autonomous learning ability.

METHODS

A systematic search will be performed using Chinese National Knowledge Infrastructure, Wanfang Data (Chinese database), VIP Information (Chinese database), Chinese Biomedical Literature, and English language databases, including PubMed and Embase, Web of Science, CINAHL Complete (EBSCO0, Cochrane library to identify relevant studies from inception to July 10, 2020. We will include random controlled trials that evaluated the different teaching methods. The Quality Assessment of Diagnostic Accuracy Studies 2 quality assessment tool will be used to assess the risk of bias in each study. Standard pairwise meta-analysis and network meta-analysis will be performed using STATA V.12.0, MetaDiSc 1.40, and R 3.4.1 software to compare the diagnostic efficacy of different hormonal biomarkers.

RESULTS

The results of this study will be published in a peer-reviewed journal.

CONCLUSION

This study will summarize the direct and indirect evidence to determine the effectiveness of different teaching methods for medical or nursing students and attempt to find the most effective teaching method.

ETHICS AND DISSEMINATION

Ethics approval and patient consent are not required, because this study is a meta-analysis based on published studies.

INPLASY REGISTRATION NUMBER

INPLASY202070017.

Academic coaching for learners in medical education: Twelve tips for the learning specialist

As medical education moves toward a competency-based model of teaching and learning, the need for individual academic coaching has increased. However, coaching for improving academic performance is underexplored relative to coaching for the improvement of technical skills. This manuscript introduces 12 tips for developing academic coaching skills (in the context of one-on-one coaching encounters as well as that of the broader learning and teaching environment) that promote lifelong learning habits. These tips were developed by drawing upon relevant literature from coaching (across disciplines), educational linguistics, the learning sciences, and my experiences as a medical education learning specialist. Key considerations for impactful academic coaching include critical self-reflection (for both the learner and learning specialist), dialogic interpersonal communication, collaborating with student leaders and faculty, and facilitating the development of self-regulated, lifelong learning skills.

[Which interventions improve the well-being of medical students? A review of the literature]

Physician's psychological distress has been known for more than a century. A meta-analysis found an increase in the suicide rate among physicians, compared to the general population, with a relative risk of 1.41 for men and 2.27 for women. Among interns, the prevalence of depression or depressive symptoms is estimated at 28.8% (IC 95%=25.3%-32.5%). The suffering of medical students prior to internship has been recognized more recently. But now there are many studies, and a few meta-analyses, which have evaluated the prevalence of anxiety, depression, burnout and, more generally, the lack of well-being. Among medical students, the prevalence of depression or depressive symptoms is estimated at 27.2% (IC 95%=24.7-29.9) and that of suicidal ideation of 11.2% (CI at 95%=9.0-13.7). Another meta-analysis found a prevalence of burnout of 44.2 % (IC 95%=33.4-55.0). Since the problem has been known researchers have tested interventions to improve the well-being of students. Our work aims to review interventions to help medical students and use validated scales. A review was published in 2016 about interventions on the learning environment, and the well-being of medical students was published; 28 studies were identified. But they did not systematically use validated questionnaires allowing a quantitative approach. Interventions included: pass/fail scoring systems (n=3), mental health programs (n=4), psycho-corporal skills programs (n=7), curriculum structure (n=3), multi-component program reform (n=5), wellness programs (n=4), and counseling/mentoring programs (n=3). We chose to focus only on studies using validated questionnaires. A search was performed in the MEDLINE biomedical electronic database until July 31, 2018. The inclusion criteria were: original study, in French or English, concerning medical students prior to internship involving an intervention to improve the well-being of medical students by measuring at least one criterion of psychological distress (anxiety, burnout, depression…) using a validated scale. Thirty-six studies were included in this review. The quality of the studies is very heterogeneous. We can distinguish three types of intervention: institutional (modification of the system of notation, classification…), in-group (management of the stress, therapy full of conscience, relaxation, psychoeducation…) or individual (screening and support custom). These interventions encompass all levels of prevention (primary, secondary and tertiary). There is limited effectiveness of group interventions. This effectiveness disappeared after SIX months with the exception of institutional interventions. The data set encourages us not to favor a single type of intervention but to promote a global intervention acting at all levels. In particular, researchers can draw on studies of doctors and interns. France is late to come to the issue with few published studies on interventions to improve the well-being of students, but recent awareness seems to have taken place. Our study has some limitations: restriction to French and English, the choice to select only comparative studies using validated scales which limited the number of studies selected but also the type of interventions not all of which allow a quantitative evaluation. In the interventions not taken into account in this review, several seem promising. They mainly involve secondary prevention: improving the training of staff and students in the detection of symptoms of depression, burnout and psychological stress, screening at-risk populations, and communication campaigns to combat the stigma of psychiatric disorders and encourage students to consult. But tertiary prevention is also of interest: have psychologists and psychiatrists in the faculties accessible to students who feel the need and can also accommodate. Finally, a certain number of faculties have set up vocational guidance and selection aids that are appreciated by students but have not been evaluated for their impact on students' health. Recent studies and meta-analyses indicate a significant prevalence of outstanding medical students, however, there is reason to be optimistic. Many health professionals and researchers are interested in the problem as well as the means to remedy it. Most studies are effective in the short term. However, the methodological limitations (low number of subjects, limited follow-up time…) and the heterogeneity of studies concerning interventions (mindfulness, psychoeducation…) on students do not allow us to conclude that they are effective in the long term. It should therefore rather move towards comprehensive care acting on the three levels of prevention: primary (institutional interventions/speech groups/psycho education), secondary (screening of subjects at risk, speech groups/psycho education/others) and tertiary (individual interventions).

