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

Influence of learning strategies and motivation on anatomy test performance of undergraduate medical students

To learn and comprehend the large amount of information in gross anatomy, undergraduate students must self-regulate their learning to be properly prepared for the exams within the available time. Even though there are many studies on learning strategies and their influence on test results and motivation, the aim of this study is to investigate characteristics of learning strategies in detail and in relation to the anatomy course of first semester students and how their use is related to anatomy test performance. For assessing the learning strategies, we used the short version of the questionnaire "Learning Strategies of University Students" (LIST-K) (Klingsieck, 2018). Further, we investigated potential influences of motivation and resources used during the self-regulated learning process. The participants in this study (N = 108) filled in the above-mentioned questionnaire LIST-K and a written multiple-choice anatomy test. A k-means cluster analysis revealed three groups of students differing in their self-reported use of learning strategies. Students used either (1) predominantly metacognitive and resource-related strategies, (2) predominantly cognitive strategies, or (3) no specific learning strategies at all. We found no significant overall relationships between the use of learning strategies and test performance. A stepwise linear regression identified the use of cognitive learning strategies (β =.269) as a significant predictor for test performance (R² =.149, p =.003), possibly as these specific learning strategies help with a systematic and effective approach while studying anatomy and retrieving large amount of memorized information. Further, motivation was identified as a negative predictor (β = -.277), which might be a result of the short time periods students have to study for exams. Overall findings underline the importance of self-regulated learning as a positive predictor for academic performance. By understanding these factors, a more student-centered approach could be adopted by educators to improve medical education and equip students with valuable approaches for their continuous education, even beyond university.

Do the teaching, practice and assessment of clinical communication skills align?

BACKGROUND

Evidence indicates that communication skills teaching learnt in the classroom are not often readily transferable to the assessment methods that are applied nor to the clinical environment. An observational study was conducted to objectively evaluate students' communication skills in different learning environments. The study sought to investigate the extent to which the communication skills demonstrated by students in classroom, clinical, and assessment settings align.

METHOD

A mixed methods study was conducted to observe and evaluate students during the fourth year of a five-year medical program. Participants were videorecorded during structured classroom 'interactional skills' sessions, as well as clinical encounters with real patients and an OSCE station calling upon communication skills. The Calgary Cambridge Observational Guides was used to evaluate students at different settings.

RESULT

This study observed 28 students and findings revealed that while in the classroom students were able to practise a broad range of communication skills, in contrast in the clinical environment, information-gathering and relationship-building with patients became the focus of their encounters with patients. In the OSCEs, limited time and high-pressure scenarios caused the students to rush to complete the task which focussed solely on information-gathering and/or explanation, diminishing opportunity for rapport-building with the patient.

CONCLUSION

These findings indicate a poor alignment that can develop between the skills practiced across learning environments. Further research is needed to investigate the development and application of students' skills over the long term to understand supports for and barriers to effective teaching and learning of communication skills in different learning environments.

Using Mixed Reality Simulation to Improve Junior Medical Trainees' Preparedness to Manage High-Acuity Trauma

High-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This quality education report sought to investigate whether a simulation course operated via mixed reality (MR) headset devices (Microsoft HoloLens) could enhance the clinical knowledge recall and preparedness to practice of junior trainees with no prior experience managing trauma.The Plan-Do-Study-Act quality improvement method was used to refine six emergency trauma vignettes compatible with an MR teaching platform. Each vignette was curated by a multidisciplinary team of orthopaedic surgeons, clinical fellows and experts in simulation-based medical education. As a baseline assessment, a 2-hour emergency trauma course was delivered using traditional didactic methods to a cohort of pre-registration medical students with no clinical exposure to high-acuity trauma (n=16). Next, we delivered the MR simulation to an equivalent cohort (n=32). Clinical knowledge scores derived from written test papers were recorded for each group during and 2 weeks after each course. Each attendee's end-of-rotation clinical supervisor appraisal grade was recorded, as determined by a consultant surgeon who supervised participants during a 2-week placement on a major trauma ward. Balancing measures included participant feedback and validated cognitive load questionnaires (National Aeronautics and Space Administration-Task Load Index).Overall, attendees of the MR simulation course achieved and sustained higher clinical knowledge scores and were more likely to receive a positive consultant supervisor appraisal. This project serves as a proof of concept that MR wearable technologies can be used to improve clinical knowledge recall and enhance the preparedness to practice of novice learners with otherwise limited clinical exposure to high-acuity trauma.

An exploratory study of goal orientations of traditional block and longitudinal integrated clerkship students

BACKGROUND

Achievement goal theory links goal setting, motivation, and learning and describes three orientations: 'mastery' (seeking learning), 'performance' (seeking positive judgments), and 'performance-avoidance' (avoiding negative judgments). Mastery orientation is considered most adaptive. The authors investigated goal orientations of traditional block clerkship (TBC) and longitudinal integrated clerkship (LIC) students.

METHODS

This was an exploratory study conducted at one US medical school. Three hundred and twenty students completed an anonymous survey consisting of three tools with validation evidence: Patterns of Adaptive Learning Survey, Task-choice Goal Measures, and Questionnaire Goal Choice Items. The authors analyzed the data using regression analyses, Chi-square, and Wilcoxon's rank-sum tests.

RESULTS

While all students rated mastery items most highly on the five-point Likert scale (mean 4.58/5.00), LIC students rated performance-orientation lower (β = -0.36, p = .04), chose personal mastery-orientation items more frequently (92% vs. 64.4%, p = .005), and perceived their learning environment as promoting less performance (β = -0.60, p = .002) and performance-avoidance (β = -0.78, p < .001) compared to TBC students.

CONCLUSIONS

LIC and TBC students differed in their report of personal and clerkship goal orientations. These differences may inform educational design and future research to promote students' mastery orientation.

Structured interviews on self-regulated learning strategies of medical students in the final year of medical school

BACKGROUND

In the final year of medical school, the educational focus is on experiences in the clinical environment. This is where students acquire most of their practical knowledge for their future career and need to optimise their Self-Regulated Learning (SRL) strategies. Hence, the current study aims to explore which SRL strategies medical students use during their clerkships in different learning settings.

METHODS

Structured interviews were conducted between May 2019 and December 2020 with 43 medical students during their final year in Munich, Germany. The students were surveyed about their SRL strategies. The transcribed data were thematically analysed using the measurements Strategy Use (SU) and Strategy Frequency (SF).

