On embedding assessments of self-regulated learning into licensure activities in the health professions: a call to action
DOI:
https://doi.org/10.36834/cmej.73855Abstract
How well have healthcare professionals and trainees been prepared for the inevitable demands for new learning that will arise in their future? Given the rapidity with which ‘core healthcare knowledge’ changes, medical educators have a responsibility to audit whether trainees have developed the capacity to effectively self-regulate their learning. Trainees who engage in effective self-regulated learning (SRL) skilfully monitor and control their cognition, motivation, behaviour, and environment to adaptively meet demands for new learning. However, medical curricula rarely assess trainees’ capacity to engage in this strategic process. In this position paper, we argue for a paradigm shift toward assessing SRL more deliberately in undergraduate and postgraduate programs, as well as in associated licensing activities. Specifically, we explore evidence supporting an innovative blend of principles from the science on SRL, and on preparation for future learning (PFL) assessments. We propose recommendations for how program designers, curriculum developers, and assessment leads in undergraduate and postgraduate training programs, and in licensing bodies can work together to develop integrated assessments that measure how and how well trainees engage in SRL. Claims about lifelong learning in health professions education have gone unmatched by responsive curricular changes for far too long. Further neglecting these important competencies represents a disservice to medical trainees and a potential risk to the future patients they will care for.
References
Butler DL, Winne PH. Feedback and self-regulated learning: A theoretical synthesis. Rev Educ Res. 1995;65(3):245-281. https://doi.org/10.3102/00346543065003245
Cleary TJ, Durning SJ, Artino AR. Microanalytic assessment of self-regulated learning during clinical reasoning tasks: recent developments and next steps. Acad Med. 2016;91(11):1516-1521. https://doi.org/10.1097/ACM.0000000000001228
Durning SJ, Cleary TJ, Sandars J, Hemmer P, Kokotailo P, Artino AR. Perspective: Viewing “strugglers” through a different lens: How a self-regulated learning perspective can help medical educators with assessment and remediation. Acad Med. 2011;86(4):488-495. https://doi.org/10.1097/ACM.0b013e31820dc384
Cutrer WB, Miller B, Pusic M V., et al. Fostering the development of master adaptive learners. Acad Med. 2017;92(1):70-75. https://doi.org/10.1097/ACM.0000000000001323
Mylopoulos M, Brydges R, Woods NNN, Manzone J, Schwartz DLDL. Preparation for future learning: A missing competency in health professions education? Med Educ. 2016;50(1):115-123. https://doi.org/10.1111/medu.12893
McAlister FA, Cram P, Bell CM. Comparing Canadian health care to that in other countries: looking beyond the headlines. CMAJ. 2018;190(8):E207-E208. https://doi.org/10.1503/cmaj.171527
Dhalla IA, Tepper J. Improving the quality of health care in Canada. CMAJ. 2018;190(39):E1162-E1167. https://doi.org/10.1503/cmaj.171045
Panadero E. A review of self-regulated learning: Six models and four directions for research. Front Psychol. 2017;8(APR):422. https://doi.org/10.3389/FPSYG.2017.00422/BIBTEX
Pintrich PR. The role of goal orientation in self-regulated learning. In: Handbook of Self-Regulation. Elsevier; 2000:451-502. https://doi.org/10.1016/B978-012109890-2/50043-3
Mylopoulos M, Woods NN. Preparing medical students for future learning using basic science instruction. Med Educ. 2014;48(7):667-673. https://doi.org/10.1111/medu.12426
Manzone JC, Mylopoulos M, Ringsted C, Brydges R. How supervision and educational supports impact medical students’ preparation for future learning of endotracheal intubation skills: a non-inferiority experimental trial. BMC Med Educ. 2021;21(1):1-9. https://doi.org/10.1186/s12909-021-02514-0
Zimmerman BJ. Attaining self-regulation: A social cognitive perspective. In: Handbook of Self-Regulation. Elsevier; 2000:13-39. https://doi.org/10.1016/B978-012109890-2/50031-7
Carver CS, Scheier MF. Attention and Self-Regulation: A Control-Theory Approach to Human Behavior. Springer Science & Business Media; 2012.
Butler DL. Investigating self-regulated learning using in-depth case studies. In. In: Zimmerman BJ, Schunk DH, eds. Educational Psychology Handbook Series. Handbook of Self-Regulation of Learning and Performance. New York, NY: Routledge/Taylor & Francis Group; 2011:346-360.
Hadwin AF, Järvelä S, Miller M. Self-Regulated, Co-Regulated, and Socially Shared Regulation of Learning. In: Schunk DH, Zimmerman B, eds. Handbook of Self-Regulation of Learning and Performance. New York, NY: Routledge; 2011:65–84.
