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Teaching Self-Regulation to Promote Professionalism
Supporting students in self-regulation: Use of formative feedback and portfolios in a problem-based learning setting. Dannefer EF et al. Medical Teacher 2013; 35: 655–660.
Reviewed by Makia Powers

What was the study question?
Can self-regulation, deemed essential in the development of professionalism, be promoted and taught in a PBL setting using self, peer and tutor feedback?

How was the study done?
First year medical students provided and received narrative feedback on two professionalism standards that could be observed during PBL sessions: Interpersonal Skills and Work Habits Faculty members developed a Professionalism Rubric that included three unprofessional behavior criteria each for Interpersonal Skills (Dominating, Quiet, Inappropriate) and for Work Habits (Late, Ill-prepared, Distracted). At the end of the year students were required to write two-page essays citing formative assessments collected throughout the year. The essays were analyzed to determine if students used PBL feedback to identify targeted areas for improvement.

What were the results?
Tutor's and peer's narrative feedback of students listed Interpersonal Skills , specifically "quietness", as a targeted area for improvement. Student’s narrative feedback reported Interpersonal Skills issues more often than Work Habit-related issues. In contrast to peers and tutors, students self-identified "dominating" behavior rather than quietness. Peers tended to give more detailed feedback and TAFIs than the tutors. The TAFIs identified in student’s summative essay were consistent with at least two tutors' assessments of TAFIs.

What are the implications of these findings?
This study shows that when a structured program is used for teaching self-regulation and professionalism, it is important to have feedback from multiple people. PBL was a useful environment to observe longitudinal growth in the areas of professionalism and self-regulation. Medical educators should consider developing strategies to help medical students attain these skills.

Editor's Note: I have sometimes wondered whether professionalism can be taught or rather just is or is not. This study indicates that focused feedback provided by self, peers, and tutors can result in improved self-awareness and enhanced professional behaviors. This study looked at first year students in PBL. It would be interesting to look at follow-up and longitudinal efforts in the same direction especially when medical students are engaged in their clinical rotations and beyond (RR).

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