RESULTS

Interview data were organized into 11 SRL strategy categories. The most used SRL strategy in general was "seeking information in the internet in form of a text" (SU: 1; SF: 2.605), with an e-learning tool; followed by "seeking social assistance from doctors" (SU: 0.977; SF: 1.884), and "seeking information in books" (SU: 0.884; SF: 1.419). There were differences in the usage of SRL in different learning contexts between female and male students. For example, 95.3% of students are "seeking social assistance from doctors" when having difficulties on the ward, but only 55.8% when they need help with written tasks (e.g. medical letter). The results show a difference in SRL usage when preparing for oral-practical (79.1% books) and written (97.7% e-learning tool) exam. However, it also appears that some students do not have SRL strategies for certain situations, mostly due to a lack of time.

CONCLUSION

Medical students in the clinical phase are adapting their SRL strategy to the learning situation. To better support students´ SRL, it is necessary to ensure availability for their preferred resources: e-learning tool and experienced physicians as supervisors. Future research should focus on strategies to handle the limited time during clerkships.

Examining Motivation of First-Year Undergraduate Anatomy Students Through the Lens of Universal Design for Learning (UDL): A Single Institution Study

Motivation is critical for meaningful learning among healthcare students studying anatomy. Learners are highly variable, and it is important to ensure learners are equally supported in the diverse aspects of an anatomy curriculum. The implementation of the educational framework, Universal Design for Learning (UDL), in anatomy curricula could potentially enhance student motivation. The multiple means of engagement principle of UDL refers to the enhancement of motivation among students. This study aimed to identify healthcare students' motivation levels at the start and end of their anatomy module and whether there was any change in motivation. The Motivated Strategies for Learning Questionnaire (MSLQ) was distributed to gather the self-reported motivation levels of first-year undergraduate medical, dental and occupational therapy (OT) and speech and language therapy (SLT) students studying anatomy at the start of their respective anatomy modules and again at the end of the module. The overall response rate was 74% and 69%, at the start and end of the study, respectively. Responses were analysed by the respective programme of study. Motivation to study anatomy among medical, dental, OT and SLT students ranged from medium to high on the MSLQ at the start of their respective anatomy modules. By the end of the anatomy modules, dental students reported high levels of motivation to study anatomy, whereas motivation among medical, OT and SLT students ranged from medium to high. A change in students' self-reported motivation levels while studying anatomy was identified. The study emphasises the benefits of UDL and its flexible nature to enhance motivation.

Perceptions of medical students and their facilitators on clinical communication skills teaching, learning, and assessment

Introduction

Despite various efforts to develop communication skills (CS) in the classroom, the transfer of these skills into clinical practice is not guaranteed. This study aimed to identify barriers and facilitators of transferring CS from the classroom to clinical environments.

Methods

A qualitative study was conducted at one Australian medical school to explore the experiences and perceptions of facilitators and students in relation to teaching and learning clinical CS. Thematic analysis was used to analyze data.

Results

Twelve facilitators and sixteen medical students participated in semi-structured interviews and focus-group discussions, respectively. Primary themes included the value of teaching and learning, alignment between approaches to teaching and actual clinical practices and students' perceptions of practice, and challenges in different learning environments.

Discussion

This study reinforces the value of teaching and learning CS by facilitators and students. Classroom learning provides students with a structure to use in communicating with real patients, which can be modified to suit various situations. Students have limited opportunities, however, to be observed and receive feedback on their real-patient encounters. Classroom session that discussed CS experiences during clinical rotation is recommended to strengthen learning both the content and process of CS as well as transitioning to the clinical environment.

Stakes of Assessments in Residency: Influence on Previous and Current Self-Regulated Learning and Co-Regulated Learning in Early Career Specialists

Introduction

Assessments drive learning but the influence of the stakes of the assessments on self-regulated (SRL) during and after residency are unknown. As early career specialists (ECS) must continue learning independently, the answer to this is important as it may inform future assessments with the potential to promote life-long learning after graduation.

Methods

We utilized constructivist grounded theory to explore the perspectives of eighteen ECS on the influence of stakes of assessments within residency on their SRL during training and in current practice. We conducted semi-structured interviews.

Results

We initially set out to examine the influence of the stakes of assessments on SRL during residency and after graduation. However, it was apparent that learners increasingly engaged with others in co-regulated learning (CRL) as the perceived stakes of the assessments increased. The individual learner's SRL was embedded in CRL in preparation for the various assessments in residency. For low-stakes assessments, the learner engaged in less CRL, taking less cues from others. As stakes increased, the learner engaged in more CRL with peers with similar intellectual level and supervisors to prepare for these assessments. SRL and CRL influenced by assessments in residency had a knock-on effect in clinical practice as ECS in: 1) developing clinical reasoning, 2) improving doctor-patient communication and negotiation skills, and 3) self-reflections and seeking feedback to deal with expectations of self or others.

Discussion

Our study supported that the stakes of assessments within residency reinforced SRL and CRL during residency with a continued effect on learning as ECS.

Self-regulated learning and the future of diagnostic reasoning education

Diagnostic reasoning is a foundational ability of health professionals. The goal of enhancing clinical reasoning education is improved diagnostic accuracy and reduced diagnostic error. In order to do so, health professions educators need not only help learners improve their clinical reasoning, but teach them how to develop expert performance. An evidence-based learning strategy that is strongly associated with expert performance is self-regulated learning (SRL). SRL is the modulation of "self-generated thoughts, feelings, and actions that are planned and cyclically adapted to the attainment of personal goals". At this time, there is little data on the use of SRL to improve diagnostic reasoning. However, there appear to be numerous opportunities to utilize SRL in novel ways to improve diagnostic reasoning given what is already known about this competency. Examples that are discussed include the role SRL can play in simulation, clinical experiences, assessment, and novel technologies such as virtual reality, artificial intelligence, and machine learning. SRL is central to the philosophy that health professionals are life-long learners, as it teaches learners "how to learn". SRL has the potential to help achieve the goal of improved diagnostic accuracy and reduced diagnostic error.

Adapting the Motivated Strategies for Learning Questionnaire to the Japanese Problem-Based Learning Context: A Validation Study

The COVID-19 pandemic has greatly changed medical education, and medical trainees' self-regulation has become more emphasized. In Japan, the concept of self-regulated learning has not been fully applied in health profession education due to a lack of effective measurement tools. We aimed to validate the translated Japanese version of the Motivated Strategies for Learning Questionnaire in the context of Problem-Based Learning (J-MSLQ-PBL). The questionnaire employs a seven-point Likert-type scale with 81 items and is categorized into two sections: motivation and learning strategies. An exploratory factor analysis (EFA) was conducted by using Promax rotation to examine the factor structure of the scale, using the collected data from 112 Japanese medical students. Factor extraction was based on a scree plot investigation, and an item was accepted when the factor loading was ≥0.40. In the motivation section, the extracted factors from the EFA were well aligned with the subscales of the original MSLQ, including "Self-Efficacy for Learning and Performance", "Task Value", "Self-Efficacy for Learning and Performance", "Test Anxiety", "Extrinsic Goal Orientation", and "Intrinsic Goal Orientation". In the learning strategies, the extracted factors poorly matched the structure of the original subscales. This discrepancy could be explained by insufficient translation, the limited sample size from a single medical school, or cross-cultural differences in learning strategies between Western and Japanese medical students. Only the motivation part of the J-MSLQ-PBL should be implemented to measure the competency elements of self-regulated learning in Japan.