Winne PH, Hadwin AF. The weave of motivation and self-regulated learning. In: Schunk DH, Zimmerman BJ, eds. Motivation and Self-Regulated Learning: Theory, Research, and Applications. Lawrence Erlbaum Associates Publishers; 2008:297-314.
Brydges R, Manzone J, Shanks D, et al. Self-regulated learning in simulation-based training: A systematic review and meta-analysis. Med Educ. 2015;49(4):368-378. https://doi.org/10.1111/medu.12649
Greene JA, Azevedo R. A macro-level analysis of SRL processes and their relations to the acquisition of a sophisticated mental model of a complex system. Contemp Educ Psychol. 2009;34(1):18-29. https://doi.org/10.1016/j.cedpsych.2008.05.006
Loyens SMM, Magda J, Rikers RMJP. Self-directed learning in problem-based learning and its relationships with self-regulated learning. Educ Psychol Rev. 2008;20(4):411-427. https://doi.org/10.1007/s10648-008-9082-7
Baker L, Wright S, Mylopoulos M, Kulasegaram K, Ng S. Aligning and Applying the Paradigms and Practices of Education. Acad Med. 2019;94(7):1060. https://doi.org/10.1097/ACM.0000000000002693
Tavares W, Hodwitz K, Rowland P, et al. Implicit and inferred: on the philosophical positions informing assessment science. Adv Heal Sci Educ. 2021:1-27. https://doi.org/10.1007/s10459-021-10063-w
Tavares W, Kuper A, Kulasegaram K, Whitehead C. The compatibility principle: on philosophies in the assessment of clinical competence. Adv Heal Sci Educ. 2020;25(4):1003-1018. https://doi.org/10.1007/s10459-019-09939-9
Schwartz DL, Lindgren R, Lewis S. Constructivism in an age of non-constructivist assessments. Constr Instr Success or Fail. 2009:34-61.
Ng SL, Kangasjarvi E, Lorello GR, Nemoy L, Brydges R. ‘There shouldn’t be anything wrong with not knowing’: epistemologies in simulation. Med Educ. 2019;53(10). https://doi.org/10.1111/medu.13928
Hofer BK, Pintrich PR. The development of epistemological theories: Beliefs about knowledge and knowing and their relation to learning. Rev Educ Res. 1997;67(1):88-140. https://doi.org/10.3102/00346543067001088
Butler DL, Cartier SC. Case studies as a methodological framework for studying and assessing self-regulated learning. In: Schunk D, Greene J, eds. Handbook of Self-Regulation of Learning and Performance. New York, NY: Routledge; 2018:352-369. https://doi.org/10.4324/9781315697048-23
Butler DL, Cartier SC. Multiple Complementary Methods for Understanding Self-regulated Learning as Situated in Context. In: Annual Meetings of the American Educational Research Association. Montreal, QC; 2005.
Järvenoja H, Järvelä S, Malmberg J. Understanding regulated learning in situative and contextual frameworks. Educ Psychol. 2015;50(3):204-219. https://doi.org/10.1080/00461520.2015.1075400
Hadwin A, Oshige M. Self-Regulation, Coregulation, and Socially Shared Regulation: Exploring Perspectives of Social in Self-Regulated Learning Theory. Teach Coll Rec. 2011;113(2):240-264. https://doi.org/10.1177/016146811111300204
Cook DA, Brydges R, Zendejas B, Hamstra SJ, Hatala R. Mastery learning for health professionals using technology-enhanced simulation: A systematic review and meta-analysis. Acad Med. 2013;88(8). https://doi.org/10.1097/ACM.0b013e31829a365d
McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation‐based mastery learning with translational outcomes. Med Educ. 2014;48(4):375-385. https://doi.org/10.1111/medu.12391
Feuerstein R, Rand YA, Hoffman MB. The Dynamic Assessment of Retarded Performers: The Learning Potential Assessment Device, Theory, Instruments, and Techniques. Baltimore: University Park Press; 1979.
Elliott JG. Dyanmic assessment in educational settings: realising potential. Educ Rev. 2003;55(1):15-32. https://doi.org/10.1080/00131910303253
Elliott JG, Resing WCM, Beckmann JF. Dynamic assessment: a case of unfulfilled potential? Educ Rev. 2018;70(1):7-17. https://doi.org/10.1080/00131911.2018.1396806
Bransford JD, Schwartz DL. Rethinking transfer: A simple proposal with multiple implications. Rev Res Educ. 1999;24:61-100. https://doi.org/10.2307/1167267
Schwartz DL, Bransford JD, Sears D. Efficiency and innovation in transfer. In: Mestre JP, ed. Transfer of Learning from a Modern Multidisciplinary Perspective. Greenwich: Information Age Publishing; 2005:1-51.