Longitudinal development of different dimensions of perfectionism in undergraduate medical students with respect to their medical school admission procedure

Objective: The concept of perfectionism comprises high standards of performance as needed in medicine, but also concerns about making mistakes and dealing with social reactions about not being perfect. Perfectionism is associated with motivation and deep learning strategies but high expression of perfectionism has been found to be associated with symptoms of stress and anxiety in students. We aim to gain insights into the longitudinal development of different dimensions of perfectionism in medical students with respect to their way of medical school admission. Methods: At the Medical Faculty of Hamburg University, 167 undergraduate medical students completed validated questionnaires (MPS-H and MPS-F) of different dimensions of perfectionism and sociodemographic data including medical school admission procedures, personality traits (BSI-10 and GSE), and symptoms of depression and anxiety (PHQ-9 and GAD-7) at the start of their first year and at half term of their second year. Results: On average, after controlling for baseline and age, a significant decrease (p≤0.05) in Self-Oriented Perfectionism was found during the first two years in students who were admitted after a waiting period (M: -12.57; 95% CI: [-21.94 - -3.35]), by other ways of medical school entrance (M: -6.36; 95% CI: [-12.71 - -0.02]), by multiple mini-interviews (HAM-Int) (M: -5.52; 95% CI: [-9.90 - -1.14]), and by a natural science test (HAM-Nat) (M: -3.41; 95% CI: [-6.71 - -0.11]. Waiting period students also showed a significant longitudinal decline in the scale Personal Standards (M: -4.62; 95% CI: [-8.04 - -1.21]. Conclusions: Since medical students from all admission groups except from the high school degree group showed a significant longitudinal decrease in Self-Oriented Perfectionism, high levels of aspects of perfectionism associated with intrinsic motivation or deep learning strategies could be included medical school admission processes. Additionally, particular attention needs to be paid not to induce a loss of intrinsic motivation or deep learning strategies during undergraduate medical education.

Virtual patients designed for training against medical error: Exploring the impact of decision-making on learner motivation

Objectives

Medical error is a significant cause of patient harms in clinical practice, but education and training are recognised as having a key role in minimising their incidence. The use of virtual patient (VP) activities targeting training in medical error allows learners to practice patient management in a safe environment. The inclusion of branched decision-making elements in the activities has the potential to drive additional generative cognitive processing and improved learning outcomes, but the increased cognitive load on learning risks negatively affecting learner motivation. The aim of this study is to better understand the impact that the inclusion of decision-making and inducing errors within the VP activities has on learner motivation.

Methods

Using a repeated study design, over a period of six weeks we provided undergraduate medical students at six institutions in three countries with a series of six VPs written around errors in paediatric practice. Participants were divided into two groups and received either linearly structured VPs or ones that incorporated branched decision-making elements. Having completed all the VPs, each participant was asked to complete a survey designed to assess their motivation and learning strategies.

Results

Our analysis showed that in general, there was no significant difference in learner motivation between those receiving the linear VPs and those who received branched decision-making VPs. The same results were generally reflected across all six institutions.