Identity and uncertainty: art-mediated medical student reflections in a time of transition

Medical education comprises intense periods of transition, which can significantly impact student well-being, as well as personal and professional development. In 2020, medical students navigating transitions from pre-clinical to clinical roles were also experiencing the historic forces of the COVID-19 pandemic and ongoing societal reckoning with systemic injustice and racism, likely heightening the usual challenges associated with these transitions. Reflection has been suggested as a tool for facilitating such transitions, and arts-mediated approaches hold promise in inspiring authentic reflection, yet they are rarely used to prompt medical student reflection. This article describes common themes in medical students' reflections on a specific period of transition during a unique moment in history, via qualitative analysis of their narrative responses to visual arts-mediated reflective prompts. The authors used a visual arts-based activity to explore medical students' hopes and concerns as they transitioned to clinical clerkships between the 2019-2020 and 2020-2021 academic years at one academic institution. Qualitative analysis using an exploratory constructivist approach revealed that students' reflections often focused on identity within three main themes: the personal self, the professional self, and the social self. Within these categories, subthemes included uncertainty and concerns focusing on medical training and knowledge, the sense of hope and value inherent to their social connections, critiques of the culture of medical education, and reflections on complicity and responsibility in racial injustice. This article not only provides a cross-sectional snapshot of the experiences of medical students during a historic moment, but also provides themes to guide discussions on training transitions and describes a low-cost, adaptable approach to facilitating deep exploration and reflection on tumultuous moments in training.

The relationships between self-regulated learning in clinical nursing practice and self-efficacy: A cross-sectional study among nursing students

PURPOSE

The aim is to examine self-regulated learning and self-efficacy levels of nursing students, the relationship between them, and to reveal the variables that make a significant difference.

DESIGN AND METHODS

This descriptive, cross-sectional study was conducted with a total of 417 nursing students. The data were collected using the Self-Regulated Learning Scale in Clinical Nursing Practice and Self-Efficacy Scale.

FINDINGS

Nursing students have high self-regulated learning (60.28 ± 11.47) and moderate self-efficacy (62.72 ± 11.04) scores, and there is a weak positive and significant relationship between them (r = 0.349, p < 0.001). Students' gender, grade, and self-confidence in practice made a significant difference in the scores (p < 0.05).

PRACTICAL IMPLICATIONS

Developing the self-regulated learning levels of nursing students can help increase the clinical practice performance of students by affecting their self-efficacy levels.

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.

Effective competency-based medical education requires learning environments that promote a mastery goal orientation: A narrative review

PURPOSE

Competency-based medical education (CBME) emphasizes the need for learners to be central to their own learning and to take an active role in learning. This approach has a dual aim: to encourage learners to actively engage in their own learning, and to push learners to develop learning strategies that will prepare them for lifelong learning. This review paper proposes a theoretical bridge between CBME and lifelong learning and puts forth the argument that in order for CBME programs to produce the physicians truly needed in our society now and in the future, learning environments must be intentionally designed to foster mastery goal orientations and to support the development of adaptive self-regulated learning skills and behaviours.

MATERIALS AND METHODS

This narrative literature review incorporated results of searches conducted by a subject librarian in PsycInfo and MedLine. Articles were also identified through reference lists of identified papers to capture older key citations. Analysis of the literature used a constructivist epistemological approach to develop an integrative description of the interaction of achievement goal orientation, self-regulated learning, learning environment, and lifelong learning.

RESULTS

Findings from achievement goal theory research support the assumption that adoption of a mastery goal orientation facilitates the use of adaptive learning behaviours, such as those described in self-regulated learning theory. Adaptive self-regulated learning strategies, in turn, facilitate effective lifelong learning. The authors offer evidence for how learning environments influence goal orientations and self-regulated learning, and propose that CBME programs intentionally plan for such learning environments. Finally, the authors offer specific suggestions and examples for how learning environments can be designed or adjusted to support adoption of a mastery goal orientation and use of self-regulated learning behaviours and strategies to help support development of adaptive lifelong learners.

Pre-Clinical Medical Students' Use of Motivational and Cognitive Study Strategies During Anatomy Learning: A Three-Year Cross-Sectional Survey

Medical students' motivation and study strategies are crucial in determining academic performance. This study aimed to assess the motivation and learning strategies of medical students as well as their association with performance in anatomy examinations. The Motivated Strategies for Learning Questionnaire, two focus group discussions, and students' current anatomy cumulative grade point average (cGPA) were used. Generally, the medical students strongly felt that anatomy is fundamental to the practice of medicine and surgery. This result was consistent with high task value scores of 5.99 ± 1.25. They were also driven by extrinsic goal orientation (5.59 ± 1.42) and intrinsic goal orientation (5.08 ± 1.26). Most medical students typically relied on elaboration (5.35 ± 1.25) ahead of other cognitive strategies namely rehearsal (5.30 ± 1.11), organization (5.15 ± 1.34), and lowest-rated critical thinking (4.77 ± 1.19). The students also relied on resource management strategies, effort regulation (5.15 ± 1.20) and time and study environment regulation (5.03 ± 1.03) more than the moderately scored peer learning (4.95 ± 1.50) and help-seeking (4.95 ± 1.09). In the focus group discussions, students reported that they often narrate or explain to each other what they would have read and understood from anatomy lectures, tutorials, and textbooks. They also bemoaned the lack of institutional support for stress burdens. The motivation and learning strategies subscales were not correlated with anatomy cGPA. Males were driven by extrinsic goals and experienced significantly higher levels of test anxiety than females (P < 0.05). Knowing the motivation and learning strategies students employ early in the medical curriculum can be leveraged to promote self-directed learning and academic achievement.

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.

At-home medical student simulation: achieving knot-tying proficiency using video-based assessment

Purpose

Due to the pandemic, we restructured our medical student knot-tying simulation to a virtual format. This study evaluated curriculum feasibility and effectiveness.

Methods

Over 4 weeks, second-year medical students (n = 229) viewed a video tutorial (task demonstration, errors, scoring) and self-practiced to proficiency (no critical errors, < 2 min) using at-home suture kits (simple interrupted suture, instrument tie, penrose drain model). Optional virtual tutoring sessions were offered. Students submitted video performance for proficiency verification. Two sets of 14 videos were viewed by two surgeons until inter-rater reliability (IRR) was established. Students scoring "needs remediation" attended virtual remediation sessions. Non-parametric statistics were performed using RStudio.