Sitzmann T, Ely K. A meta-analysis of self-regulated learning in work-related training and educational attainment: What we know and where we need to go. Psychol Bull. 2011;137(3):421-442. https://doi.org/10.1037/a0022777
Martin L, Schwartz DL. Prospective adaptation in the use of external representations. Cogn Instr. 2009;27(4):370-400. https://doi.org/10.1080/07370000903221775
Belenky DM, Nokes-Malach TJ. Motivation and transfer: The role of mastery-approach goals in preparation for future learning. J Learn Sci. 2012;21(3):399-432. https://doi.org/10.1080/10508406.2011.651232
Steenhof N, Woods NN, Van Gerven PWM, Mylopoulos M. Productive failure as an instructional approach to promote future learning. Adv Heal Sci Educ. 2019;24(4):739-749. https://doi.org/10.1007/s10459-019-09895-4
Bernacki ML, Byrnes JP, Cromley JG. The effects of achievement goals and self-regulated learning behaviors on reading comprehension in technology-enhanced learning environments. Contemp Educ Psychol. 2012;37(2):148-161. https://doi.org/10.1016/j.cedpsych.2011.12.001
Chaudhary ZK, Mylopoulos M, Barnett R, et al. Reconsidering Basic: Integrating Social and Behavioral Sciences to Support Learning. Acad Med. 2019;94(11S Association of American Medical Colleges Learn Serve Lead):S73-S78. https://doi.org/10.1097/ACM.0000000000002907
Hatala R, Marr S, Cuncic C, Bacchus CM. Modification of an OSCE format to enhance patient continuity in a high-stakes assessment of clinical performance. BMC Med Educ. 2011;11(1):1-5. https://doi.org/10.1186/1472-6920-11-23
Azevedo R, Harley J, Trevors G, et al. Using trace data to examine the complex roles of cognitive, metacognitive, and emotional self-regulatory processes during learning with multi-agent systems. In: International Handbook of Metacognition and Learning Technologies. Springer; 2013:427-449. https://doi.org/10.1007/978-1-4419-5546-3_28
Hadwin AF, Nesbit JC, Jamieson-Noel D, Code J, Winne PH. Examining trace data to explore self-regulated learning. Metacognition Learn. 2007;2(2-3):107-124. https://doi.org/10.1007/s11409-007-9016-7
Winne PH. Improving measurement of self-regulated learning. Educ Psychol. 2010;45(4):267-276. https://doi.org/10.1080/00461520.2010.517150
Shariff F, Hatala R, Regehr G. The nature of learning from simulation: now I know it, now I’ll do it, I’ll work on that. Med Educ. 2020;54(7):652-659. https://doi.org/10.1111/medu.14153
Shariff F, Hatala R, Regehr G. Learning after the simulation is over: the role of simulation in supporting ongoing self-regulated learning in practice. Acad Med. 2020;95(4):523-526. https://doi.org/10.1097/ACM.0000000000003078
Harrison CJ, Könings KD, Schuwirth L, Wass V, van der Vleuten C. Barriers to the uptake and use of feedback in the context of summative assessment. Adv Heal Sci Educ. 2015;20(1):229-245. https://doi.org/10.1007/s10459-014-9524-6
Harrison CJ, Könings KD, Molyneux A, Schuwirth LWT, Wass V, van der Vleuten CPM. Web‐based feedback after summative assessment: how do students engage? Med Educ. 2013;47(7):734-744. https://doi.org/10.1111/medu.12209
Eva KW, Munoz J, Hanson MD, Walsh A, Wakefield J. Which factors, personal or external, most influence students’ generation of learning goals? Acad Med. 2010;85(10):S102-S105. https://doi.org/10.1097/ACM.0b013e3181ed42f2
Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005;80(10):S46-S54. https://doi.org/10.1097/00001888-200510001-00015
Regehr G, Eva K. Self-assessment, self-direction, and the self-regulating professional. Clin Orthop Relat Res. 2006;449:34-38. https://doi.org/10.1097/01.blo.0000224027.85732.b2
Eva KW, Regehr G. “I’ll never play professional football” and other fallacies of self‐assessment. J Contin Educ Health Prof. 2008;28(1):14-19. https://doi.org/10.1002/chp.150
Eva KW, Regehr G. Exploring the divergence between self-assessment and self-monitoring. Adv Health Sci Educ Theory Pract. 2011;16(3):311-329. https://doi.org/10.1007/s10459-010-9263-2
Kapur M. Examining Productive Failure, Productive Success, Unproductive Failure, and Unproductive Success in Learning. Educ Psychol. 2016;51(2):289-299. https://doi.org/10.1080/00461520.2016.1155457
Loibl K, Roll I, Rummel N. Towards a theory of when and how problem solving followed by instruction supports learning. Educ Psychol Rev. 2017;29(4):693-715. https://doi.org/10.1007/s10648-016-9379-x
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