46.

Self-Regulated Learning

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 HSS is a relatively new content area, so motivated students will
need to take more ownership for their own learning and
assessment.

 How to adapt to the less structured learning environment of

the clinical workplace?

 How to develop successful self-regulated learning habits

that will be necessary throughout one’s medical career.

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 The modern health care environment is dynamic and rapidly
evolving, demanding that physicians continuously update their
knowledge and skills to keep pace with scientific advances and
changes in systems of care.

Physicians, nurses, para-medics, biomedical engineers, in

practice are expected to monitor their knowledge and skills, take
action to address personal gaps, and stay current with new
developments in the field.

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 Each one of us must engage in repeated cycles of learning:
seeking meaningful evidence about one’s performance, identifying
gaps, creating goals, pursuing resources, and re-assessing.

The concepts of lifelong learning and self-direction of one’s learning

are increasingly emphasized for professionals and trainees.

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 True growth requires a willingness
to openly acknowledge one’s
limitations and actively pursue
learning opportunities.

This strategy can be daunting, but it is critical to the delivery of safe

and effective patient care.

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 The process of how learners and physicians engage in ongoing
learning can be understood through the lens of self-regulated
learning theory, which describes the processes by which individuals
adjust their behaviors to achieve goals.

Self-regulation comprises one’s thoughts, feelings, and actions that

are directed toward achievement of goals.

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 Self-regulated learning describes a cycle of control of one’s
academic and clinical performance through the following:
1. Goal-directed behavior
2. The use of specific strategies to attain goals
3. Adapting and modifying behaviors or strategies to optimize
learning and performance.

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 Self-regulated learners therefore take charge of their own learning
through strategies that involve their thoughts and actions.

They actively monitor their own learning rather than passively

waiting to be told what and how to learn.

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 The three components of self-regulated learning translate to three
phases or steps that a student follows during a learning activity:

1. Before: The student prepares by reading the assignment or gathering

information about the activity and sets goals and plans to achieve
those goals.

1. During: The student uses strategies to focus and optimize learning.

These can entail when and where to study, with whom to study or
practice, how to participate in a small group, and what strategies to use
(e.g., quizzing, rehearsing).

1. After: After an activity, the student reviews what happened and reflects
on what worked well and what could have worked better. This reflection
informs the next attempt with the same or a similar learning activity.

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 1. Goal Setting

first phase of self-regulated learning includes setting a goal for what

is to be accomplished. Based on this goal, the student can begin
goal-directed behavior.

Useful goal setting involves goals that are achievable and

measurable within a defined timeframe, so that the student or the
teacher can know if the goal was accomplished.

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 There are the two different kinds of goals:

 Process goals: Process goals are the steps taken to achieve an

outcome. For medical students, process goals could include
how much or when to study for an examination, how to practice
cardiac auscultation and seek feedback during a clerkship, or
learning a mnemonic for a patient handoff.

 Outcome goals: Outcome goals are the end product the student
seeks. Outcome goals can include a course grade, acceptance
to a residency, or successfully leading a team briefing.

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 In general, process goals are more helpful for early learners
because they clearly define the steps that need to improve.
However, over the long run, a balance of process goals and outcome
goals is effective.

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 2. Self-Efficacy

Self-efficacy entails one’s belief in one’s own ability to accomplish

something. Strong self-efficacy increases one’s performance of that
action (i.e., if you believe you can do something, you are more likely to
succeed).

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 3. Attributions

In the third phase of self-regulated learning, students reflect on how

they did and interpret why their performance played out as it did. In
this phase, students engage in attribution by identifying the primary
reasons for the results they achieved.

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 The attributions that best promote learning and self-regulated learning
behaviors are internal, unstable, and controllable. The student who
will achieve the best performance will believe that performance in
clinical settings or on examinations is due to the effort or approach
used to study and learn the knowledge and skills.

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 In order to fulfill their potential, students should have a growth
mindset, believing that their potential to improve is within their
control. Students should focus on their efforts and study strategies
rather than worrying, “Am I smart enough?” when faced with a
challenge. Teachers and clinical supervisors should praise
students’ effort and persistence and the strategies they use and
choices they make rather than their ability or intelligence.

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