Results

All 229 medical students completed the curriculum within 1-4 h; 1.3% attended an optional tutorial. All videos were assessed: 4.8% "exceeds expectations", 60.7% "meets expectations", and 34.5% "needs remediation." All 79 needing remediation due to critical errors achieved proficiency during 1-h group sessions. IRR Cohen's κ was 0.69 (initial) and 1.0 (ultimate). Task completion time was 56 (47-68) s (median [IQR]); p < 0.01 between all pairs. Students rated the overall curriculum (79.2%) and overall curriculum and video tutorial effectiveness (92.7%) as "agree" or "strongly agree". No definitive preference emerged regarding virtual versus in-person formats; however, 80.2% affirmed wanting other at-home skills curricula. Comments supported home practice as lower stress; remediation students valued direct formative feedback.

Conclusions

A completely virtual 1-month knot-tying simulation is feasible and effective in achieving proficiency using video-based assessment and as-needed remediation strategies for a large student class.

Readiness to enter the workforce: perceptions of health professions students at a regional Australian university

BACKGROUND

Perceived readiness for practice can help mitigate the stress and uncertainty associated with transitioning from university into the workforce. This study aimed to identify factors influencing the readiness for clinical practice among final-year medical, dental, and pharmacy students at an Australian regional university.

METHODS

The study utilised a sequential explanatory mixed-methods approach with surveys administered for the quantitative phase and interviews/focus groups for the qualitative phase. Descriptive statistics and inductive thematic analysis were utilised for the quantitative and qualitative data, respectively. Triangulation of findings from both phases facilitated in-depth understanding of the factors that influenced participants' self-perceived readiness for clinical practice.

RESULTS

From the three disciplines, 132 students completed the survey and 14 participated in the focus groups and interviews. Students felt most prepared in their patient-centred capabilities, core skills, and advanced consultation skills, and least prepared in their system-related capabilities and clinical care skills. Themes identified as essential enablers and confidence builders in relation to workforce readiness in all three disciplines were: gained knowledge and skills, value of clinical placement experiences, support from peers, family and staff. However, students felt their work-readiness was impaired by heavy academic workloads and poor knowledge of health care systems, which affected skills development. Participants suggested additional support in health care system and clinical governance, mental healthcare, and induction to placement sites to further improve their work readiness.

CONCLUSIONS

The findings of this study suggest that improving work-readiness of healthcare students requires alignment of learning needs to real-world practice opportunities, ensuring support systems are appropriate, and early familiarisation with the healthcare system.

Preclinical to clinical transition experiences of dental students at an Australian Regional University

INTRODUCTION

Clinical experience is a crucial component of dental education as it prepares students for real-world practice. Our study aimed to investigate the transition from preclinical to clinical training experiences of dental students at a regional Australian dental school.

MATERIALS AND METHODS

A mixed-methods study was conducted using a survey and focus groups. Participants were dental students who recently transitioned into clinical training. Survey data were analysed quantitatively using descriptive statistics, whilst the qualitative data were thematically analysed using the conceptual framework of organisational socialisation theory (OST).

RESULTS

Forty-eight of the 69 students in the cohort completed the survey and 10 participated in the focus groups. The quantitative findings revealed that the transition was perceived to be abrupt and associated with a heavy workload. However, orientation sessions and engaging in chairside teaching made transitioning into clinical studies easier. The qualitative findings revealed that the transition process occurred in three phases. In phase 1, participants navigated the educational and social challenges using developmental characteristics such as resilience and positivity. Lessons learnt in phase 1 were used to make necessary learning adjustments in phase 2 and this subsequently enhanced developmental growth in the final phase, which helped ease the transition.

CONCLUSION

This study confirms that transitioning into clinical training can be complex. However, the educational and socialisation challenges associated with the transition can provide stimulating developmental learning opportunities that advance students' adjustments to the clinical environment with positive, empowering and motivational outcomes that facilitate a smooth transition.

Medical Student Perspectives on Their Role as Emerging Physicians During the COVID-19 Pandemic

The COVID-19 pandemic caused a large strain on the US medical system, with shortage of medical personnel being a key issue. The role of medical school students during a pandemic is not well established. Understanding the perspectives of medical students with regard to their role is essential in determining how to facilitate the use of their skills in combating the pandemic. To evaluate medical student perspectives on the COVID-19 pandemic, an anonymous online survey was distributed to medical students, primarily in the Northeastern United States. In the sample of 232 students, there were significant differences between students in different class years when assessing moral obligations to assist with the COVID-19 pandemic (p = 0.002). A higher percentage of first and second year medical students (pre-clinical training, around 48%) felt that healthcare students are morally obligated to assist as compared to third and fourth year students (clinical training, 30.43% of third years and 23.19% of fourth years). In all class years, the majority said they would regret their decision if they had chosen not to study medicine (62.32% to 79.31%) and most students did not feel their motivation to become a physician had been decreased (84.78% to 87.50%). Though the study was limited because the majority of subjects were from New York, the results provide insight into medical students' attitudes about the COVID-19 pandemic and can be used in the planning of how best to utilize medical students in this and in future situations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01374-z.

Facilitated transitions: coaching to improve the medical school to residency continuum

Background: Current efforts incompletely address the educational, social, and developmental aspects of a learner's transition from medical school to residency.Objective: To determine the feasibility and acceptability of a transition to residency (TTR) coaching program.Designs: In March 2019, we designed, implemented, and evaluated a TTR coaching program for students who matched into residency programs at our institution. Goals were to stimulate reflection on successes and challenges encountered during medical school, develop strategies to problem-solve barriers and address concerns, identify professional and personal resources, improve confidence, and make an action plan.Results: Of eligible learners, 42% (10/24) enrolled in TTR coaching. Learners were most interested in coaching in the following areas: wellbeing (70%, 7/10), interpersonal/communication skills (60%, 6/10), and learning plan development (50%, 5/10). The majority (90%; 9/10) expressed satisfaction with the program and would recommend participation. One month after starting internship, 90% (9/10) of learners stated the program helped facilitate their transition. Learners who did not enroll in TTR cited concerns around the coach selection process (72%, 8/11), upcoming travel (45%, 5/11), insufficient time/competing demands (27%, 3/11), and lack of perceived benefit (18%, 2/11).Conclusion: This pilot study demonstrated preliminary feasibility and acceptability for TTR coaching.

