Self-regulated learning is a key competence to engage in lifelong learning. Research increasingly acknowledges that medical students in clerkships need others to regulate their learning. The concept ...of "co-regulated learning" captures this act of regulating one's learning by interacting with others. To effectively cultivate such skills in students, we need to increase our understanding of co-regulated learning. This study aimed to identify the purposes for which students in different phases of clinical training engage others in their networks to regulate their learning.
In this social network study, we administered a questionnaire to 403 medical students during clinical clerkships (65.5% response rate). The questionnaire probed into the composition of students' co-regulatory networks and the purpose for which they engaged others in specified self-regulated learning activities. We calculated the proportion of students that engaged others in their networks for each regulatory activity. Additionally, we conducted ANOVAs to examine whether first-, second-, and third-year students differed in how they used their networks to support self-regulation.
Students used others within their co-regulatory networks to support a range of self-regulated learning activities. Whom students engaged, and the purpose of engagement, seemed to shift as students progressed through clinical training. Over time, the proportion of students engaging workplace supervisors to discuss learning goals, learning strategies, self-reflections and self-evaluations increased, whereas the proportion of students engaging peers to discuss learning strategies and how to work on learning goals in the workplace decreased. Of all purposes for which students engaged others measured, discussing self-reflections and self-evaluations were consistently among the ones most frequently mentioned.
Results reinforce the notion that medical students' regulation of learning is grounded in social interactions within co-regulatory networks students construct during clerkships. Findings elucidate the extent to which students enact self-regulatory learning within their co-regulatory networks and how their co-regulatory learning behaviors develop over time. Explicating the relevance of interactions within co-regulatory networks might help students and supervisors to purposefully engage in meaningful co-regulatory interactions. Additionally, co-regulatory interactions may assist students in regulating their learning in clinical workplaces as well as in honing their self-regulated learning skills.
Introduction
Recent conceptualizations of self-regulated learning acknowledge the importance of co-regulation, i.e., students’ interactions with others in their networks to support self-regulation. ...Using a social network approach, the aim of this study is to explore relationships between characteristics of medical students’ co-regulatory networks, perceived learning opportunities, and self-regulated learning.
Methods
The authors surveyed 403 undergraduate medical students during their clinical clerkships (response rate 65.5%). Using multiple regression analysis, structural equation modelling techniques, and analysis of variance, the authors explored relationships between co-regulatory network characteristics (network size, network diversity, and interaction frequency), students’ perceptions of learning opportunities in the workplace setting, and self-reported self-regulated learning.
Results
Across all clerkships, data showed positive relationships between tie strength and self-regulated learning (β = 0.095,
p
< 0.05) and between network size and tie strength (β = 0.530,
p
< 0.001), and a negative relationship between network diversity and tie strength (β = −0.474,
p
< 0.001). Students’ perceptions of learning opportunities showed positive relationships with both self-regulated learning (β = 0.295,
p
< 0.001) and co-regulatory network size (β = 0.134,
p
< 0.01). Characteristics of clerkship contexts influenced both co-regulatory network characteristics (size and tie strength) and relationships between network characteristics, self-regulated learning, and students’ perceptions of learning opportunities.
Discussion
The present study reinforces the importance of co-regulatory networks for medical students’ self-regulated learning during clinical clerkships. Findings imply that supporting development of strong networks aimed at frequent co-regulatory interactions may enhance medical students’ self-regulated learning in challenging clinical learning environments. Social network approaches offer promising ways of further understanding and conceptualising self- and co-regulated learning in clinical workplaces.
The differences of learning experiences in the workplace put challenges on the assessment: the assessment programme should be aligned with the general competency framework of the curriculum and also ...fit to the differences in learning contexts of the workplace. We used van der Vleuten's programmatic assessment model to develop a workplace-based assessment programme for final year clerkships. We aimed to design a programme that stimulates learning, supports assessment decision, is feasible and non-bureaucratic. The first experiences with the programme show that students think that the programme has high learning value and the assessment is sufficiently robust. Many of the commonly reported weaknesses of work-based assessment (not a good fit with the educational context, too complex, too bureaucratic and too much work) were not mentioned by the students.
Purpose
To conduct a bibliometric case study of the journal
Perspectives on Medical Education
(PME) to provide insights into the journal’s inner workings and to “take stock” of where PME is today, ...where it has been, and where it might go.
