Council on Medical Student Education in Pediatrics


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What influences self-directed learning during the clinical years?

Exploring the factors influencing clinical students’ self-regulated learning Berkhout JJ et al. Medical Education 2015: 49:589-600

What was the study question?
What are the factors that affect medical students’ self-regulated education efforts, essential for acquiring the skill of lifelong learning, during clinical clerkships?

How was the study done?
Semi-structured interviews of 17 students were conducted using a constructivist grounded theory approach. The participants represented a broad range of age, experience and clinical inpatient and outpatient clerkship experiences.  Participants were also evenly distributed between two universities, one with a traditional pre-clinical curriculum and the other with a problem-based, self-directed pre-clinical curriculum. Recorded transcripts were rigorously coded within grounded theory concepts and discussed within the entire research group. Though rigorously conducted, only three men (of 17 participants) were interviewed suggesting the findings may need to be interpreted with caution.

What were the results?
Four primary factors either supported or hindered students’ self-directed learning during the clinical clerkships: students’ goals, autonomy offered, recognized opportunities, and anticipated outcomes. Regarding goals, the students often focused on their own goals (to learn while avoiding “looking bad” to their evaluators) over external goals determined by clerkship leadership. The students were often unable to determine the relevance of goals created by leadership.  Autonomy allowed for greater opportunity for self-directed learning and an enhanced recognition by the student for learning opportunities. If students anticipated a favorable outcome, they were more likely to self-direct their learning as evidenced by one student choosing, with the agreement of clerkship leadership, to follow a diabetes nurse practitioner for a day rather than the internist originally scheduled.

What are the implications of the findings?
The authors found the skill of self-directed learning in the complex setting of clinical clerkships was not necessarily an innate trait in the learner, but rather more likely evident in an environment with greater autonomy and where the goals of the clerkship were shared by the learner.  An accompanying editorial noted that effective feedback to improve self-directed learning in the clinical setting is limited and should be further explored, as self-directed learning is a skill critical for acquiring the habit of lifelong learning.

Editor’s note:  These articles made me wonder if COMSEP could create tools to assist clerkship directors in creating a learning environment that explicitly promotes, and shows the rewards of, self-directed learning (SLB).


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