What Were You Thinking? Medical Students' Metacognition and Perceptions of Self-Regulated Learning

PHENOMENON

As a component of self-regulated learning, metacognition is gaining attention in the medical education research community. Metacognition, simply put, is thinking about one's thinking. Having a metacognitive habit of mind is essential for healthcare professionals. This study identified the metacognitive competencies of medical students as they completed a conceptual learning task, and provided insight into students' perceptions of self-regulated learning in their curriculum. Approach: Eleven third-year medical students from a Dutch University were purposively sampled to participate in this qualitative study. The study design included a think-aloud assignment followed by a semi-structured interview. During the assignment, participants were instructed to think aloud while solving questions about medical physiological concepts such as blood flow, pressure, and resistance. Think-aloud data were collected through audiotaping and used to identify participants' metacognitive competencies. The assignment also served as a prompt for an interview in which participants were questioned about metacognitive knowledge, monitoring, experiences, and perceptions of self-regulated learning in their curriculum. All data were transcribed verbatim and analyzed iteratively using a template analysis. Findings: Students differed in their use of metacognitive skills, with an overall focus on monitoring and, to a lesser extent, on planning and evaluation. Additionally, differences were found in students' metacognitive knowledge and metacognitive experiences. There was apparent use of inefficient, superficial predictive cues. Regarding perceptions of self-regulated learning skills, some students felt no need to develop such skills as they perceived medical education as an exercise in memorizing facts. Others emphasized the need for more insight into their actual level of knowledge and competence. Insights: Pre-clinical medical students require explicit teaching of metacognitive skills to facilitate self-regulated learning. Educators should aim to integrate metacognition in the everyday discourse of the classroom to foster an environment in which students discuss their own learning.

Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1889559.

Validation of Metacognitive Awareness Inventory from a Private Medical University in India

BACKGROUND

Metacognition is the awareness and the capability to regulate one's own thinking process. Metacognition is critical in medical education for clinical reasoning and management. Hence, the objective of this study is to evaluate the construct validity and reliability of the Metacognitive Awareness Inventory (MAI) among first-year medical and dental students, from a private medical university in India, using confirmatory analysis and internal consistency method.

MATERIALS AND METHODS

This was a cross-sectional study using convenient sampling. Fifty-two-item MAI was administered to 933 first-year medical and dental students from a private medical university in India. Exploratory factor analysis (EFA), principal component analysis, Cronbach's α, and confirmatory factor analysis with global fit indices were performed. Structural equation modeling (SEM) was performed to evaluate the relationship between the structural path and factors using AMOS version 22.

RESULTS

During EFA, 12 items with <0.40 factor loadings were trimmed sequentially. The remaining items with respective factors had a good internal consistency of ≥ 0.9. Comparative fit index (0.78), goodness-of-fit index (0.8), adjusted goodness of fit index (0.77), Tucker-Lewis index (0.7), standardized root mean square residual (0.06), and root mean square error of approximation (0.09) values showed that six-factor model fits to satisfactory. Pearson's correlation coefficient was found to be high between factors (>0.80). SEM for each item (observed) and factor (unobserved) illustrated the hypothesized model.

CONCLUSION

The resultant 40-item model based on MAI designed by Schraw is a valid and reliable tool for assessing the metacognitive awareness of Indian students. Employing a valid and reliable tool in assessing the metacognitive awareness will help the academicians in incorporating appropriate curricular interventions.

Health Science Students' Perspective on Quality-of-Care-Relating Medical Professionalism

Purpose

Health science students need to be professional to improve quality of care (QOC) in the current Vietnamese healthcare system. Therefore, we aim to evaluate medicine and traditional medicine (TM) students’ perception of the professional attributes relating to QOC for improving inter-disciplined professionalism training that promotes QOC in Vietnam.

Methods

The cross-sectional study was carried on 2039 students of 6 years at the University of Medicine and Pharmacy at Ho Chi Minh City (HUMP) from the medical and TM faculty in March, 2021. The Vietnamese American Board of Internal Medicine (ABIM) questionnaire (2011) was used as the survey instrument. The confirmatory factor analysis (CFA) was performed to confirm the validity of the scale in TM students. Mean, Min–Max, standard deviation and sample paired t-test were performed for Likert scale. The one-way ANOVA was used for inferential statistics.

Results

The CFA demonstrated the validity of the Vietnamese questionnaire in measuring 4 QOC-relating professional attributes, previously found in medical students for TM students. In both faculties and across academic years, students perceived self-awareness and ensuring QOC as the leading important attribute, while social duty and professional habit as the least important attribute. Contrasting with preclinical phase, students’ perception did not differ significantly between the two faculties in their clinical years (p > 0.05).

Conclusion

TM students share universal QOC-relating professional traits with medical students. Moreover, exposure to clinical environment might increase inter-disciplined agreement on importance of these attributes. However, health sciences students’ underestimation of social duty and professional habit persists throughout 6 academic years. Hidden curriculum in clinical training such as specialist-centeredness might hinder the students’ improvement in perception of these traits. Therefore, these traits should strongly be emphasized in professionalism training to decrease the effects of hidden curriculum on them.

Utilizing Structured Worksheets to Strengthen Resident Teaching on the OB/GYN Clerkship

OBJECTIVE

To determine if structured worksheets can aid resident teaching on the obstetrics and gynecology (OB/GYN) clerkship.

DESIGN

We developed structured worksheets to aid residents in teaching medical students. In this pilot study, we measured the impact of the material by conducting end of clerkship focus groups between October 2017 to June 2018 and administering surveys to medical students who had recently completed the clerkship. We performed analyses of the focus group transcriptions for positive and negative themes and analyzed questionnaire data utilizing unpaired t-test and chi-square test to determine whether resident use of structured worksheets influenced student perception of resident teaching quality.

SETTING

Medical students rotated at either an academically affiliated public safety-net hospital or tertiary maternity care hospital.

PARTICIPANTS

Medical students completing the OB/GYN clerkship volunteered to participate.

RESULTS

A total of 37 students participated in focus groups and completed the survey. Focus group comments revealed a generally positive attitude towards the structured worksheets. The survey data revealed that this material helped to facilitate student's clinical reasoning skills and assisted residents in using questions to effectively teach.

CONCLUSIONS

Structured worksheets can aid resident teaching on the OB/GYN clerkship. Students perceived the teaching material most favorably when residents utilized the material in a purposeful and timely manner. Effective resident use of structured worksheets on the OB/GYN clerkship can strengthen a culture that promotes student learning.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01318-7.