Methods
Data, including bibliographic metadata, reviewer and author details, and downloads, were collected for manuscripts submitted to and published in PME from the journal’s Editorial Manager and Web of Science. Gender of authors and reviewers was predicted using Genderize.io. To visualize and analyze collaboration patterns, citation relationships and term co-occurrence social network analyses (SNA) were conducted. VOSviewer was used to visualize the social network maps.
Results
Between 2012–2019 PME received, on average, 260 manuscripts annually (range = 73–402). Submissions were received from authors in 81 countries with the majority in the United States (US), United Kingdom, and the Netherlands. PME published 518 manuscripts with authors based in 31 countries, the majority being in the Netherlands, US, and Canada. PME articles were downloaded 717,613 times (mean per document: 1388). In total 1201 (55% women) unique peer reviewers were invited and 649 (57% women) completed reviews; 1227 (49% women) unique authors published in PME. SNA revealed that PME authors were quite collaborative, with most authoring articles with others and only a minority (
n
= 57) acting as single authors.
Discussion
This case study provides a glimpse into PME and offers evidence for PME’s next steps. In the future, PME is committed to growing the journal thoughtfully; diversifying and educating editorial teams, authors, and reviewers, and liberating and sharing journal data.
Abstract
Background
Simulation-based education can induce intense learner emotions. The interplay between emotions and learning is less well understood. Gaining greater insights into learner emotions ...has potential to guide how best we manage emotions and optimise learning. This study aimed to understand learners’ lived emotional experiences in complex simulation and the perceived impact on learning.
Methods
Eight final-year medical students participated in the study. Wearing video-glasses, participants took part in a ward-based simulation. Video-footage was used to elicitate exploratory interviews and analysed using Template Analysis reflexively.
Results
Analysis yielded four main themes: ‘nervous anticipation’: encapsulating the fear, anxiety and uncertainty experienced by learners prior to simulation; ‘shock and awe’: feelings of anxiousness and being overwhelmed at the start of a simulation; ‘in the moment: flowing or buffeting with the emotions’: experiencing fear of being judged as incompetent, but also experiencing positive emotions such as satisfaction; ‘safe-landing?’: whilst debriefing aimed to encourage more positive emotions, negative emotions about the simulation could persist even with debriefing.
Conclusions
Complex simulation can evoke intense emotions in students. If students experienced a positive progression, they reported positive emotions and felt competent which was perceived to have a positive impact on learning. If students experienced failure, they reported strong negative emotions which made them question about their future performance and was perceived as negative for learning. Bringing to the surface these complex emotional dynamics, could permit educators to be aware of and adapt the
emotional climate
within simulation in order to optimise learning.
Background
Despite increasing calls for patient and public involvement in health‐care quality improvement, the question of how patient evaluations can contribute to physician learning and performance ...assessment has received scant attention.
Objective
The objective of this study was to explore, amid calls for patient involvement in quality assurance, patients' perspectives on their role in the evaluation of physician performance and to support physicians’ learning and decision making on professional competence.
Design
A qualitative study based on semi‐structured interviews.
Setting and Participants
The study took place in a secondary care setting in the Netherlands. The authors selected 25 patients from two Dutch hospitals and through the Dutch Lung Foundation, using purposive sampling.
Methods
Data were analysed according to the principles of template analysis, based on an a priori coding framework developed from the literature about patient empowerment, feedback and performance assessment.
Results
The analysis unearthed three predominant patient perspectives: the proactive perspective, the restrained perspective and the outsider perspective. These perspectives differed in terms of perceived power dynamics within the doctor‐patient relationship, patients' perceived ability, and willingness to provide feedback and evaluate their physician's performance. Patients' perspectives thus affected the role patients envisaged for themselves in evaluating physician performance.
Discussion and conclusion
Although not all patients are equally suitable or willing to be involved, patients can play a role in evaluating physician performance and continuing training through formative approaches. To involve patients successfully, it is imperative to distinguish between different patient perspectives and empower patients by ensuring a safe environment for feedback.
Introduction
Many health professions education (HPE) scholars frame assessment validity as a form of argumentation in which interpretations and uses of assessment scores must be supported by ...evidence. However, what are purported to be validity arguments are often merely clusters of evidence without a guiding framework to evaluate, prioritise, or debate their merits. Argumentation theory is a field of study dedicated to understanding the production, analysis, and evaluation of arguments (spoken or written). The aim of this study is to describe argumentation theory, articulating the unique insights it can offer to HPE assessment, and presenting how different argumentation orientations can help reconceptualize the nature of validity in generative ways.