Conclusions

The findings demonstrated that the inclusion of decision-making elements did not make a significant difference to undergraduate medical students’ motivation, perceived self-efficacy or adopted learning strategies. The length of the intervention was sufficient for learners to overcome any increased cognitive load associated with branched decision-making elements being included in VPs. Further work is required to establish any immediate impact within periods shorter than the length of our study or upon achieved learning outcomes.

Measuring medical students' reflection on their learning: modification and validation of the motivated strategies for learning questionnaire (MSLQ)

BACKGROUND

Reflection on learning is an essential component of effective learning. Deconstructing the components of reflection on learning using a self-regulated learning (SRL) framework, allows the assessment of students' ability to reflect on their learning. The aim of this study was to validate an instrument to measure medical students' reflection on their learning.

METHODS

A systematic search was conducted to identify the most suitable instrument to measure students' reflection on their learning based on the theoretical framework of SRL. The search identified the Motivated Strategies for Learning Questionnaire (MSLQ) which contained five subscales: internal goal orientation, self-efficacy, critical thinking, metacognitive/self-regulation, help seeking and peer learning. Using the original MSLQ as the foundation, we carried out three phases of a research program to develop a useful set of items: an expert panel's review of items, a substantial pilot study, and a factor analysis of ratings of a modified set of items by preclinical and final year medical students.

RESULTS

The factor analysis of the Modified MSLQ extracted four subscales with reasonable internal consistency: self-orientation, critical thinking, self-regulation and feedback-seeking. Each subscale correlates highly with the Modified MSLQ score, with modest inter-correlations between the subscales suggesting that they are measuring different components of the total score.

CONCLUSION

Medical students and their educators need to be able to monitor their learning in their complex academic and clinical environments. The Modified MSLQ provides a means of investigating and tracking individual medical students' reflections on their learning.

Study habits and academic achievement among medical students: A comparison between male and female subjects

PURPOSE

Study habits of medical students contribute to better understanding learner achievement and success. This study examines the relationship between study habits, including gender and nonacademic factors that affect learning, to investigate their relationship with performance outcomes.

METHODS

This study was conducted in March 2015 at the College of Medicine and Applied Medical Science at Taif University. A survey was administered, measuring study habits such as study time, study partners, source of study, breaks, study interruptions, difficulty concentrating, study activity, and delayed study. Comparisons were examined by high and low grade point average (GPA) and by gender.

RESULTS

A total of 257 students completed the questionnaire (59% high GPA and 41% low GPA; 50% males and 50% females). Results indicated significant differences for time of study, study materials, study interruptions, study enjoyment between students of high and low GPAs. Gender differences were found for study time, study methods, study breaks, student activity, and delayed study time.

CONCLUSIONS

This study found that study habits differ by gender and also have significant impact on performance outcomes of learners. Given that students' academic success is an important outcome for medical schools, these findings call for implementing these results to enhance curricular changes and promote better learning outcomes.

Validation of a new study skills scale to provide an explanation for depressive symptoms among medical students

Background

Medical students are faced with enormous academic demands that may influence their emotional wellbeing. The high rate of depression among medical students and its negative impact is an impetus to find explanation for the factors associated with it. Study skills that students possess might be such a factor. The current tools for the assessment of the study skills may have certain limitations, particularly for different cultural settings.

Objectives

This study aimed to develop and validate a Study Skills Inventory (SSI), and to investigate the relationship between the students’ study skills and the extent (severity) of depressive symptoms, measured using the validated tool.

Method

The first version of the SSI was developed through expert consensus. The inventory was then administered to a randomly selected group of medical students. Confirmatory factor analysis was conducted for the internal validity. External validation was conducted by comparing the results of the SSI with the “Approaches and Study Skills Inventory for Students” (ASSIST). After validation, the correlation between the SSI total score with the Beck Depression Inventory II (BDI-II) total score was investigated using the Pearson correlation coefficient. The means of the total study skills scores for each severity category of depression were compared using ANOVA.

Results

A total of 23 items, representing five sub-scales, were included in the inventory. Based on 372 student responses (response rate of 93%), the five-factor solution explained a cumulative variance of 52% and Cronach alpha was 0.84. The SSI total score had a significant negative association with the BDI-II depression score (Pearson correlation of -.348** and P<0.0001).

Conclusion

This study showed evidence for acceptable reliability and validity of the newly developed SSI. Poor study skills were found to correlate with higher depressive symptoms. This association needs confirmation in future research and could open a new door for better understanding of student depression.