Implementation of self-directed learning within clinical clerkships

Background: The main aim of medical curricula is to prepare students for the first day at the work place. While teaching clinical competence is pivotal, clinical clerkships are often the last chance to close knowledge gaps with the help of clinical teachers. Self-directed learning is a dynamic field for research within medical education, though its curricular implementation is rare. This study focuses on the needs assessment of clinical clerkships using the concept of self-directed learning. Methods: The study comprised an educational experience at the Ludwig-Maximilians Universität (LMU) Munich. Medical students (n=1446, 59% female) in their second clinical year were instructed to specify learning objectives (LOs) by Doran`s SMART criteria and to gauge the probability of their fulfilment prior to the mandatory clerkship. In a second questionnaire one week later, the students rated the actual subjective fulfilment of the LOs. Data was coded with regards to the German National Catalogue of Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) and investigated qualitatively. Factors that determine goal achievement were collected and coded binary (barrier vs. enabler). Univariate analysis was used when appropriate. Results: The acquisition of "clinically practical abilities" (29%), "diagnostic methods" (21%) and "professional communication" (13%) were the LOs mentioned most. Throughout the week, subjective fulfilment diminished. Rich (vs. poor) availability to "practical exercise" (31%), "engagement of the physicians and other medical staff" (27%) and "personal initiative" (23%) resulted in higher subjective fulfilment. Conclusions: The self-chosen LOs reflect the needs of students for which the clinical teacher should be prepared. Considering these findings, it seems possible to close practical training gaps. We support the consideration of establishing curricular anchored self-directed learning in clinical clerkships. Further empirical studies would be beneficial in revealing its positive effects on the learning progress.

Limited effects from professional identity formation-oriented intervention on self-regulated learning in a preclinical setting: a randomized-controlled study in Japan

BACKGROUND

Developing self-regulated learning in preclinical settings is important for future lifelong learning. Previous studies indicate professional identity formation, i.e., formation of self-identity with internalized values and norms of professionalism, might promote self-regulated learning. We designed a professional identity formation-oriented reflection and learning plan format, then tested effectiveness on raising self-regulated learning in a preclinical year curriculum.

METHODS

A randomized controlled crossover trial was conducted using 112 students at Jichi Medical University. In six one-day problem-based learning sessions in a 7-month pre-clinical year curriculum, Groups A (n = 56, female 18, mean age 21.5y ± 0.7) and B (n = 56, female 11, mean age 21.7y ± 1.0) experienced professional identity formation-oriented format: Group A had three sessions with the intervention format in the first half, B in the second half. Between-group identity stages and self-regulated learning levels were compared using professional identity essays and the Motivated Strategies for Learning Questionnaire.

RESULTS

Two-level regression analyses showed no improvement in questionnaire categories but moderate improvement of professional identity stages over time (R2 = 0.069), regardless of timing of intervention.

CONCLUSIONS

Professional identity moderately forms during the pre-clinical year curriculum. However, neither identity nor self-regulated learning is raised significantly by limited intervention.

You can have both: Coaching to promote clinical competency and professional identity formation

Coaching is a critical tool to guide student development of clinical competency and formation of professional identity in medicine, two inextricably linked concepts. Because progress toward clinical competence is linked to thinking, acting and feeling like a physician, a coach's knowledge about a learner's development of clinical skills is essential to promoting the learner's professional identity formation. A longitudinal coaching program provides a foundation for the formation of coach-learner relationships built on trust. Trusting relationships can moderate the risk and vulnerability inherent in a hierarchical medical education system and allow coaching conversations to focus on the promotion of self-regulated learning and fostering skills for life-long learning. Herein, we describe a comprehensive, longitudinal clinical coaching program for medical students designed to support learners' professional identify formation and effectively promote their emerging competence.

Student perceptions of the learning environment in Norwegian occupational therapy education programs

BACKGROUND

To support students' motivation towards constructive and persistent study efforts, their learning environment needs attention.

AIM

To develop knowledge about occupational therapy students' perceptions of the learning environment and assess whether identified differences between education programs were stable or changed across the 3 years of study.

METHODS

Norwegian occupational therapy students completed the Course Experience Questionnaire (CEQ) while in their first, second, and third years of study. Differences between programs were analysed with multivariate and univariate analysis of variance.

RESULTS

Among the first-year students, perceptions of the learning environment differed significantly between the six programs on five out of six scales. Apart from a continued difference on overall study satisfaction, the initial differences were no longer significant 1 year later. Differences on three scales (emphasis on independence, appropriate workload, and generic skills) were present in the third year of study.

CONCLUSIONS AND SIGNIFICANCE

Students' perceptions of the learning environment became more similar over time, during the first 2 years of study, possibly reflecting that the students have become more accustomed to the student role and to the culture and requirements of the education programs. However, differences between study sites re-occurring in the third year suggest that group-based comparisons of learning environment perceptions across time may be inconclusive.

Patients Encounter as a Motivating Factor for Academic Performance in a Medical Neuroscience Course

BACKGROUND

The integration of patient encounters into the first year of the medical school curriculum is known to be of vital importance in the development of critical thinking and communication skills. We investigated whether exposure of first year medical students to patient encounters during a first year medical school neuroscience course result in a high level of motivation associated with the clinical encounter, and whether this high level of motivation translates to higher academic performance as measured by their performance on formative and summative examinations.

METHODS

First year medical students interacted with patients presenting with different neurological disorders in a small group informal session. Following the small group interactions with patients, students participated in a large group debriefing session involving discussions with peers, biomedical sciences faculty, and clinicians. Students then completed a survey designed to assess their motivation in correspondence with the Attention, Relevance, Confidence, and Satisfaction (ARCS) model of motivation. These results were then correlated with students' performance in the neuroscience examinations.

RESULTS

The total mean score was high for all categories of the ARCS model of motivation (4.26/5) and was highest for Relevance (4.46/5). When these motivation scores were correlated with students' performance on the formative and summative examinations, a significant positive correlation was found between motivation and performance on both the formative (r = 0.85) and summative (r = 0.95) neuroscience examinations.

CONCLUSION

Encounters with patients presenting with neurological disorders during a first year medical neuroscience course result in a high level of motivation associated with the clinical encounter, and this was positively correlated with their academic performance.

Perceptions and processes influencing the transition of medical students from pre-clinical to clinical training

BACKGROUND

The transition from pre-clinical to clinical medical training is often characterised by several challenges which may have different impacts on students' well-being and learning experiences. To ensure smooth transition, it's important to understand how these students navigate through the challenging processes.

METHODS

This study employed a mixed-methods design using a survey, focus groups and interviews among medical students who had entered their first clinical year of study (Year 4). Using a 5-point Likert scale, survey participants rated items which related to their transition experience in the areas of professional socialisation; workload; patient contact; knowledge and skills; and learning and education. The qualitative questions explored challenges in transition, coping strategies and recommendations to foster smooth transitioning. The survey data was analysed using descriptive and inferential statistics while thematic analysis was used to establish emerging themes from the qualitative data. The Westerman Transition Framework was utilised in the triangulation of study findings.