Methods
The authors followed a five‐step critical review process consisting of iterative cycles of focusing, searching, appraising, sampling, and analysing the argumentation theory literature. The authors generated and synthesised a corpus of manuscripts on argumentation orientations deemed to be most applicable to HPE.
Results
We selected two argumentation orientations that we considered particularly constructive for informing HPE assessment validity: New rhetoric and informal logic. In new rhetoric, the goal of argumentation is to persuade, with a focus on an audience's values and standards. Informal logic centres on identifying, structuring, and evaluating arguments in real‐world settings, with a variety of normative standards used to evaluate argument validity.
Discussion
Both new rhetoric and informal logic provide philosophical, theoretical, or practical groundings that can advance HPE validity argumentation. New rhetoric's foregrounding of audience aligns with HPE's social imperative to be accountable to specific stakeholders such as the public and learners. Informal logic provides tools for identifying and structuring validity arguments for analysis and evaluation.
In #HPE we often conceptualize validity as an argument. But what is argumentation? From what guiding principles might HPE draw? @Midwest_MedPeds @DrDanSchumacher @erikwdriessen @LaraVarpio review argumentation theory to explore these questions.
In recent years, postgraduate assessment programmes around the world have embraced workplace-based assessment (WBA) and its related tools. Despite their widespread use, results of studies on the ...validity and reliability of these tools have been variable. Although in many countries decisions about residents’ continuation of training and certification as a specialist are based on the composite results of different WBAs collected in a portfolio, to our knowledge, the reliability of such a WBA toolbox has never been investigated. Using generalisability theory, we analysed the separate and composite reliability of three WBA tools mini-Clinical Evaluation Exercise (mini-CEX), direct observation of procedural skills (DOPS), and multisource feedback (MSF) included in a resident portfolio. G-studies and D-studies of 12,779 WBAs from a total of 953 residents showed that a reliability coefficient of 0.80 was obtained for eight mini-CEXs, nine DOPS, and nine MSF rounds, whilst the same reliability was found for seven mini-CEXs, eight DOPS, and one MSF when combined in a portfolio. At the end of the first year of residency a portfolio with five mini-CEXs, six DOPS, and one MSF afforded reliable judgement. The results support the conclusion that several WBA tools combined in a portfolio can be a feasible and reliable method for high-stakes judgements.
Programmatic assessment is an integral approach to the design of an assessment program with the intent to optimise its learning function, its decision-making function and its curriculum ...quality-assurance function. Individual methods of assessment, purposefully chosen for their alignment with the curriculum outcomes and their information value for the learner, the teacher and the organisation, are seen as individual data points. The information value of these individual data points is maximised by giving feedback to the learner. There is a decoupling of assessment moment and decision moment. Intermediate and high-stakes decisions are based on multiple data points after a meaningful aggregation of information and supported by rigorous organisational procedures to ensure their dependability. Self-regulation of learning, through analysis of the assessment information and the attainment of the ensuing learning goals, is scaffolded by a mentoring system. Programmatic assessment-for-learning can be applied to any part of the training continuum, provided that the underlying learning conception is constructivist. This paper provides concrete recommendations for implementation of programmatic assessment.
Current postgraduate medical training programmes fall short regarding residents' development of generic competencies (communication, collaboration, leadership, professionalism) and reflective and ...deliberate practice. Paying attention to these non-technical skills in a structural manner during postgraduate training could result in a workforce better prepared for practice. A development-oriented performance assessment (PA), which assists residents with assessment of performance and deliberately planned learning activities, could potentially contribute to filling this gap. This study aims to explore residents experiences with the PA.
We conducted a qualitative interview study with 16 residents from four different medical specialties who participated in the PA, scheduled halfway postgraduate training. The PA was conducted by an external facilitator, a psychologist, and focused specifically on professional development and career planning. Residents were interviewed 6 months after the PA. Data were analysed using the framework method for qualitative analysis.
Residents found the PA to be of additional value for their training. The overarching merit was the opportunity to evaluate competencies not usually addressed in workplace-based assessments and progress conversations. In addition, the PA proved a valuable tool for assisting residents with reflecting upon their work and formulating their learning objectives and activities. Residents reported increased awareness of capacity, self-confidence and enhanced feelings of career-ownership. An important factor contributing to these outcomes was the relationship of trust with the facilitator and programme director.
The PA is a promising tool in fostering the development of generic competencies and reflective and deliberate practice. The participating residents, facilitator and programme directors were able to contribute to a safe learning environment away from the busy workplace. The facilitator plays an important role by providing credible and informative feedback. Commitment of the programme director is important for the implementation of developmental plans and learning activities.
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