Reliability, convergent validity and factor structure of the DASS-21 in a sample of Vietnamese adolescents

OBJECTIVES

To assess the internal consistency, latent structure and convergent validity of the Depression, Anxiety and Stress Scale-21 (DASS-21) among adolescents in Vietnam.

METHOD

An anonymous, self-completed questionnaire was conducted among 1,745 high school students in Hanoi, Vietnam between October, 2013 and January, 2014. Confirmatory factor analyses were performed to assess the latent structure of the DASS-21. Factorial invariance between girls and boys was examined. Cronbach alphas and correlation coefficients between DASS-21 factor scores and the domain scores of the Duke Health Profile Adolescent Vietnamese validated version (ADHP-V) were calculated to assess DASS-21 internal consistency and convergent validity.

RESULTS

A total of 1,606/ 1,745 (92.6%) students returned the questionnaire. Of those, 1,387 students provided complete DASS-21 data. The scale demonstrated adequate internal consistency (Cronbach α: 0.761 to 0.906). A four-factor model showed the best fit to the data. Items loaded significantly on a common general distress factor, the depression, and the anxiety factors, but few on the stress factor (p<0.05). DASS-21 convergent validity was confirmed with moderate correlation coefficients (-0.47 to -0.66) between its factor scores and the ADHP-V mental health related domains.

CONCLUSIONS

The DASS-21 is reliable and suitable for use to assess symptoms of common mental health problems, especially depression and anxiety among Vietnamese adolescents. However, its ability in detecting stress among these adolescents may be limited. Further research is warrant to explore these results.

The self-regulated learning of medical students in the clinical environment - a scoping review

BACKGROUND

Self-regulated learning is the individual's ability to effectively use various strategies to reach their learning goals. We conducted this scoping review to explore what has been found regarding self-regulated learning in the clinical environment and how this was measured.

METHODS

Using Arksey and O'Malley's five-stage framework, we searched three medical and educational databases as well as Google Scholar for literature on the self-regulated learning of medical students in the clinical environment published between 1966 and February 2017. After results were screened and relevant studies were identified, the data was summarised and discursively reported.

RESULTS

The search resulted in 911 articles, with 14 articles included in the scoping review after the inclusion criteria was applied. Self-regulated learning was explored in these studies in various ways including qualitative, quantitative and mixed methods. Three major findings were found: 1) levels of self-regulated learning change in the clinical environment, 2) self-regulated learning is associated with academic achievement, success in clinical skills and mental health and 3) various factors can support self-regulated learning levels in medical students.

CONCLUSIONS

Most of articles exploring the self-regulated learning of medical students during the clinical years have been published in the last 5 years, suggesting a growing interest in the area. Future research could explore the self-regulated learning levels of medical students during the clinical years using a longitudinal approach or through the use of novel qualitative approaches.

Medical student changes in self-regulated learning during the transition to the clinical environment

BACKGROUND

Self-regulated learning (SRL), which is learners' ability to proactively select and use different strategies to reach learning goals, is associated with academic and clinical success and life-long learning. SRL does not develop automatically in the clinical environment and its development during the preclinical to clinical learning transition has not been quantitatively studied. Our study aims to fill this gap by measuring SRL in medical students during the transitional period and examining its contributing factors.

METHODS

Medical students were invited to complete a questionnaire at the commencement of their first clinical year (T0), and 10 weeks later (T1). The questionnaire included the Motivated Strategies for Learning Questionnaire (MSLQ) and asked about previous clinical experience. Information about the student's background, demographic characteristics and first clinical rotation were also gathered.

RESULTS

Of 118 students invited to participate, complete paired responses were obtained from 72 medical students (response rate 61%). At T1, extrinsic goal orientation increased and was associated with gender (males were more likely to increase extrinsic goal orientation) and type of first attachment (critical care and community based attachments, compared to hospital ward based attachments). Metacognitive self-regulation decreased at T1 and was negatively associated with previous clinical experience.

CONCLUSIONS

Measurable changes in self-regulated learning occur during the transition from preclinical learning to clinical immersion, particularly in the domains of extrinsic goal orientation and metacognitive self-regulation. Self-determination theory offers possible explanations for this finding which have practical implications and point the way to future research. In addition, interventions to promote metacognition before the clinical immersion may assist in preserving SRL during the transition and thus promote life-long learning skills in preparation for real-world practice.