RESULTS

A total of 141 students participated in the survey while 12 students participated in the focus group discussions and interviews. The quantitative part of the study showed that the students were anxious about the process and considered the workload to be heavy while also identifying gaps in their knowledge. Similarly, the qualitative findings revealed that workload and professional socialisation were identified as disruptive novel elements and the students also reported feelings of inadequacy and incompetence due to perceived knowledge gaps. These shortcomings and challenges were tackled by seeking support from peers and senior medical students as a way of coping with the anxiety and stress. As the students progressed, they admitted and accepted that the transition was a gradual process and an essential learning curve.

CONCLUSION

The process of transitioning from preclinical to clinical years is considered stressful and abrupt with the introduction of disruptive novel elements that create feelings of incompetence and unpreparedness in students. Educators need to consider developing social and developmental strategies that emphasise nurturing and empowering clinical learning environments and facilitate reflective and transformative life-long learning opportunities for students.

Validating Self-Reflection and Insight Scale to Measure readiness for Self-Regulated Learning

BACKGROUND

Professional behavior of physicians is under scrutiny by medical associations, media, and patients; therefore, medical students are expected to be self-directed learners rather than the passive ones. One of the useful strategies for professional development and life-long learning of students is self-regulated learning. Self-regulation concept and lifelong learning commitment are in the heart of medical practice. Therefore, this study aimed to evaluate the validity of Self-Reflection and Insight Scale (SRIS) to inspect the medical students' readiness for self-regulation.

MATERIALS AND METHODS

SRIS was translated according to the Sousa and Rojjanasrirat guideline. To examine the reliability and validity evidence of the scale, 136 medical students from Tehran University of Medical Sciences completed the questionnaire. Internal consistency and intraclass correlation were used to examine the reliability evidence, as well as qualitative content validity, and confirmatory factor analysis and exploratory factor analysis (EFA) were used to examine the construct validity of the scale.

RESULTS

The content validity of the scale was verified. Cronbach's alpha and the Interclass Correlation Coefficient value for the four-factor model was 0.87 and 0.79, respectively. Goodness-of-fit indices displayed acceptable and poor values (P = 0.0001, χ² = 373.51, df = 167, Root Mean Square Error Of Approximation = 0.096, standardized root mean square residual = 0.12). EFA was conducted; a well-structured model was achieved through the EFA. The new four-factor model was extracted as the best model by performing EFA.

CONCLUSION

SRIS Persian version is saturated with four factors and has desirable content validity and constructs reliability.

Promoting self-regulated learning skills in medical students is the need of time

Objectives

Currently, there is a need to develop safe and competent medical graduates. Research reveals that the promotion of learning skills enhances lifelong experience. The objective of this study is to measure medical students' aptitude in four essential components of self-regulation: planning, monitoring, control, and reflection.

Methods

This cross-sectional study recruited 96 MBBS students using a snowball sampling technique. The Internet link to the online survey, designed on Google forms, was shared through Facebook, WhatsApp, and e-mail. A self-regulation questionnaire comprising 22 items was administered to all participants, and the collected data were analysed using SPSS version 20.

Results

Among the respondents, 50 (52.1%) women and 46 (47.9%) men completed the survey. The response rate was 78% (96 out of 123). The mean age of the respondents was 22.5 years. The mean self-regulation score was found to be 71.56 ± 11.19. Among self-regulation components, the lowest score was found for planning, with an average value of 27.01 ± 1.33, and the highest average value was noticed for reflection, 34.08 ± 1.30.

Conclusions

Our conclusions are as follows: although we have included the traits of seven-star doctors in our mission and vision statement, we could not identify the strategies to acquire these traits. One of the strategies involves promoting self-regulation in our students through various teaching methodologies.

Beyond the struggles: a scoping review on the transition to undergraduate clinical training

CONTEXT

The transition to clinical training within medical school is often seen as a struggle and students remain in distress despite numerous efforts to minimise threats. Efforts to change this may be misdirected if they are based on narrow conceptualisations of transitions. The authors conducted a scoping review to explore existing conceptual perspectives regarding the transition within medical school from pre-clinical training to clinical training to suggest a research agenda and practical implications.

METHODS

Between October 2017 and February 2018 the authors searched PubMed, MEDLINE, ERIC, PsycINFO, Web of Science and CINAHL for English language literature with no date limits and retrieved 1582 articles; 46 were included in this review. Two reviewers independently screened articles and extracted data. Data were then charted, analysed and discussed with the research team.

RESULTS

The transition to clinical training was often described negatively as 'difficult', 'a problem' and 'a struggle'. Our analysis found that researchers in medical education conducted studies on the transition to clinical training from three conceptual perspectives: educational; social, and developmental. Most research approached the transition to clinical training as a problem to be addressed from an educational perspective through transition to clerkship courses and curriculum innovations. Some research was conducted from a social perspective, focusing on building relationships. Regarding development, authors found a few articles highlighting opportunities for personal and professional development by nurturing transferrable learning strategies and reflection.

CONCLUSIONS

This review provides an empirical base on which future research can be built to better understand and support medical students' ability to navigate change. Finding new perspectives to approach the transition to clinical training could allow researchers to look beyond preparing students for struggles.

Challenging cases during clinical clerkships beyond the domain of the "medical expert": an analysis of students' case vignettes

Background: During clinical clerkships students experience complex and challenging clinical situations related to problems beyond the domain of the "Medical Expert". Workplace routine may leave little opportunity to reflect on these situations. The University of Zurich introduced a mandatory course directly after the clinical clerkship year (CCY) to work up these situations. Prior to the course each student submitted a vignette on a case he or she had perceived challenging during the CCY and which was not related to the domain of the "Medical Expert" role. In this paper we want to characterize these cases in respect to most prominent themes and related CanMEDS roles. The goal was to inform clinical supervisors about potential teaching demands during the CCY. Methods: All case vignettes submitted by a years' cohort were analysed by three researchers in two ways: for the clinical characteristics and the main theme of the underlying problem and the most prominent CanMEDS roles involved. Themes of the underlying problem were aggregated to overarching topics and subsequently to main categories by pragmatic thematic analysis. Results: 254 case vignettes covered the whole spectrum of clinical disciplines. A wide range of underlying themes could be assigned to five main categories: "communication within team" (23.2%), "communication with patients and relatives" (24.8%), "patient behavior and attitudes" (18.5%), "clinical decision making" (24.0%), and "social and legal issues" (9.4%). Most frequent CanMEDS roles were "Communicator" (26.9%) and "Professional" (23.5%). Conclusions: Cases students perceived as challenging beyond the "Medical Expert" were reported from all clinical disciplines. These were mainly related to communicational and professional issues, mirrored by the CanMEDS roles "Communicator" and "Professional". Therefore, supervisors in clinical clerkships should put an additional teaching focus on communication and professionalism.

