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A framework to help learners improve clinical reasoning


Microanalytic assessment of self-regulated learning during clinical reasoning tasks: recent development and next steps. Cleary TJ, Durning SJ, Artino AR. Academic Medicine 2016 (published online ahead of print)

Reviewed by Michael S. Ryan

What was the study question?
What is the state of the literature surrounding self-regulated learning-microanalytic assessment and training (SRL-MAT)?

How was the study done?
This study was a review of literature on SRL-MAT

What were the results?
SRL-MAT is a framework previously developed by the authors of this study (see Durning SJ, Acad Med 2011 for original description) designed to couple assessment with remediation during performance of clinical reasoning tasks. SRL-MAT can be conceptualized as a feedback cycle which involves three phases: forethought (before), performance (during), and selfreflection (after). In the forethought phase the learner develops goals for the activity, plans for his/her approach, and self-assesses. In the performance phase, the learner explicitly considers how the process is going to self-regulate for improvement. In the self-reflection phase, the learner reflects on his/her performance and plans for future performances. So far, data has shown that learners’ forethought influences performance on clinical reasoning and knowledge based assessments (USMLE Step 1). In addition, the SRL-MAT framework may provide insight into learners’ adaptive and maladaptive responses to successes and failure in clinical reasoning tasks.

What are the implications?
The SRL-MAT framework is still relatively new and long-term studies have not been conducted to determine its effectiveness. However, there is substantial appeal to facilitate clinical reasoning development and this framework uniquely couples direct observation with reflection-in-action. Based on the early data and the educational theory underpinning the framework, SRL-MAT may serve as a promising method to assess, predict, and remediate clinical reasoning skills at the time of observation.

Editor’s Note: This framework seems especially suited to endeavors to help learners who are struggling in some capacity but it likely has applicability to all learners and even to practitioners seeking to improve. I only wish it had a catchier label than SRL-MAT. (RR)

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