Motivation, Cognitive and Resource Management Skills: Association of Self-Regulated Learning Domains with Gender, Clinical Transition and Academic Performance of Undergraduate Medical Students

BACKGROUND

Studies have associated self-regulated learning with better medical academic performance. However, limited data depicts inter-gender variabilities and differences between pre-clinical students and those undergoing clinical transition. Our study aims to bridge this gap.

METHODS

In this comparative cross-sectional study, Motivated Strategies for Learning Questionnaire was administered to 550 undergraduate students of Army Medical College.

RESULTS

Three hundred thirty-nine of 550 students responded. Reliability analysis was performed (Cronbach's α = 0.936). Extrinsic motivation was higher than intrinsic. Use of cognitive, metacognitive, and resource management skills was modest. Academic performance was weakly but significantly correlated with intrinsic goal orientation (p = 0.031), extrinsic goal orientation (p = 0.003), elaboration (p = 0.001), time/study environment (p = 0.009), and effort regulation (p = 0.009). Extrinsic goal orientation mean score was significantly lower (p < 0.001) for third year students when compared with that of pre-clinical students. Females had higher task-value scores (p = 0.009) while males had higher self-efficacy (p = 0.002) and critical thinking (p = 0.012) scores.

CONCLUSION

Study concludes that academic performance and self-regulated learning domains are weakly but significantly correlated. Students undergoing clinical transition have lower extrinsic motivation. Inter-gender variabilities exist in task-value, critical thinking, and self-efficacy domains. This study opens up new vistas for educationists who should revise curricula, academic reward systems, and pedagogy forms. Interventional studies should be designed to bring improvements in self-regulated learning domains.

Helps from flipped classroom in learning suturing skill: The medical students' perspective

BACKGROUND

Today, flipped classroom (FC) has been widely used in medical education. However, the effectiveness of FC remains controversial. The variation may cause by different subjects or different course design. Moreover, those studies did not explain how the association among different domains of learning objective was in FCs. The purpose of this study was to explore the help of learning domains from a FC of suturing skill in year-5 medical students.

DESIGN

This study determined sample size according to statistical power. A minimum number of 77 participants for regression analysis are needed. Therefore, this study enrolled 78 medical students in a 2-hour suturing course, which consisted of pre-class video and in-class instruction. Both simple and mattress suturing were taught. The students received an anonymous survey with questionnaire of Help from Instruction Questionnaire for Clinical Skills (HIQ-CS) after the course. The HIQ-CS was developed by medical education team according to Bloom's taxonomy, and its reliability was favorable (Cronbach's ^l = 0.839). Factor loadings among all items in the HIQ-CS was also favorable (0.790 to 0.849). This study determined consensus of students' perspective by median (Me) and interquartile range (IQR), and tested mediation among different learning domains by regression.

RESULTS

The results showed medical students agreed FC can help them in learning suturing (Me = 4, IQR = 1). The cognitive help (β = .526, p < .001) was completely mediated by psychomotor help (β = .399, p < .001) and affective help (β = .413, p < .001) to overall helps in FC. The affective help (β = .617, p < .001) was partially mediated by psychomotor help to overall helps in FC.

CONCLUSIONS

FC may help students in learning suturing skill in different domains. Our model explains the cognitive help from FC provides an important foundation for the helps of other domains. Although the model should be examined by different curricula and measurements in future, the model of help from instruction in our study provided an innovated concept and framework in medical education.

Contextual attributes promote or hinder self-regulated learning: A qualitative study contrasting rural physicians with undergraduate learners in Japan

BACKGROUND AND OBJECTIVES

Previous studies support the notion that East Asian medical students do not possess sufficient self-regulation for postgraduate clinical training. However, some East Asian physicians who are employed in geographically isolated and educationally underserved rural settings can self-regulate their study during the early phase of their postgraduate career. To explore the contextual attributes that contribute to self-regulated learning (SRL), we examined the differences in self-regulation between learning as an undergraduate and in a rural context in East Asia.

METHODS

We conducted interviews and diary data collection among rural physicians (n = 10) and undergraduates (n = 11) in Japan who undertook self-study of unfamiliar diseases. We analyzed three domains of Zimmerman's definition of SRL: learning behaviors, motivation, and metacognition using constructivist grounded theory.

RESULTS

Rural physicians recognized their identity as unique, and as professionals with a central role of handling diseases in the local community by conducting self-study. They simultaneously found themselves being at risk of providing inappropriate aid if their self-study was insufficient. They developed strategic learning strategies to cope with this high-stakes task. Undergraduates had a fear of being left behind and preferred to remain as one of the crowd with students in the same school year. Accordingly, they copied the methods of other students for self-study and used monotonous and homogeneous strategies.

CONCLUSIONS

Different learning contexts do not keep East Asian learners from being self-regulated. Awareness of their unique identity leads them to view learning tasks as high-stakes, and to initiate learning strategies in a self-regulated manner. Teacher-centered education systems cause students to identify themselves as one of the crowd, and tasks as low-stakes, and to accordingly employ non-self-regulated strategies.

Anything but Shadowing! Early Clinical Reasoning in Emergency Department Improves Clinical Skills

Introduction

Transitioning from the pre-clinical environment to clerkships poses a challenge to students and educators alike. Students along with faculty developed the Clinical Reasoning Elective (CRE) to provide pre-clinical students exposure to patients in the emergency department and the opportunity to build illness scripts and practice clinical skills with longitudinal mentorship in a low-stakes environment before entering clerkships. It is a voluntary program. Each year, the CRE has received overwhelming positive feedback from students. The objective of this study is to determine if the CRE improved students’ clinical skills and reported comfort in their skills.

Methods

We examined the relationships between students’ self-reported participation in the CRE and their individual scores on a comprehensive clinical assessment (CCA) at the end of the pre-clerkship period. A total of 178 students took the CCA exam in 2016. Of these, 113 participated in the CRE and 65 did not. Seven students who participated in CRE did not complete the exit survey and were omitted from analysis. We performed regression analysis and dichotomous (participants/nonparticipants) comparisons of means with t-tests. Survey of student reactions was collected.

Results

Participants completed an average of 10 sessions over the course of the program (range=1–20). Involvement in the CRE was associated with significantly increased scores on Abdominal History; Pulmonary Physical Exam; Overall History-Taking; Overall Communication; and Overall Physical Exam (p<0.05). Nearly all students (97%) reported that the program offered opportunities to enhance clinical skills, increased their comfort with patients, and better prepared them for their clinical years.

Conclusion

There were measurable improvements in clinical skills performance for students who participated in CRE. As many schools seek to incorporate early clinical exposure to their curricula, this program provides a successful framework to provide meaningful clinical exposure to real patients that also shows objective benefits to students’ clinical skills.